InforMED

FLASH: Make Sure Patients Can Reach You

April 27, 2017

Our provider directories are a key resource for our members to reach you. Members use them to search for new providers, get directions to clinics, and find contact information to schedule appointments.

To make sure the information in our provider directories is accurate, we are performing audits. CMS audits are also being done to ensure compliance with new regulations for Medicare Advantage and federal marketplace health plans.

To help us meet CMS requirements, we have partnered with LexisNexis Health Care and its Verify Health Care Portal (Verify HCP) solution. Verify HCP lets you verify directory information online for several payers at the same time, which means each payer won’t need to contact you individually.

LexisNexis will begin its quarterly outreach for us in May and will reach out by email to review directory information. If you’re not the person who should receive this request, send the new person’s name, email, and phone number to your provider relations specialist by May 2.

And don’t forget to notify us of any changes to your information with the provider information change form.

Contact your provider relations specialist or call us at 1-800-851-3379, option 3, if you have any questions.

FLASH: Important Update Regarding Preauthorizations

April 20, 2017

We know many of you are actively attending training and reviewing current workflows in preparation for our upcoming preauthorization requirements.  Our partnership with eviCore is progressing as expected, and we’re looking forward to improved turnaround times for our members and providers.

Note: Your Health Alliance for providers will be ready to process the new preauthorization requests on May 22 for dates of service of June 1 and after. We had originally shared that you could begin submitting preauthorizations on April 24, so please make note of this new date.

Continue to follow the current processes for preauthorizations today through May 31. The genetic testing module within eviCore will also be rolled out at a later date, and training will be available beforehand. In the meantime, continue to submit preauthorization requests related to genetic testing as you do today.

Thank you, and please share this update with all staff responsible for submitting preauthorizations.

FLASH: New eviCore Preauthorization Online Training Sessions

April 10, 2017

As discussed in the February webinars, starting in May, eviCore will begin managing additional preauthorization services for our commercial and Medicare members.

For dates of service on or after May 1, you must request preauthorizations through eviCore on Your Health Alliance for providers. You can start using eviCore to submit these requests on April 24.

These additional, hour-long training sessions will go over how to submit preauthorization requests to eviCore and how to access tools and resources, including a quick reference guide.

Medical Oncology

Anyone who is responsible for submitting Medical Oncology preauthorization requests for our members should register for one of these online training sessions:

Preauthorization: Health Alliance Medical Plans – Medical Oncology

  • Monday, April 17 at 10 a.m. CST
  • Wednesday, April 19 at 2 p.m. CST
  • Tuesday, April 25 at 11 a.m. CST
  • Thursday, April 27 at 1 p.m. CST
  • Wednesday, May 3 at 9 a.m. CST

Radiation Therapy

Anyone who is responsible for submitting Radiation Therapy preauthorization requests for our members should register for one of these online training sessions:

Preauthorization: Health Alliance Medical Plans – Radiation Therapy

  • Tuesday, April 18 at 11 a.m. CST
  • Thursday, April 20 at 1 p.m. CST
  • Wednesday, April 26 at 9 a.m. CST
  • Friday, April 28 at 1 p.m. CST
  • Thursday, May 4 at 10 a.m. CST

Musculoskeletal Services: Pain/Joint/Spine and MSK Therapies

Anyone who is responsible for submitting Pain/Joint/Spine and/or PT/OT/ST preauthorization requests for our members should register for one of these online training sessions:

Preauthorization: Health Alliance Medical Plans – Musculoskeletal Services

  • Wednesday, April 19 at 9 a.m. CST
  • Friday, April 21 at 1 p.m. CST
  • Monday, April 24 at 1 p.m. CST
  • Thursday, April 27 at 10 a.m. CST
  • Friday, May 5 at 9 a.m. CST

Lab Management

Anyone who is responsible for submitting Lab Management preauthorization requests for our members should register for one of these online training sessions:

Preauthorization: Health Alliance Medical Plans – Lab Management

  • Monday, April 17 at 1 p.m. CST
  • Thursday, April 20 at 10 a.m. CST
  • Tuesday, April 25 at 3 p.m. CST
  • Friday, April 28 at 9 a.m. CST
  • Monday, May 1 at 10 a.m. CST

Sleep Management

Anyone who is responsible for submitting Sleep Management preauthorization requests for our members should register for one of these online training sessions:

