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Click on notice to view full story:
- October 6, 2008 - Executive Director - Ark-La-Tex Health Network
To: Ark-La-Tex PHO Members
CHRISTUS St. Michael Directors and ManagersFrom: Paul Sarna, M.D. - Chairman of the ALT Board of
Directors
Chris Karam, FACHE - PresidentSubject: Executive Director - Ark-La-Tex Health Network
- October 6, 2008 - Medicare Identity Theft
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Executive DirectorSubject: Are You a Victim of Identity Theft?
- September 16, 2008 - TDI Commissioner’s Bulletin
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: TDI Commissioner’s Bulletin #B-0059-08
- September 12, 2008 - Aetna Assists Those Affected By Hurricane Ike
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: Aetna Assists Those Affected By Hurricane Ike
- September 12, 2008 - Alert concerning coverage for BCBSTX members
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: Alert concerning coverage for BCBSTX members
- September 3, 2008 - Texas Health and Human Services Commission - Training for Facilities Regarding the CHIP Perinatal 3038 (Emergency Certification Form)
- Sept. 8, 2008: Session #1 - 8:00-9:00 AM
- Sept. 8, 2008: Session #2 - 4:00-5:00 PM
- Sept. 9, 2008: Session #1 - 3:00-4:00 PM
- Sept. 10, 2008: Session #2 - 3:30-4:30 PM
- Sept. 11, 2008: Session #1 - 8:00-9:00 AM
- Sept. 11, 2008: Session #2 - 2:00-3:00 PM
- Targeted Hospital/StaffAudience:
- - Hospital intake staff
- - Hospital billing staff
- - Hospital-based social workers
- - Hospital birth registry data-entry staff
- - Hospital perinatal health plans Please RSVP to Pam Hardin, HHSC at Pamela.Hardin@hhsc.state.tx.us or 512/206-5110 so we can ensure the appropriate number of call-in lines. Let us know which session you will be attending.
- Topics include:
- - Changes to Application Process and use of 3038 form
- - Question and answer time
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: Training for Facilities Regarding the CHIP Perinatal 3038 (Emergency Certification Form)
[The following information is taken directly from a memo issued August 26, 2008 by Albert Hawkins, Executive Commissioner of the Texas Health and Human Services Commission.]
The Health and Human Services Commission is offering webcast/phone conference training on the recent changes to the CHIP Perinatal 3038 new process change. The webcast/phone conference will be offered over several days and different times. The following is a schedule of the webcast/phone conference. Attached are instructions for accessing the webcast/phone conference.
Thanks for your interest in HHSC’s webcast/phone conference. To ensure easy access to this meeting, please save the instructions below and refer to them the day of the event.
BEFORE THE MEETING: To ensure that your browser is configured properly click here. If you receive a warning or fail indicator, please call 1-800-860-8000 for Qwest Conferencing Help Desk Support.
AT THE TIME OF THE MEETING: Be sure all pop-up blockers are disabled! Ten minutes before the start of the meeting, log-on to the web and dial into the phone system by following these instructions:
A. Go to http://qwest.conferencing.com/ and click "PARTICIPANT LOGIN."
B. Enter the Moderator's Meeting Number 1139012 and click "JOIN MEETING AS PARTICIPANT."
C. In the "DISPLAY NAME" section enter your name.
A new screen will appear that asks, “How are you joining the meeting?” Select the first option, "DIAL ME NOW" and enter the phone number for the phone you will use to participate in the training. The system will call you when the meeting is about to begin. NOTE: If you are calling from a large phone system and you have an extension that must be dialed manually, select the third option--DIAL IN NOW--and follow the on-screen directions.
Click the "CONTINUE" button at the bottom right corner of the screen. You will be placed in the waiting room until the meeting starts. If you need assitance at anytime please call the Qwest Conferencing Help Desk at 1-800-860-8000. Please note that the ability to dial in using your telephone is limited to the first 125 people. The webcast/conference call will be recorded and the archive will be placed on the HHSC website for access by those who are not able to participate in the live meeting.
- August 19, 2008 - New Requirement for Ordering/Referring Information on Ambulatory Surgical Center (ASC) Claims for Diagnostic Services
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: New Requirement for Ordering/Referring Information on Ambulatory Surgical Center (ASC) Claims for Diagnostic Services
The article, titled “New Requirement for Ordering/Referring Information on Ambulatory Surgical Center (ASC) Claims for Diagnostic Services,” is available on the CMS MLN Matters Web page at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6129.pdfWhat You Need to Know
Effective: January 1, 2009 Implementation: January 5, 2009
Change Request (CR) 6129 states that CMS has determined that beginning January 1, 2009, the ordering/referring physician needs to be reported on claims for diagnostic radiology services submitted by ASCs, as it is for other Part B claims for diagnostic services (modifier TC). The name of the ordering/referring physician needs to be present in block 17, and the National Provider Identifier (NPI) of the physician needs to be present in block 17B of the CMS-1500 (or in Data Element Loops 2420E and 2310B of the 837P).
Claims will be returned as unprocessable (using Claim Adjustment Reason Code 16 – Claim/service lacks information that is needed for adjudication) for the services without the ordering/referring physician name or NPI on the claim.
Providers may reference CR 6129, Transmittal 1572, dated August 8, 2008.
Information provided from:
http://www.trailblazerhealth.com - August 18, 2008 - TDI Hosts Meeting on Electronic Billing for Workers' Compensation
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: TDI Hosts Meeting on Electronic Billing for Workers' Compensation
The Texas Department of Insurance, Division of Workers' Compensation has scheduled a meeting for interested stakeholders to discuss issues related to electronic billing for workers' compensation. The meeting will be from 1-4 p.m. on Aug. 25, in the Tippy Foster Room at the TDI-DWC Central Office, 7551 Metro Center Drive, Suite 100, in Austin.
A copy of the agenda is available online, and those unable to attend in person may listen to the meeting online by locating the meeting on the agency calendar and clicking on the Webcast link. In addition, the agency plans to provide teleconference capabilities for the meeting. Teleconference instructions can be found near the bottom of the meeting agenda.
The meeting will update providers and carriers on the agency's e-billing initiative, provide clarification on several issues and offer a forum for stakeholder input. (John Hawkins/Charles Bailey, J.D./Richard Schirmer, FACHE)
Information provided by: August 15, 2008 weekly edition of Health Care Advocate
Editor: Ann Ward, APR
Associate Editor: Amanda Engler, APR
Production Editor: Kathy LiThe Health Care Advocate is a publication of the Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, Texas 78701-2172; P.O. Box 679010, Austin, Texas, 78768-9010. Telephone 512/465-1050 for information. For additional information regarding specific articles, please contact the person whose name is provided in parentheses at the end of each article. According to Texas Government Code 305.027, this material may be considered "legislative advertising." Authorization for its publication is made by John Hawkins, THA, P.O. Box 679010, Austin, Texas, 78768-9010.
- August 12, 2008 - Restitution due some Blue Cross and Blue Shield of Texas customers
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: Restitution due some Blue Cross and Blue Shield of Texas customers
10:15 AM CDT on Saturday, August 9, 2008
By TERRENCE STUTZ / The Dallas Morning News
tstutz@dallasnews.comAUSTIN – Blue Cross and Blue Shield of Texas has been ordered by state regulators to pay restitution of $3.9 million to thousands of members and a $250,000 fine for underpayment of claims related to care in out-of-network hospitals and other medical facilities.
State Insurance Commissioner Mike Geeslin ordered the health insurer to make the payments over the next several months and specified that if they don't total at least $3.9 million, the balance must be paid to the state as an additional fine.
Doug Danzeiser of the Texas Department of Insurance said the underpayments date to Jan. 1, 2004, and involves thousands of Blue Cross members in Texas enrolled in Preferred Provider Organization plans.
