Administrative simplification is something we all desire and strive for in the healthcare industry.

Transcription

1 PPO Network One Union Square 600 University Street, Suite 1400 Seattle, WA (800) Fall Provider Newsletter ADMINISTRATIVE SIMPLIFICATION PROVIDERSOURCE Administrative simplification is something we all desire and strive for in the healthcare industry. Credentialing with Health Plans has been one of those administrative tasks that has been especially burdensome for providers and a significant overhead cost for Health Plans. New uses of technology can make the credentialing process faster and more efficient for providers. In an effort to enhance current credentialing processes, increase customer satisfaction, and decrease the average turnaround time, First Choice Health (FCH) is committed to the adoption of SSB FCH retrieves credentialing information from ProviderSource. ProviderSource allows practitioners to enter credentialing data into a single source, as well as upload images of required documentation, thus eliminating the need to send the same information to multiple healthcare organizations. This is a free service hosted by OneHealthPort to help healthcare providers manage provider data used for credentialing and privileging. We encourage you to use this service at to complete initial credentialing or re-credentialing with our organization. Once we receive the application from ProviderSource, our comprehensive credentialing process ensures that all providers in our network meet a specific set of standards before they are approved to render services to the members utilizing our network. If you have questions regarding the credentialing process, please contact our Credentialing Department at (800) , Ext 2106 or option 6. What s in your Fall Newsletter Administrative Simplification - ProviderSource... 1 Impact of 5010 Electronic Billing Transaction Standards on Washingon Vaccine Association claims...2 Provider Relations Webinars...3 Client Updates...3 State of Network...3 Clinical Performance Improvement Network (CPIN)...4 Changes to View Priced Claims Status on the Provider Web page...4 New PIM provider update form... 4 Changes for Sound Health and Wellness Trust... 5 Holiday Schedule... 5 FCH Charitable Giving Committee... 5 (800)

2 Impact of 5010 Electronic Billing Transaction Standards on Washington Vaccine Association Claims As you are probably aware, changes have been made to electronic billing requirements under ANSI These changes were effective January 1, 2012 and apply to healthcare providers who transmit any health information in electronic form in connection with a HIPAA transaction. One of the changes requires that the billing address used be a physical address. The Washington Vaccine Association (WVA) would like you to know that you will need to make changes to the electronic claims you are submitting on behalf of WVA. Please continue to use the dosage-based assessment (DBA) process, with the following changes for 5010 compliant transactions: The billing provider address in loop segment 2010AA must be a complete street address with a 9-digit zip code and cannot be a PO Box or lockbox. The WVA address should be: Washington Vaccine Association, Marketplace Tower PH-A, 2025 First Avenue, Seattle WA Fill in the new pay to provider field (2010AB loop for ANSI claims) with the usual WVA PO lockbox information: PO Box 94002, Seattle WA This will allow payers to continue to use the WVA lockbox address as a location for payments and correspondence. PAPER CLAIMS The 5010 standards control electronic transactions. No changes have been announced as of yet for the existing CMS-1500 form. Providers should continue to bill the WVA PO lockbox information: PO Box 94002, Seattle WA in box 33 on the CMS 1500 form. FOR MORE INFORMATION For more information, please consult your billing and practice management service or certified professional coder. In order to ensure that claims you bill on behalf of WVA are not denied or returned you will need to work with your vendors to make sure that the right addresses are captured and sent in the correct locations. (800)

3 Provider Relations Webinars Client Updates New Payors: Mutual Assurance Administrators has initiated a direct contract effective 6/1/12 (previous access was through Beech Street). Terminating Payors: First Choice Health PPO Network (FCH PPO) would like to remind you about our Provider webinars. We now have two viewing options. The current webinar option is a live presentation that is offered monthly at a pre-determined date and time. You have the ability to ask questions at the end of the presentation as we will have the Website open and can troubleshoot with the callers live. A new, second option is to view the pre-recorded webinar anytime. The presentation is about 20 minutes long and it provides you with contact information for Provider Relations if you have questions after viewing it. FCH provides these webinars to help you and your office staff navigate through our web pages and utilize the tools offered to help understand our business model. We will cover topics such as: BenefitMD has left the group health market effective 8/31/12. Their groups have moved to Employee Benefit Management Services (EBMS) or WebTPA effective 8/16/12. Devon Health Services Inc termed 7/9/12. Other Updates: Zenith Administrators is now known as Zenith American Solutions. State of the Network How to look up a Payor or employer/group by name or number Who and where to call for claims status Payor web links where they are located on the Provider Web pages When to call Provider Relations for assistance ID card samples AK OR WA ID MT WY CO ND SD To sign up for a webinar or view the pre-recorded presentation, please go to: If you sign up for the live webinar, after you are registered, you will receive two s. The first will confirm that we have received your information to attend the webinar. The second will arrive 2-3 days prior to the webinar and will contain all necessary information to dial in and attend the webinar. Please contact Provider Relations with any questions regarding these webinars at (800) Ext or via at ProviderRelations@fchn.com. In an ongoing effort to maximize value to our network, FCH PPO is always working to recruit new providers, target expansion areas and fill any gaps that may exist within our network service area. We are pleased to announce that as of August 2012, our network includes 66,530 practitioners, 312 hospitals, and 2,150 ancillary facilities. (800)