Preauthorization: Health Alliance Medical Plans – Sleep Management

  • Tuesday, April 18 at 3 p.m. CST
  • Friday, April 21 at 9 a.m. CST – DME Providers Only
  • Monday, April 24 at 10 a.m. CST
  • Wednesday, April 26 at 2 p.m. CST – DME Providers Only
  • Tuesday, May 2 at 11 a.m. CST

How to Register

  • Once you’ve picked a session, go to eviCore.webex.com.
  • Choose the Training Center tab from the top menu.
  • Find the date and time of the session you want to attend in the Upcoming tab. All of the training sessions are named according to their specialty area, which are in the above sections before the training times.
  • Choose Register.
  • Enter your registration information.

Attending Your Online Training Session

After you’ve registered, you’ll get an email that includes:

  • The toll-free phone number and pass code you’ll need for the session’s audio
  • A link to the online session
  • The session password

Save this registration email to access your session, and don’t forget to mark your calendar and ensure you’ll be able to fully participate in the session.

You can also access the presentation materials by using the eviCore Resources link in the Forms & Resources section of Your Health Alliance for providers. Or you can get a copy of the presentation slides by emailing ProviderRelations@evicore.com.

View as PDF

 

Reid April Newsletter

April 10, 2017

Preauthorization Updates

We will be sharing regular updates about functionality changes to our preauthorization tools – Clear Coverage, eviCore, and Health Alliance preauthorization forms.

eviCore

Finish Later and Attach Clinicals Later

  • This has been updated so provider offices can choose Finish Later to come back to an authorization within 2 business days. This also allows you to attach the clinicals before submitting a preauthorization.

OB Ultrasounds

  • At this time, multiple OB ultrasounds cannot be batched into one authorization request.
  • Submit separate authorizations when multiple exams are requested.
  • We’re working with eviCore for a solution, and we will keep you updated as changes occur.

Breast Ultrasounds

  • Do not require preauthorization.

OB/GYN Codes Flipped

  • From time to time, users experienced changes to CPT codes within the eviCore system. This issue has been corrected, and OB/GYN offices should no longer be seeing this problem.

Can’t Choose Rendering Provider

  • As of March 13, we’ve corrected the issue that you could not choose providers, including physicians, hospitals, and imaging centers, as the rendering provider or site. (You will no longer receive the message, “not certified for this program” when you make this selection.)

Rendering Provider vs. Ordering Provider

  • Rendering provider and ordering provider are the same as long as the rendering provider is not a hospital or imaging center.

Don’t Use the Enter Key on Your Keyboard

  • eviCore requires you to choose select, continue, or submit on a preauthorization. If you use the Enter key on your keyboard, the preauthorization will be lost, and it will take you back to the beginning.

Clear Coverage

Call with Inpatient Home Health Discharges Preauths

  • Preauthorizations for patients being discharged from an inpatient setting to home health will be handled by calling our medical management department. Use Clear Coverage for all outpatient home health preauthorizations.

Missing CPT Codes

  • The missing CPT codes for home health have been updated and can now be selected.

Meet with a Coding Specialist

The risk adjustment coding consultants are continuing to request meetings with high-volume participating provider offices. These meetings are designed to share member-specific examples of coding and quality measure needs and to update providers on the latest efforts to educate on risk adjustment. Along with member specific examples, there is information on yearly risk adjustment data validation (RADV) audits, and how provider practice participation is essential in this process.

A member of the coding consultant team is willing to meet with you to discuss any coding or quality questions you may have, or to provide member-specific examples from your panel of members. If interested, contact us at CodingCounts@healthalliance.org.

 

Midwest April Newsletter

April 6, 2017

Infertility Preauthorizations Move Back to Your Health Alliance

We will be reverting back to how infertility was preauthorized prior to eviCore, so you should submit requests on Your Health Alliance for providers and office personnel.

Any ultrasounds ordered to establish a diagnosis of infertility should be submitted through eviCore, as these fall under the patient’s medical benefit until the diagnosis of infertility has been made.

If you have questions about this information, contact your provider relations specialist.

Preauthorization Updates

We will be sharing regular updates about functionality changes to our preauthorization tools – Clear Coverage, eviCore, and Health Alliance preauthorization forms.

eviCore

Finish Later and Attach Clinicals Later

  • This has been updated so provider offices can choose Finish Later to come back to an authorization within 2 business days. This also allows you to attach the clinicals before submitting a preauthorization.