Under those plans, members are encouraged to use hospitals and physicians in the company's preferred provider network, and they receive a higher level of benefits if they do. Members can go outside the network, but they receive lesser benefits and are financially responsible for a greater share of the costs.
Several complaints from consumers and hospitals about "unreasonably low" payments by Blue Cross for medical care in facilities not in the company's network prompted an investigation by the Texas Department of Insurance that led to the commissioner's order. Blue Cross, the largest health insurer in Texas, denied the allegations.
Mr. Geeslin also charged that the company misrepresented to consumers which providers are in its network and thus subject to a higher level of benefits.
"TDI has received complaints that Blue Cross and Blue Shield of Texas' Web site listing of its contracted providers has listed providers as being contracted when they were not contracted," the order said. Failure to maintain an accurate listing of preferred providers is also a violation of state law.
Mr. Danzeiser said most of the affected consumers sought care in out-of-network hospitals because of medical emergencies or because the services they required were not available in regular network facilities.
"Blue Cross was paying less on these claims than what they represented to people that they would pay," said Mr. Danzeiser, deputy commissioner for regulatory matters.
Although the health insurer disputed the allegations, Mr. Danzeiser said the company has agreed to pay the fine and reimburse members who the state says were shortchanged.
Blue Cross must notify affected members of the reimbursements by mid-December. In addition, Blue Cross officials have to implement new procedures for paying claims at out-of-network facilities by the middle of August.
Information provided by:
http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/DN-insurefine_09tex.ART.State.Edition1.4da8c4b.html - July 21, 2008 - Medical Board Reduces License Processing Time, Clears Backlog
To: Ark-La-Tex Health Network Providers
From: Carol Daniels, CPCS Credentialing Coordinator
Subject: Licensing time declines from 100 days to 44 days
AUSTIN— The Texas Medical Board has reduced the time it takes to process medical license applications by 56 days, clearing the backlog of applications it has been struggling to eliminate for more than a year.
Board officials say the addition of six full-time employees appropriated by the Texas Legislature during the last session has allowed them to shave the average time it takes to get a medical license from about 100 days in September to 44 days in June.
“We have already exceeded the goal established by the Texas Legislature, which is an average of 51 days to issue licenses,” says Roberta Kalafut, MD, TMB’s board president. “The legislature asked us what we needed to get the job done and they gave us what we asked for. It was enough.”
The licensing backlog began after voters in Texas approved Proposition 12 in 2003, granting the Legislature the authority to cap noneconomic damages in healthcare liability cases. Physicians and physicians-to-be flocked to the state in numbers never anticipated by even the staunchest supporters of the proposition, and the resulting influx caused a backlog that left some doctors waiting up to eight months to get licensed.
The board says the number of physician license applications increased from from 2,992 in fiscal year 2005 to 4,026 in fiscal year 2006. The number was 4,041 in fiscal year 2007. The board has received more than 3,000 applications this fiscal year and expects to again exceed 4,000 applications.
"We had the same number of licensure analysts in 2007 as we had in 2003, even though the number of applications we received had increased by 57%," says Kalafut.
TMB also has eliminated the licensing backlog, it says. Thirty-three applications were waiting to be screened last month. As recently as February, there were 507 applications backlogged, taking about 90 days to process.
“Texas is an attractive place for physicians to practice, as the number of applications we receive demonstrates,” Kalafut says. “But the sudden jump in the number of applications put a serious strain on a licensing system designed for a far fewer number. That problem has been addressed.”
This information provided by Texas Healthflash July 21, 2008 issue. www.healthleadersmedia.com
- July 16, 2008 - Congress overrides veto; Medicare payment bill becomes law
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: Congress overrides veto; Medicare payment bill becomes law
The Senate has voted 70 to 26 to override the president's veto of the Medicare Improvement Act for Patients and Providers (H.R. 6331). This action follows a successful override vote earlier today by the House of Representatives.
Success was only achieved due to an extraordinary grassroots effort by Medical Group Management Association (MGMA) members, the American Medical Association, medical specialties, senior citizens and military families. The bill achieves two of MGMA's top advocacy objectives for 2008.
First, it reverses the 10.6 percent payment cut that went into effect on July 1 and halts the 5.4 percent cut scheduled for Jan 1, 2009.
Second, Congress addressed a severe operational deficiency in the Medicare Advantage (MA) program. Currently, Medicare Advantage private fee-for-service (PFFS) plans are not required to establish traditional provider networks. This has created tremendous beneficiary confusion and provider distrust. H.R. 6331 makes significant improvements to the program by eliminating the ability of PFFS plans to "deem" physicians where there are two or more MA plans in an area beginning in 2011. This change in the law is the direct result of MGMA's two-year grassroots campaign to revise unfair MA contracting policies.
MGMA is working with Congress and the Centers for Medicare & Medicaid Services to address the administrative difficulties caused by the delay in passage of this legislation.
The Senate vote will be posted shortly here
Please continue to access your MGMA Washington Connexion and mgma.com for further information.
Information provided from;
http://www.mgma.com/
MGMA® and ACMPE® do not sell or rent e-mail addresses, please see our privacy policy. To unsubscribe from this or other MGMA/ACMPE communications, please visit your subscription management page.
© 2008 Medical Group Management Association®, American College of Medical Practice Executives®,
MGMA Center for Research, and MGMA Services Inc.
All rights reserved.MGMA
104 Inverness Terrace East
Englewood, Colorado 80112 USA - July 16, 2008 - President vetoes Medicare physician payment bill
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSubject: President vetoes Medicare physician payment bill
Act now! President vetoes Medicare physician payment bill
Today the president vetoed the Medicare Improvement Act for Patients and Providers (H.R. 6331). The House of Representatives must now schedule a new vote to override the veto, followed by a similar vote in the Senate. A two-thirds majority in each chamber must support a veto override for it to succeed.
Please use the grassroots hotline at 800.833.6354 to call Congress and urge lawmakers to immediately override the veto of H.R. 6331 to provide 18 months of positive Medicare payments to physicians and ensure that Medicare beneficiaries have access to quality care.
Please click the links below to see how your senators and representatives previously voted on this bill. If they voted "yea", thank them for their support of this important legislation and urge them to vote to override the presidential veto. If they voted "nay", urge them to reconsider their position and vote to override the veto.
This bill reverses the 10.6 percent cut to Medicare reimbursement that took effect July 1 and the projected 5.4 percent cut scheduled for 2009. It continues the 0.5 percent payment increase for 2008 and provides an additional 1.1 percent increase in 2009.
See how your representatives previously voted.
See how your senators previously voted.
Click here to determine who your senators are.
Click here to determine who your representative is.
Information provided from;
http://www.mgma.com/
MGMA® and ACMPE® do not sell or rent e-mail addresses, please see our privacy policy. To unsubscribe from this or other MGMA/ACMPE communications, please visit your subscription management page.
© 2008 Medical Group Management Association®, American College of Medical Practice Executives®,
MGMA Center for Research, and MGMA Services Inc.
All rights reserved.MGMA
104 Inverness Terrace East
Englewood, Colorado 80112 USA - July 10, 2008 - Senate Listens, Passes Medicare Bill, Stops Fee Cuts
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorSenate Listens, Passes Medicare Bill, Stops Fee Cuts Intense lobbying by the Texas Medical Association, the Texas Medical Association Political Action Committee (TEXPAC), and their member physicians paid off this afternoon as Texas Sens. John Cornyn and Kay Bailey Hutchison joined 67 of their Senate colleagues in reversing the 10.6-percent cut in Medicare physician payments by a vote of 69-30. The margin is large enough to protect it from President Bush's threatened veto. The vote proved once again that physicians can make a difference when they make their voices heard in Congress.