4 Clinical Performance Improvement Network (CPIN) The WSMA has joined with the Puget Sound Health Alliance and the Washington Academy of Family Physicians to create the Clinical Performance Improvement Network (CPIN), an educational program designed to assist physician practices focus efforts on quality improvement. The collaborative effort is led by Lance Heineccius, WSMA s director of performance improvement and lead technical staff for the WSMA Foundation for Health Care Improvement. The goal of CPIN is to offer opportunities for medical practices to collaborate with one another, sharing best practices, proven innovations, and resources to stimulate accelerated and efficient implementation into practice settings. CPIN offers learning sessions bi-monthly or quarterly, either in person or via webinars. Event duration ranges from minutes, with the general format being formal presentations with ample time reserved for discussion and networking (for in-person meetings). AMA Category 1 CME credit and AAFP Preferred CME credit will be available for most sessions at no cost to participants. For additional information, please contact Lance Heineccius at Lance@wsma.org or call (206) The link to WSMA s website is clinical-performance-improvement-network. CHANGES TO VIEW Priced Claims Status on the Provider Web page We would like to make you aware of a new enhancement to this widely used tool on the Provider web page. Currently, you can view priced claims status on the web page to determine when a claim was received, how it was priced, allowed amount, where it was sent and when, etc. The pricing worksheet can be printed and used for claims processing. With the new enhancement, if your claim is submitted on paper to FCH along with any documentation (EOB, notes, etc.) for pricing, the scanned image of the document(s) as well as the claim will now be available for viewing along with the pricing worksheet. Once you select the FCH Claim ID, the scanned images will show after the pricing worksheet. If you have any questions regarding this change, please contact Provider Relations at (800) Ext New PIM provider update form First Choice Health Provider Information Management (PIM) department is excited to showcase the new Provider Update form that can be found on the FCH website at Currently, the form is just a list of required fields that need to be updated and you can submit to the PIM department. If there is additional documentation (i.e. W9, license, etc), you have to send that in a separate fax to the department. The new form will be a PDF that can be filled out and saved to your desktop and then attached to an along with any other documentation (W9, license, etc.) and sent directly to the PIM department. This will greatly increase the efficiency of updating your demographic information with FCH as well as decrease the additional calls requesting information from Providers. Providers should begin to use this form immediately if any demographic information needs to be updated such as Mailing address, Tax ID number (TIN) change, NPI change, etc. As a reminder, since we are not a payor, we do not update or store your pay-to address at FCH. The address that you wish to have payments sent to is passed on to our payors via EDI transaction or via address in box 33 on the CMS 1500 form. Please contact Provider Relations if you have any questions regarding this new form at (800) Ext (800)

5 Holiday Schedule FIRST CHOICE HEALTH WILL BE CLOSED FOR THE FOLLOWING HOLIDAYS: Thanksgiving: Thursday & Friday November 22nd & 23rd, 2012 Christmas: Monday & Tuesday December 24th & 25th, 2012 New Years Day: Tuesday January 1st, 2013 President s Day: Monday February 18th, 2013 Changes for Sound Health and Wellness Trust Access to our Customer Service and Provider Relations voic systems will be available the days we are closed. We will respond to all messages within 24 hours of re-opening. If you have any questions regarding the holiday schedule, please contact Provider Relations at (800) Ext Effective October 1, 2012, the provider network for Behavioral Health benefits for Sound Health & Wellness Trust will change from OptumHealth Behavioral Solutions to First Choice Health. FCH Charitable Giving Committee Behavioral Health Care Management will also transition to the First Choice Health Behavioral Health Coordinated Care (BHCC) program. First Choice Health BHCC staff will help existing patients and treating providers with questions regarding this change. First Choice Health and OptumHealth will work together to ensure that patients have a smooth transition and to coordinate treatment. WHERE CLAIMS SHOULD BE SENT All claims for mental health services that are submitted October 1, 2012 and after (regardless of the date of service) should be sent to: Sound Health & Wellness Trust P.O. Box 2265 Seattle, WA For electronic claims, please send to EDI submitter # FOR MORE INFORMATION If you have other questions about this change in Behavioral Health provider networks, please call First Choice Health at (800) You may continue to call the Trust Office for eligibility and benefit questions at (206) or (800) First Choice Health Charitable Giving Committee will be donating to the organizations below. For third quarter the following organizations will benefit from our contributions: Ballard Food Bank Make-A-Wish Foundation of Oregon Northwest Child Camp Primetime Clothes for Kids Lynnwood For fourth quarter we will be donating to these organizations: Sound Mental Health The Alaska Medicare Clinic Youth Care Orion Center Seattle King County Crisis Line and 211 Mary s Place (800)