OB Ultrasounds

  • At this time, multiple OB ultrasounds cannot be batched into one authorization request.
  • Submit separate authorizations when multiple exams are requested.
  • We’re working with eviCore for a solution, and we will keep you updated as changes occur.

Breast Ultrasounds

  • Do not require preauthorization.

OB/GYN Codes Flipped

  • From time to time, users experienced changes to CPT codes within the eviCore system. This issue has been corrected, and OB/GYN offices should no longer be seeing this problem.

Can’t Choose Rendering Provider

  • As of March 13, we’ve corrected the issue that you could not choose providers, including physicians, hospitals, and imaging centers, as the rendering provider or site. (You will no longer receive the message, “not certified for this program” when you make this selection.)

Rendering Provider vs. Ordering Provider

  • Rendering provider and ordering provider are the same as long as the rendering provider is not a hospital or imaging center.

Don’t Use the Enter Key on Your Keyboard

  • eviCore requires you to choose select, continue, or submit on a preauthorization. If you use the Enter key on your keyboard, the preauthorization will be lost, and it will take you back to the beginning.

Clear Coverage

Call with Inpatient Home Health Discharges Preauths

  • Preauthorizations for patients being discharged from an inpatient setting to home health will be handled by calling our medical management department. Use Clear Coverage for all outpatient home health preauthorizations.

Missing CPT Codes

  • The missing CPT codes for home health have been updated and can now be selected.

2017 Commercial Provider Manual Available

You can find the commercial provider manual for all of our plans in the Forms & Resources section of Your Health Alliance for providers. In it, you’ll find more information about:

  • Our Quality Improvement program, including its purpose, goals, objectives, scope, structure, key personnel, and technical resources and systems
  • Our complex case management program and how to refer a member
  • How to access and request our utilization management and pharmaceutical management criteria
  • Affirmative statement about incentives related to UM decision making
  • When decision timeframes begin for non-urgent pre-service requests received after 
business hours
  • How to use our pharmacy management procedures and processes, including our 
formulary, pharmaceutical classes, tier information, preauthorization, managed dose limitations, step-therapy, generic substitution, pharmacy savings programs, and how to request a medical exception
  • Our disease management programs, including what we do and how you and your patients can access program services
  • A comprehensive list of clinical guidelines, including non-preventive and preventive, as well as behavioral health
  • Preventive care guidelines for all age groups
  • Members’ rights and responsibilities

Meet with a Coding Specialist

The risk adjustment coding consultants are continuing to request meetings with high-volume participating provider offices. These meetings are designed to share member-specific examples of coding and quality measure needs and to update providers on the latest efforts to educate on risk adjustment. Along with member specific examples, there is information on yearly risk adjustment data validation (RADV) audits, and how provider practice participation is essential in this process.

A member of the coding consultant team is willing to meet with you to discuss any coding or quality questions you may have, or to provide member-specific examples from your panel of members. If interested, contact us at CodingCounts@healthalliance.org.

New Provider Relations Specialists

We’re excited to welcome Abby Klitzing to our provider relations specialist team. She’s responsible for the local service area to the West, which includes Macon, Moultrie, Shelby, Dewitt, Fayette, Effingham, McLean, and Woodford counties, and all regional dialysis and home infusion providers.

If you’re a provider in one of these areas, you can reach Abby at 217-383-8240 or Abby.Klitzing@healthalliance.org.

We’re also excited to welcome Kelly Cagle to our team. She’s responsible for the local service area to the North, which includes Champaign, Clark, Coles, Crawford, Cumberland, Douglas, Edgar, Jasper, and Vermillion counties in Illinois, and Warren, Fountain, Parke, Putnam, Vigo, Clay, Sullivan, and Vermillion counties in Indiana, and all regional DME/orthotics and prosthetics providers.

If you’re a provider in one of these areas, you can reach Kelly at 217-255-4730 or Kelly.Cagle@healthalliance.org.

Pharmacy Updates

Commercial

Tier Changes – Effective April 1, 2017

  • Zortress – Moved from Tier 2 to Tier 5 (Non-Preferred Specialty)
    • Must be ordered through CVS Specialty

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