TMA President Josie Williams, MD, said Texas physicians "want to commend the courage and wisdom" of both Senators Cornyn and Hutchison "who voted for their constituents – our patients – today. Our Texas senators listened to their patients and physicians and reversed the 10.6-percent physician Medicare cuts that went into effect July 1. We cannot thank them enough for standing up for our patients."
The bill the Senate approved, House Resolution 6331, has already passed the House of Representatives by a veto-proof 355-59 margin. It:
• Stops the 10.6-percent cut, continues current rates for the rest of this year, and provides an additional 1.1-percent increase in 2009;
• Gives Congress 18 months to devise a long-term replacement for the Sustainable Growth Rate financing formula, as we demand in TMA's Texas Medicare Manifesto;
• Extends the Geographical Practice Cost Index, which protects physicians practicing in most of Texas; and
• Provides parity for Medicare mental health benefits and increases coverage for preventive services.Senators Cornyn and Hutchison originally voted against the bill when it came up just before Congress recessed for the July 4 holiday. That prompted an angry response from physicians across Texas who flooded their offices with e-mails and telephone calls demanding they change their votes and protect senior citizens' access to care. "TEXPAC harnessed the collective voice and coordinated and executed the teamwork that paid off for today's vote," said Manuel Acosta, MD, chair of the TEXPAC Board of Directors.
"The U.S. Senate got it right today," Dr. Williams said. "Physicians of the Texas Medical Association applaud Congress, especially our two Texas senators, for voting for elderly patients, military families, and persons with disabilities."
Dr. Williams said, "TMA continues to call for a long-term solution to fix Medicare's flawed physician payment formula, and we applaud Senator Cornyn and Hutchison for calling on all the members of the Senate to put aside their partisan infighting and devise a permanent long-term solution. With the additional time now afforded Congress, there is no excuse for not working on a bipartisan solution to protect Medicare beneficiaries and their physicians."
Information provided from- www.texmed.org
Last Published: 7/9/2008
TMA: 401 West 15th Street, Austin TX 78701 Ph: (800) 880-1300, (512) 370-1300
Copyright 1999-2007 Texas Medical Association All Rights Reserved - July 02, 2008 - Texas Medical Board has scheduled additional Town Hall Meetings
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorTMB SCHEDULES EIGHT ADDITIONAL TOWN HALL MEETINGS
Board also will Offer Licensing Seminars to Assist ApplicantsBecause of the success of its initial Town Hall meetings, the Texas Medical Board will conduct eight additional Town Hall meetings/licensing seminars this summer in locations across the state.
“Our first meetings have gone very well,” said Dr. Roberta Kalafut, TMB’s board president. “We have heard several very good suggestions and we have addressed many concerns. The give and take has been dynamic and, I think, very valuable both for the board and for participants.”
The two-part meetings include a Town Hall meeting, which is an open forum designed to stimulate discussion, and a licensing seminar for individuals who assist physicians seeking licensure. So far, TMB has provided in-depth training to dozens of credentialing and medical staff services personnel who help physicians acquire their licenses.
TMB has conducted Town Hall meetings/licensing seminars in Brownsville, Midland and Austin and has events scheduled for Fort Worth this week. With the addition of the eight Town Hall meetings to the schedule, TMB will have conducted 13 meetings in all parts of the state by September.
“We want to hear from everyone, medical professional and consumer alike, who has an opinion or suggestions about medical regulation, the board’s rules and its policies,” Kalafut said. “Our mission is to protect the public, and we will not compromise that mission. But there may be ways to accomplish it in ways that are less burdensome for physicians. We are open to any ideas, suggestions or questions.”
The meetings are open to the public. No registration is required.
Town Hall meetings/licensing seminars will be conducted at the following locations:
July 8 and 9 – Bryan/College Station – Both sessions will be conducted in Lecture Hall 1 on the first floor of the Joe Reynolds Medical Building at Texas A&M University, at the southwest corner of University Drive and Olsen Boulevard. The Town Hall meeting will be at 7 p.m. on July 8 and the licensing seminar will begin at 8:30 a.m. on July 9.
July 15 and 16 - Houston – Both sessions will be at the University of Texas Medical School at 6431 Fannin St. The Town Hall meeting will be in Room MSB 1.006 (the first floor lecture hall) at 7 p.m. on July 15 and the licensing seminar will be in Room MSB 2.006 at 8:30 a.m. on July 16.
July 29 and 30 – Lubbock – Both sessions will be conducted in the Texas Tech University Health Sciences Center, 3601 4th Street (4th Street and Indiana Avenue). The Town Hall meeting will be at 7 p.m. on July 29 in Room ACB100, and the licensing seminar will begin at 8:30 a.m. on July 30 be in Room ACB120.
August 5 and 6 – Tyler – Both sessions will be in the Biomedical Research Auditorium at The University of Texas Health Science Center, 11937 U.S. Highway 271. The Town Hall meeting will be at 7 p.m. on August 5 and the licensing seminar will begin at 8:30 a.m. on August 6.
August 12 and 13 – Dallas – Both sessions will be conducted in the T. Boone Pickens Biomedical Building Auditorium, Room NG3.112 on the third floor, at the University of Texas Southwestern Medical Center at Dallas, 6001 Forest Park Road. The Town Hall meeting will begin at 7 p.m. on August 12, and the licensing seminar will begin at 8:30 a.m. on August 13.
August 19 and 20 – El Paso – Both sessions will be conducted in Auditorium B on the second floor of the Administration Building at Texas Tech University Health Science Center, 4800 Alberta Avenue. The Town Hall meeting will begin at 7 p.m. on August 19 and the licensing seminar will begin at 8:30 a.m. on August 20.
August 25 and 26 – San Antonio – Both sessions will be conducted at the School of Medicine at the Joe R. and Teresa Lozano Long Campus of the University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive. The Town Hall meeting will begin at 7 p.m. on August 25 in Lecture Room MED 309L. The licensing seminar will begin at 8:30 a.m. in Lecture Hall 3.104A.
September 3 and 4 – Galveston – The meetings will be held at the University of Texas Medical Branch at Galveston. The rooms will be announced.
September 9 and 10 – Amarillo – The meetings will be held at the Texas Tech University Health Science Center. The rooms will be announced.
- July 02, 2008 - Holding Claims Paid Under the Medicare Physician Fee Schedule
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
Interim Executive DirectorCMS has requested the following information be furnished to providers of health care.
To the extent possible, CMS is working with Congress, health care providers and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, Non-Physician Practitioners (NPPs) and other providers of services paid under the Medicare Physician Fee Schedule (MPFS), beginning July 1, 2008. In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July. This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before June 30, 2008, will be processed and paid under normal procedures.
After 10 business days, contractors will begin releasing claims to process under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims that have already processed.
Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service on or after July 1, 2008, billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule will be automatically reprocessed, if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to resubmit a revised claim.
To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers that are secondary to Medicare.
In addition, providers should be on the alert for more information about other legislative provisions that may affect Medicare Fee-for-Service (FFS) providers.
(CMS Joint Signature Memorandum (JSM) 08382, dated June 30, 2008, and CMS Contractor Provider Education Listserv (200806-24), dated June 30, 2008)
- June 17, 2008 - CHIP Perinatal clients at or Below 185% Federal Poverty Level
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
PHO Coordinator and Provider RelationsImportant Changes in Application Process for Emergency Medicaid
The Texas Health and Human Services Commission is changing the process many expectant mothers use to get perinatal services provided through the Children’s Health Insurance Program (CHIP). The change involves the form that must be filled out to ensure the hospital is paid facility fees for labor and delivery for women getting CHIP perinatal coverage whose income is at or below 185 percent of the federal poverty level.
Currently, women in this income range must apply for Emergency Medicaid to cover their hospital labor and delivery fees. This can cause a problem for the hospital if the mother has new income that puts her over the Medicaid limit. Beginning August 1, 2008, HHSC will instead require the expectant mother’s provider to fill out Form 3038, the Emergency Medical Services Certification. The expectant mother will receive this form from HHSC a month before her due date, along with a letter reminding her to send information about the birth of her child after delivery. The letter will instruct the woman to take the form to her provider, have the provider fill out the form, then mail the form back to HHSC in a preaddressed, postage-paid envelope. In many cases this activity will happen after delivery when the mother is being discharged from the hospital.
Once HHSC receives the completed Form 3038, Emergency Medicaid coverage will be added for the mother for the period of time identified by the health care provider. Form 3038 is the same form currently required to complete Emergency Medicaid certification.
It is important to understand that in this new arrangement, the CHIP perinatal mother will not be required to fill out a new application or provide new supporting documentation to apply for Emergency Medicaid. Instead, HHSC will determine the woman’s eligibility for Emergency Medicaid by using income and other information the mother to-be provided when she originally applied for CHIP perinatal coverage, as well as information included on the Form 3038.
In cases where a woman fails to send back the Form 3038 within a month after her due date, HHSC will send her another Form 3038 with a postage paid envelope. If the woman fails to submit the second form, and the hospital cannot locate a Type Program 30 for her in the TMHP online provider look-up system, then the hospital can bill her for facility fees incurred during her stay.
For more information on this change contact lisa.bartels@hhsc.state.tx.us.
To access Form H3038 click here
- June 16, 2008 - FCI Provider Roster and Lab Clarification
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
PHO Coordinator Physician and Provider RelationsThis notice is to provide you with a current copy of the FCI provider panel to utilize for referrals for FCI inmates, provide access to the current FCI Drug Formulary and also to provide information regarding the current Lab process.
You may CLICK HERE FOR CURRENT PANEL LISTING. Additionally, a copy of the current drug formulary for FCI inmates may be accessed by clicking the following link: www.bop.gov/news/PDFs/formulary.pdf
Several questions have also arisen regarding the current processing of claims for Lab services provided to FCI inmates. The new FCI contract that went into effect October 29th, and terms are applicable to FCI Providers for claims with dates of service beginning March 1st, 2008 and after. The new contract indicates that labs for FCI inmates be sent to the designated FCI lab company. At this time, however, FCI has not secured a contract with a preferred lab company.
Until FCI deems a specific lab provider, all claims for lab related services are to be sent directly to FCI for payment. The Ark-La-Tex contract does not include terms for those services. The contact information for those services is as follows:
Denise Swint
FCI Lab Claim Processing
Federal Correction Institute
P.O. Box 9500
Texarkana, Tx 75505-9500
903-223-4450If you have any additional questions, please feel free to contact our office directly at 903/735-5381.
- June 5, 2008 - Texas Medical License Applications Update
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMC, CMOM
PHO Coordinator Physician and Provider RelationsPlease see the below information which may be useful to your practice operations:
SOURCE: Texas Medical Board Press Release
FOR IMMEDIATE RELEASE
Thursday, June 5, 2008
LIST SYSTEM TO SPEED UP MEDICAL LICENSE APPLICATIONS
New System Allows Applicants to Track Status, Communicate with TMB
Click here Website address to access this information:
On June 1, the Texas Medical Board implemented the Licensure Inquiry System of Texas, an online license application tracking system that promises to reduce the time required to process and issue physician licenses in Texas. A public/private partnership, LIST was funded by a grant from the Texas Hospital Association.
The LIST application uses existing technology in an innovative manner, and is designed for ease of use by applicants and TMB staff alike. It allows applicants to track the status of their physician licensure applications online 24 hours a day without requiring the assistance of TMB staff, including providing detailed explanations of any missing items needed to process the application. LIST allows applicants to communicate with TMB from anywhere in the world with internet access. The system also creates an easily accessible archive of all such communication between TMB and the applicant.
LIST also allows TMB to broadcast to all applicants in the event that changes in statute or TMB rules modify requirements for licensure.
Prior to the implementation of LIST, an applicant was required to contact TMB to determine the status of their application, confirm receipt of submitted materials or determine what might still be needed to complete their application.
“The fact that it is available 24 hours a day from anywhere in the world is very significant,” said Dr. Roberta M. Kalafut, TMB’s Board President. “Doctors may work challenging hours, and contacting TMB during regular business hours may be difficult. Also, doctors who want to practice in Texas come from all over the world. Business hours here might be the middle of the night where the applicant resides.”
The new system is expected to reduce the time required to license a physician in Texas by adding efficiencies not only for TMB staff but also for the applicants, who will have real-time access to all the materials they submitted.
“There is a great need in Texas for additional doctors, particularly in rural and border areas where Texans’ medical needs are underserved,” said Dr. Dan Stultz, president and CEO of THA. “This system will streamline the application process, putting more doctors in the field. We immediately saw the potential when TMB approached us about funding this project and we are very pleased to be involved.”
- May 28, 2008 - Foster Care Program
To: Ark-La-Tex Health Network Providers
From: Joanne Gibson, CMC
For those ALT Providers who have recently chosen to participate in the Foster Care Program offered by Texas True Choice (TTC) through Healthcare Partners of East Texas (HPET) and administered through the Superior Health Plan Network, participation became effective April 1, 2008.
Additional information regarding the program, the Provider Manual & Health Passport, and other Foster Care-related information can be found at www.superiorhealthplan.com.
Your participation information will also now be included in the STAR Health Directory. You may direct any questions regarding member participation or benefits to Superior Health Plan Network at (866) 439-2042; a copy of the Quick Reference Guide is enclosed for your convenience.
Additionally, ALT has been notified that the attached STAR Health Questionnaire form is now required by the State for all Participating Providers in this program. Therefore, please complete the form and fax back to ALT at your earliest convenience so we can forward to HPET.
If you are a current ALT Provider not currently participating in the Foster Care Program but are interested in receiving more information, please contact me at 903-735-5380 or joanne.gibson@christushealth.org for a ballot.
Please do hesitate to contact us with any other questions or concerns. Thank you.
- April 4, 2008 - Evolutions Termination
To: Ark-La-Tex Health Network Providers
From: Joanne Gibson, CMC
Please be advised of our receipt of written notification from Evolutions Healthcare Systems of their intent to terminate the contractual agreement with Ark-La-Tex Health Network, effective 5.18.08.
If you have any questions, please do not hesitate to contact our office. Thank you.
- October 18, 2007 - Arkansas Blue Cross Blue Shield - Physical Medicine & Rehabilitation Changes
To: Ark-La-Tex Health Network Providers
From: Joanne Gibson, CMC
Effective October 1, 2007, the reimbursement changed for Physical Medicine and Rehabilitation codes under the Arkansas Blue Cross Blue Shield USAble and Health Advantage agreements through Ark-La-Tex Health Network. A summary of these changes was communicated to your office in the June 2007 and September 2007 edition of the Arkansas Blue Cross Blue Shield publication ProvidersNews.
The following is a summary of that information:
The conversion factor for CPT codes 97001-97799 will change from its current reimbursement of $48.89 to $40.00. The reimbursement allowance for the Arkansas Blue Cross and Blue Shield fee schedule will be calculated by using $40.00 times the applicable 2007 Medicare RVUs. In addition, all discounts applied to these services will be removed from the Arkansas Blue Cross and Blue Shield fee schedule for Covered Services represented by CPT Codes 97001-97799. Therefore, providers who participate in the Arkansas First Source PPO network and the Health Advantage HMO network will receive an Allowance of 100% of the Arkansas Blue Cross fee schedule for Covered Services represented by CPT Codes 97001-97799. In addition, Covered Services represented by HCPCS Codes G0237, G0238, G0283 and S9092 will be included in this revision.
PLEASE NOTE: If you choose not to accept this change in reimbursement, you must notify Ark-La-Tex Health Network of your desire to terminate your agreement with Arkansas Blue Cross Blue Shield.
If you have further questions, please feel free to contact me at 903-735-5380, joanne.gibson@christushealth.org. Thank you.
- October 1, 2007 - "Delay in Tamper Resistant Prescription Pad Requirement"
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMOM
PHO Coordinator Physician and Provider RelationsLegislation Delaying the "Tamper-Resistant" Prescription Pad Requirement
An intense lobbying campaign by MGMA, pharmacy organizations, state officials and provider groups has caused a six-month delay of the Oct. 1 requirement to use tamper-resistant prescription pads for Medicaid prescriptions.
On Sept. 26, the House of Representatives approved H.R. 3668, a bill that includes the six-month delay. Late on Sept. 27, the Senate passed a companion measure. The President signed the bill into law on Sept 29.
The Oct. 1 start date caused backlogged orders for compliant pads and little time for education and compliance for pharmacists, physicians and the 55 million Medicaid beneficiaries. This rule does not apply to prescriptions that are emergency refills, in some institutionalized settings, for Medicaid managed care plans and that are phoned, faxed or electronically transmitted to the pharmacy.
Click here to read the August letter from the Centers for Medicare & Medicaid Services (CMS) to state Medicaid directors.
Click here to read related CMS FAQs.
- September 26, 2007 - "Tamper-Resistant" Prescription Pad Requirement Effective October 1, 2007
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMOM
PHO Coordinator Physician and Provider RelationsPlease see the attached information regarding the new federal requirement of "Tamper-Resistant" prescription pads.
Click here for the actual legislation.
Click here for a copy of the letter from CMS to each State Medicaid Director
Click here for the Background Information sheet.
If you have any questions, please feel free to contact our office.
- September 25, 2007 - NPI: Claim Rejection Information and NPI Registry Suspension
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMOM
PHO Coordinator Physician and Provider RelationsEffective October 8, 2007, TrailBlazer will begin rejecting claims when NPI/Legacy ID combinations do not match on the NPI crosswalk file.
When a claim is returned, a provider should first verify that the correct NPI was submitted. If correct, the provider will need to verify that their Medicare legacy identifier (PIN) corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES).
Important Message about the NPI Registry...(as of 09/24/2007):
Many providers have noted the recent instability of NPPES and the NPI Registry. CMS has begun implementing changes that should eliminate the instability and expects that these changes will be completed next week. NPPES will remain in operation while these changes are being made, but the NPI Registry will remain down until all changes have been implemented.
CMS expects the NPI Registry to be back inoperation sometime next week.
If you haven't yet used the NPI Registry, be sure to check it out after it's operational again:
https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do
Getting an NPI is free--not having one can be costly.
Visit the TrailBlazer NPI Web page for helpful information and links to NPI-related Web sites.
- September 6, 2007 - Discontinuation of
UnitedHealthcare Medical ID Swipe Card at the Time of Service
To: Ark-La-Tex Health Network Providers
From: Heather Post, CMOM
PHO Coordinator Physician and Provider RelationsPlease note: The following notice contains information regarding a payor not currently contracted with Ark-La-Tex Health Network (ALT). ALT is providing this notice as a service toour provider network and for your information only.
Ark-La-Tex Health Network has become aware that effective August 24, 2007, UnitedHealthcare has discontinued the use of the MasterCard® Terminal as an option for checking health care benefit eligibility and copayment information when using the UnitedHealthcare Medical swipe card. This capability has been replaced with the use of a 3-track card reader. Please click on the link below to view the complete article:
- August 21, 2007 - Allied Health Provider
Credentialing/DEA
To: Ark-La-Tex Health Network Providers
From: Carol Daniels, CPCS, Credentialing Coordinator
Jamie Short, Credentialing SpecialistAllied Health Provider Credentialing
Ark-La-Tex Health Network would like to announce that it has expanded its participating provider panel to include Physician Assistants, Advanced Practice Nurse Practitioners and Certified Registered Nurse Anesthetist. For more information or to receive an application packet please contact Carol Daniels or Jamie Short.
Drug Enforcement Administration
The Drug Enforcement Administration amended, effective January 2, 2007, its registration regulations to make it clear that when an individual practitioner practices in more than one state, he or she must obtain a separate DEA registration for each state in which the practitioner provides care.
- August 8, 2007 - DISCOUNT CARD - Carexpress
To: Ark-La-Tex Health Network Providers
From: Joanne Gibson, Managed Care Coordinator
Please be advised that we have been notified of the marketing and distribution of the discount card Carexpress with the indication of participation by ALT providers. The card was found to have originated from a Provider Select, Inc. client.
Provider Select, Inc. has since confirmed that they have not promoted this discount card, and have again made their clients aware that ALT providers do not participate in these programs nor accept these cards.
If you have any questions, please feel free to contact me at 903-735-5380 or (joanne.gibson@christushealth.org).
- May 31, 2007 - NPI Data Dissemination - Update
To: Ark-La-Tex Health Network Providers
From: Heather Post, PHO Coordinator and Provider Relations
Many of you have wanted to find out if/when we would have the ability to access NPIs on the web, similar to the way the UPIN information has been available in the past. CMS will be publishing the NPPES Data Dissemination Notice today (May 30, 2007); the initial downloadable file and the query-only database will be available to the public 30-days after publication (June 28, 2007). Below is a link for the official information from CMS.
www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp
- May 31, 2007 - REMINDER NOTICE - Blue Cross Blue Shield of Texas AIM Radiology Program
To: Ark-La-Tex Health Network Providers
From: Joanne Gibson, Managed Care Coordinator
Please note: The following notice contains information regarding a payor not currently contracted with Ark-La-Tex Health Network (ALT). ALT is providing this notice as a service to our provider network and for your information only.
REMINDER - BlueChoice physicians must contact American Imaging Management, Inc. (AIM) to receive a Radiology Quality Initiative (RQI) number when ordering or scheduling outpatient high tech imaging procedures (CTs, MRIs, PETs and Nuclear Cardiology studies) for PPO members. In addition, the facility performing these procedures should receive this RQI number before rendering these services.
You can inquire whether an RQI number has been obtained by contacting AIM through any of the following methods:
Phone 800-859-5299
Fax 800-610-0059
Website www.americanimaging.net
If you have any questions regarding the RQI program, you may visit the BCBS website at www.bcbstx.com or contact your local Facility Provider Network office.
- April 12, 2007 - Arkansas State and Public School Employees now requiring high-tech radiology authorizations
From: Heather Post, PHO Coordinator Physician and Provider Relations
To: Ark-La-Tex Health Network Providers
Please see the attached notice regarding any provider participating with Arkansas State and Public School Employees. This group will also now require high-tech radiology authorizations. Please CLICK HERE to review the information regarding the Arkansas State and Public School Employees new high-tech radiology requirements for all providers.
If you have any questions, please feel free to contact us. Thank you.
- March 27, 2007 - United Radiology Notification Program Effective April 16, 2007
- • CT scans
- • MRIs
- • MRAs
- • PET scans, and
- • nuclear medicine studies, including nuclear cardiology.
- • Phone: 1-866-889-8054
- • Fax: 1-866-889-8061
- • Online: www.unitedhealthcareonline.com, notifications, radiology notification submission and status
- • Phone: 1-866-889-8054 (select prompt #2 to check status of a notification request)
- • Online: www.unitedhealthcareonline.com, notifications, radiology notification submission and status
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
Please note: The following notice contains information regarding a payor not currently contracted with Ark-La-Tex Health Network (ALT). ALT is providing this notice as a service to our provider network and for your information only.
ALT has been notified that the United Healthcare Radiology Notification Program will be effective April 16, 2007.
Prior notification is required for the following defined set of outpatient imaging procedures:
Advanced diagnostic imaging services that take place in an emergency room, observation unit, Urgent Care facilities or during an inpatient stay do not require notification.
TO OBTAIN NOTIFICATION:
Ordering Physician/Provider
Rendering Physician/Provider
For additional information found on the United Healthcare website, click here.
For a list of Frequently Asked Questions, click here.
To view the Quick Reference Guide, click here.
If you have additional questions about the Radiology Notification Program, please contact your local UnitedHealthcare Network Account Manager or call 1-800-637-5792, or email radiology@customerelation.com.
And, as always, please contact us at ALT if we can assist in any way. Thank you.
- March 26, 2007 - CHIP Perinatal Program Info and ID Card Examples
From: Heather Post, PHO Coordinator, Physician and Provider Relations
To: Ark-La-Tex Health Network Providers
To view information on the CHIP Perinatal Program, including examples of the mother and covered dependent ID cards, please click here.
If you have any questions, please feel free to contact us. Thank you.
- April 25, 2007 - United Healthcare 2007-2008 UHC Admin Guide and Network Bulletin Information
From: Heather Post, PHO Coordinator Physician and Provider Relations
To: Ark-La-Tex Health Network Providers
Please note: The following notice contains information regarding a payor not currently contracted with Ark-La-Tex Health Network (ALT). ALT is providing this notice as a service to our provider network and for your information only.
If you have any questions, please feel free to contact us. Thank you.
- March 12, 2007 - Medicare PFFS Plan Research Results
From: Heather Post, CMOM, Provider Relations
To: Ark-La-Tex Health Network Providers
ALT has received many questions regarding the Medicare PFFS plans. These plans do not require a provider to enter into a contract, however in providing services to a patient covered by this plan, the provider has agreed to the terms and conditions that vary with these plans. For these reason, as an aid to our ALT providers, we have researched each of the plans certified on our counties, and provided the results of this research on our webpage.
Keep in mind, because these plans do NOT require contracts, they are NOT OFFERED through ALT. The information provided is a courtesy to help your office operations. The list is intended to provide for EACH PLAN a Summary of Benefits, Terms and Conditions, etc. so that your office may determine by plan/product whether or not you choose to participate.
You may access the results of this information on our website www.altpho.org by clicking RELATED SITES and then clicking on MEDICARE PFFS PLANS to expand the selection. There are a multitude of plans certified by county by state, however ALT researched those plans currently sold and marketed in our service area. If you find your office is seeing patients under a PFFS plan that is not included on this listing, please forward us a that plan information, and we will attempt to research and add to the information on our site.
ALT hopes everyone finds this information helpful.
- March 2, 2007 - Daylight-saving bug could foil computers
Microsoft has issued warnings related to the changes with Daylight Savings Time. With the changes to the DST a problem with your computer could occur. Below is a CNN article with more detail. The most common problems can occur in the calendars, so you may want to verify appointment times between March 11th and March 31st. See the related article by clicking on the following link:
- February 27, 2007 - AMCO~Windsor Health Plan
From: Heather Post, Provider Relations Representative
To: AMCO/Windsor Health Plan, Inc Correspondence
Ark-La-Tex Health Network (ALT) was recently made aware of a letter from AMCO/Windsor Health Plan, Inc informing them of a new Medicare Advantage health plan. The letter explains the plan is offered through the provider’s current relationship through AMCO. The letter also states that all providers WILL BE INCLUDED in this plan unless they return the ‘opt out form’ within 10 working days.
Today, ALT made contact with Johnna Thomas. Executive Director of AMCO. Mrs. Thomas indicated that there had been some confusion on which physicians received this letter, based on a determination regarding which physicians are associated with the PHO and which physicians are directly contracted with AMCO. ALT confirmed with Mrs. Thomas that letters received by ALT providers can be disregarded, and no ALT provider will be automatically included in this Medicare Advantage panel if an ‘opt out form’ is not returned.
ALT will be reviewing the Windsor Health Plan Medicare Advantage agreement for possible participation through the PHO. Until a determination is made for ALT to offer this product to the ALT membership, any provider wishing to participate may contract directly with AMCO/Windsor Health Plan by signing the letter of agreement received and would need to be returned directly to the Windsor Health Plan offices.
If you have any questions, please feel free to contact us. Thank you.
- February 26, 2007 - Aetna website
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
We have received notification that Aetna now has new information and features available online.
• Benefit information is now available, including but not limited to, life maximums, referral requirements, and plan names and descriptions. This data is now available regardless of how you access Aetna member information, whether it is on their website or another vendor/clearinghouse website.
• Pre-populated drop down lists containing Provider IDs (TIN, PIN, and or/NPI) have also been added. Instructions on how to best use this tool are located within the “Add a Provider” screen.
• There is an improved “printer friendly feature” by using the printer icon located on the upper right of the screen.
• Check multiple member’s eligibility at one time using the “click for more detail” link. Access co-pay information, patient details such as plan information, deductible, coinsurance, Aetna Healthfund and coordination of benefits information by clicking on the “Select” link.
Access the secure Aetna website at www.aetna.com/provider If you have questions or need information, please select the ‘Contact Us’ field on the website.
- February 22, 2007 - CHRISTUS Health Uninsured Policy
From: Hal Patton, Executive Director
To: Ark-La-Tex Health Network Providers
Attached please find a letter from Chris Karam addressed to the CSMHS medical staff and the Ark-La-Tex Health Network physician network, announcing the implementation of the CHRISTUS Health Uninsured Policy.
As a result of this policy, an uninsured person will no longer be faced with the full billed charge for services received, but will be afforded a reduction dependant upon their qualifications according to Federal Poverty Level guidelines.
It is important the financial counselors at CSMHS pre-qualify the uninsured to determine the level of responsibility and assistance. To expedite the process for your patients, your assistance is requested, as indicated in the attached letter.
Upon your review, if you have questions, please do not hesitate to contact our office. As always, thank you for your continued support.
- February 13, 2007 - Texas Blue Cross Blue Shield – NPI numbers
- Go to
- Click on the NPI in the upper right hand corner and then “How do I submit my NPI to BCBS”
- Be sure to include your confirmation letter with the submission form; the fax number is on the form
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
Please note: The following notice contains information regarding a payor not currently contracted with Ark-La-Tex Health Network (ALT). ALT is providing this notice as a service to our provider network and for your information only.
ALT has recently received notice that provider NPI information must be received by Texas Blue Cross and Blue Shield no later than April 15th.
To submit your information, you must complete the submission form on the provider website:
As an additional reminder, BCBS is currently accepting claims with either your BCBS provider number(s) only or the BCBS provider number(s) and NPI number(s) through May 23rd. Beginning May 23rd, only your NPI number(s) will be required on all claims.
If you have any questions, please feel free to contact us. Thank you.
- February 2, 2007 - Texas Standardized Application
- Work History (page 3): removed language regarding "five year" work history
- Public Transportation (page 7 & Attachment F): removed subway as an option
- Section II-Disclosure Questions (page 8): Changed first sentence to: Please provide an explanation for any question answered yes, except 16....
- Section II-Disclosure Questions (page 9): Question 16, removed the word "ever"
- Section II-Disclosure Questions (page 9): Question 23, changed the word "able" to "unable"; reworded so that a "yes" answer would indicate an issue that would require further explanation and investigation
- Section III-Standard Authorization, Attestation and Release (page 12): Removed "Social Security Number" and added "Last 4 digits of SSN or NPI (PLEASE PRINT OR TYPE)"; this was in response to concerns that when the release is copied and sent to other entities to obtain background information on the applicant, the SSN is visible to anyone who opens the mail and could lead to identity theft.
From: Carol Daniels, Credentialing Coordinator
To: Ark-La-Tex Health Network Providers
To all Offices that utilize the Texas standardized application:
Early this past summer, the Texas Department of Insurance (TDI) posted a revision to the Texas Standardized Application on its website. Many were dissatisfied with the new format and with the fact that it required retooling of their databases. By the number of complaints filed, it was clear that the new application did not meet the needs of all parties. The TDI held several stakeholder meetings to address the application; further revisions were recommended but the TDI was unable to obtain consensus on a single form that that would meet the needs of all concerned.
Therefore, effective January, 1, 2007, the TDI decided to revise the TDI application once again. The revisions include:
Here is the link to the revised TDI application:
It is anticipated that hospitals may use an addendum to obtain additional information not included in the TDI application.
- January 19, 2006 - Advantra Freedom
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
Coventry Health Care, Inc. has recently announced a new Medicare Advantage Private Fee-For-Service (PFFS) plan called Advantra Freedom. The Advantra Freedom plan reimburses providers for services covered by the plan at current Medicare geographically adjusted reimbursement levels, less any member co-payments or coinsurance. For existing Medicare providers there is no additional contract required for participation; providers agree to accept the plan on a patient-by-patient basis. Medicare beneficiaries who enroll in Advantra Freedom can see any Medicare provider, physician or supplier.
Please see the attached Advantra Freedom Provider Quick Reference Guide with more information. You may also visit their website at www.advantrafreedom.com or call 1-800-713-5095 for more detailed information and expanded payment guidelines.
As you recall, First Health Group Corp., owner and operator of CCN and The First Health Network, is now a subsidiary of Coventry Health Care, Inc. and has begun its consolidation under the First Health name. During 2007, plan ID cards bearing the names or logos of CCN, Healthcare Value Management (HCVM), PPO Oklahoma, or First Health should be recognized as accessing the First Health Network. First Health national account business will be under the “Coventry” name, and new patient ID cards bearing the name Coventry Health Care National Network will replace the current First Health Direct cards.
Advantra Freedom (Coventry PFFS) Admin Guide
Please note that Ark-La-Tex Health Network (ALT) does not currently have an agreement with Coventry Health Care, Inc., but are providing the above information as a service to our providers. As always, if you have any questions, please do not hesitate to contact us at any time. Thank you.
- January 8, 2007 - Texas Medicaid
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
Ark-La-Tex Health Network (ALT) received the following from the January/February 2007 issue of the Texas Medicaid Bulletin, provided for your information. As always, if you have any questions, please feel free to contact us at any time.
2007 Texas Medicaid Provider Procedures Manual:
The 2007 Texas Medicaid Provider Procedures Manual will soon be mailed on compact disc (CD) to all currently enrolled Texas Medicaid providers. The manual will also be available for download from the Texas Medicaid & Healthcare Partnership (TMHP) website at www.tmhp.com. Providers that cannot access the 2007 Texas Medicaid Provider Procedures Manual through the Internet may request a printed copy by calling the TMHP Contact Center at 1-800-925-9126.
Using the TMHP Website:
The TMHP website www.tmhp.com, was designed to streamline providers’ participation in the Texas Medicaid Program. Through the website, providers can submit claims and appeals, download provider manuals and bulletins, verify client eligibility, view Remittance and Status (R&S) and panel reports, and stay informed with current news and updates.
Authorization Requirements for CT, CTA, MRI, and MRA:
Effective July 1, 2006, prior authorization became a requirement for all outpatient, elective diagnostic computerized tomography (CT), computerized tomographic angiography (CTA), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) imaging studies. Prior authorization is required for all outpatient non-emergent studies (i.e. those that are preplanned or scheduled) before services are rendered. Retrospective authorization is required within seven calendar days for outpatient emergent/urgent studies when the physician determines that a medical emergency that imminently threatens life or limb exists and the medical emergency requires advanced diagnostic imaging, or when additional studies conducted at the time of the test are indicated by the radiologist.
The Radiology Prior Authorization Request Form is available on the TMHP website. For more information, call the TMHP Contact Center at 1-800-925-9126.
- January 2, 2007 - Rural Health Designation
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
We have had several provider offices contact us to request information on how to obtain rural health status, in response to the Rural Health ballot recently sent out. Contact information is listed below. If you have any questions, please let us know. Thank you
Arkansas:
Pinnacle Business Solutions
Phone: (501)918-7462
Address: Provider Enrollment
Provider Audit & Reimbursement
PO Box 1418, Little Rock AR 72203
Texas:
TrailBlazer Health Enterprises, LLC
Phone: (866)-528-1603
Address: Provider Enrollment
PO Box 650458, Dallas TX 75265-0458
- December 15, 2006 - Ark-La-Tex Health Network Providers
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
Ark-La-Tex Health Network (ALT) and American PPO (APPO) have revised our agreement to reflect a change in timeline for claims submission. The revised section of the contract now reads:
5.4 BILLING AND PAYMENT OF SERVICES: PHO Providers shall submit claims on behalf of Members within one hundred and eighty (180) days of the date of service, and PHO Providers shall look to Payors that are accessing the American PPO network pursuant to direct contracts with American PPO for payment of Covered Services rendered to Members in accordance with the terms and conditions of this Agreement. Notwithstanding this limitation, Members are primarily responsible and may be billed directly by PHO Providers for co-payments, coinsurance amounts and Deductibles. PHO providers will accept payment at negotiated rates as set forth in “Schedule A” as payment in full for Covered Services if paid in accordance with this Agreement. In no case shall a Payor be required to pay in excess of the billed charges. Payor shall reimburse Providers according to the current Texas State Law pertaining to prompt payment, currently SB418.
Please note that this change also applies to the new CIGNA product recently balloted to ALT Providers. As always, if you have any questions, please feel free to contact me. Thank you.
- December 8, 2006 - Medicare Reimbursement
- A 1.5% bonus for physicians choosing to participate in the Physician Voluntary Reporting Program that begins July 2007;
- An extension of the geographic adjustment for physician services;
- A one-year extension of the therapy cap exceptions;
- A 1.6% increase in dialysis payments; and
- A continuation of independent laboratory billing for the technical component of medical services.
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
We have recently received notification through the Medical Group Management Association (MGMA) that congressional leaders have reached agreement on a package of legislative provisions addressing Medicare reimbursement. It halts the 5% cut in physician services scheduled to take effect January 1, and instead mandates a one-year freeze at current payment levels. The House is scheduled to vote on the legislation soon, and Senate action is anticipated in the next few days.
The legislative package also includes:
Please Click here for the Medicare attachment
Additional information on Medicare Provisions in the Tax Relief and Health Care Act of 2006 are attached for your review. As always, if you have any questions, please do not hesitate to contact us. Thank you.
- December 4, 2006 - Coventry/First Health
From: Heather Post,CMOM ~ ALT Provider Relations
To: Ark-La-Tex Health Network Providers
Please Click here to see a memo/announcement from Coventry Health Care, Inc which has acquired First Health Corp. regarding changes you will begin seeing implemented.
As ALT receives additional notifications, we will continue to keep you informed as well. As always, if you have any questions, please do not hesitate to contact us. Thank you.
- December 4, 2006 - MultiPlan / PHCS
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
We recently received notification of the acquisition of Private Healthcare Systems (PHCS) by MultiPlan, effective October 18, 2006. Currently, Ark-La-Tex Health Network does not have a direct agreement with PHCS; however, MultiPlan is accessed through the Ark-La-Tex Health Network agreement with Healthcare Partners of East Texas.
How does this affect your participation in the MultiPlan, PHCS and/or HealthEOS networks? As indicated in the notice supplied to us, MultiPlan has stated that CURRENTLY THERE WILL BE NO CHANGES TO YOUR PRESENT PROCESS. Continue to submit claims in the manner you currently follow for both companies, and MultiPlan will continue to honor the terms of your existing contract(s). The process of integrating the operations of PHCS has just begun, and they have communicated that they do not anticipate making any changes to the operation of the HealthEOS network until late 2007.
As ALT receives additional notification, we will continue to keep you informed as well. As always, if you have any questions, please do not hesitate to contact us. Thank you.
- November 30, 2006 - Updated United Radiology Notification Program
From: Hal Patton, Executive Director
To: ALT Provider and Office Staff
Please Click here for information on United’s Radiology Notification Program.
If you have any questions, please do not hesitate to contact us. Thank you.
- November 10, 2006 - American PPO / CIGNA Ballot
From: Hal Patton, Executive Director
To: ALT Provider and Office Staff
For those physicians who have been approved in the CIGNA credentialing process and have agreed to participate in the CIGNA product offered through the agreement with Ark-La-Tex Health Network (ALT) and American PPO, CIGNA has been assigning effective dates of completion of credentialing as effective dates of participation in the product.
We have been notified that for those physicians that wish to participate, completion of the ballot will expedite participation in American PPO / CIGNA. Please review the attached ballot, indicate your response, and return to ALT within 30 days. If you have already returned a ballot due to our notification that you have passed CIGNA credentialing, thank you. Another ballot response is not needed.
Upon passing CIGNA credentialing, you then will be notified by CIGNA of your effective date. CIGNA will copy us of this effective date correspondence as well.
If you have any questions, please do not hesitate to contact us. Thank you.
- November 5, 2006 - New Medicare P4P Demo Aims at Smaller Physician Practices *
From: Heather Post, ALT Provider Relations
To: ALT Provider and Office Staff
* Excerpt from Part B News, October 30th, 2006 Edition
You will find information from the 10/30 issue of Part B News below. Offices with Arkansas practices may want to participate in the program offered. If interested, please visit the Arkansas Foundation for Medical Care by calling 501-375-5700 or you can
Click here to visit www.afmc.org
Medicare P4P Demo Aims at Smaller Physician Practices
Practices with 12 or fewer physicians now have their turn – at least if your practice resides in one of four states – to test a Medicare pay-for-performance (P4P) program. CMS has announced a three-year demo to begin by next July that would try P4P in perhaps 800 small and medium-sized physician practices in Arkansas, California, Massachusetts and Utah.
Medicare began a three-year P4P demo involving large physician practices in 2005 (PBN 2/7/05). Congress has directed CMS to test the reimbursement scheme, before making a decision to take it nationally.
Practices that participate in the new Medicare Care Management Performance (MCMP) demo will continue to be paid on a fee-for-service basis. They also could be eligible to earn an annual incentive of up to $10,000 per physician and up to $50,000 per practice, based n the results of the quality data they report to Medicare. They’d get an additional 25% if they submit their clinical quality measures using an electronic medical record certified by the Certification Commission for Healthcare Information Technology (CCHIT).
Participating physician will submit data annually on up to 26 quality measures related to care for patients with diabetes, congestive heart failure and coronary artery disease, as well as the provision of preventive health services, such as immunizations or cancer screenings.
In its first year, the program will be a “pay-for-reporting” initiative to provide baseline information on quality and let practices become familiar with quality measurement process. In the following two years, practices will receive incentive payments based on their performance on the quality measures. These quality measures include HbA1c, LDL cholesterol levels, lipid profile and protein in urine. These are similar to those being used in the large physician practice P4P demo.
To be eligible to participate, physicians must be the main provider of primary care to at least 50 fee-for-service Medicare beneficiaries in a solo or small to medium-sized group practice, generally with 12 or fewer physicians.
They also would have to be enrolled in the Doctor’s Office Quality—Information Technology (DOQ-IT) project, which was implemented by CMS in those four states to promote adoption of electronic health records in small to medium-sized physician practices.
If you’re in one of the four states and are interested in applying contact your QIO, says a CMS official. – E. Zablocki
- October 19, 2006 - Blue Cross Blue Shield of Texas AIM Radiology Program
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
We recently received the following information from BlueCross Blue Shield of Texas (BCBSTX).
Please note that ALT providers are not contracted with BCBSTX through ALT the following is provided as a service for your information only. However, if you have any questions, please contact us and we would be happy to assist. Thank you.
BlueChoice physicians must contact American Imaging Management, Inc. (AIM) to receive a Radiology Quality Initiative (RQI) number when ordering or scheduling outpatient high tech imaging procedures (CTs, MRIs, PETs and Nuclear Cardiology studies) for PPO members. In addition, the facility performing these procedures should receive this RQI number before rendering these services.
You can inquire whether an RQI number has been obtained by contacting AIM through any of the following methods:
Phone: 800-859-5299
Fax: 800-610-0059
Website: www.americanimaging.net
If you have any questions regarding the RQI program, you may visit the BCBS website at www.bcbstx.com or contact your local Facility Provider Network office.
- July 26, 2006 - Arkansas Blue Cross Blue Shield NPI number
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
Arkansas Blue Cross Blue Shield (ABCBS) will soon be sending out letters to providers indicating that they do not have a national provider identifier (NPI) in their system.
Please note that AHIN users can log on to ?NPI Administration? and follow instructions on entering their NPIs.
For paper submission, providers should print the ?change of data? form from the ABCBS website and must include the following information on the form: Provider name, current ABCBS provider number, e-mail address, medical records fax number, NPI and practice location. A paper copy of their NPI notification from the National Plan and Provider Enumeration System (NPPES) must also be attached.
This information can also be found on page 2 of the ABCBS June 2006 ProvidersNews, also found on the ABCBS website.
If you have any questions, please feel free to contact
our office at 903-735-5381
- July 25, 2006 - CHRISTUS St. Michael Health System Associate ID cards
From: Joanne Gibson, Managed Care Coordinator
To: Ark-La-Tex Health Network Providers
We have recently been notified that there has been some confusion regarding the CHRISTUS St. Michael Health System Associate ID cards.
Please note that the cards begin with the letters ?C?, ?H?, and then a Zero. The Zero is many times misread as a letter ?O?, which could cause your claim to be rejected if submitted incorrectly.
If you have any questions, please feel free to contact me. Thank you.
- July 01, 2006 - ALT Participation in Aetna Products/Networks through ProNet
- Aetna Open Choice PPO
- Aetna Open Choice POS II
- Aetna HealthFund
- Aetna Select Administrators
From: Heather Post, ALT Provider Relations
To: ALT Provider and Office Staff
Several questions have arisen regarding which Aetna products/networks ALT participants are included in. After contacting Aetna representatives, I have received clarification that Ark-La-Tex providers that participate in ProNet are included in the below listed AETNA products/networks. Please pass this information on to appropriate staff members in your offices.
These products/networks are PPO-based and do not require a "gate-keeper." Other Aetna products/networks, such as Managed Choice, Elect Choice, and Open Access are HMO-based products, and are not offered in our service area.
If you have any questions or concerns, please feel free to contact me directly. Have a wonderful Fourth of July holiday!
- June 27, 2006 - CMS releases proposed changes to physician fee schedule methodology
- A bottom-up method for direct costs, as opposed to the current top-down approach;
- Use of supplemental survey data;
- Elimination of the nonphysician work pool; and
- Development of a new method to calculated indirect practice expense.
From: Heather Post, ALT Provider Relations
To: ALT Provider and Office Staff
CMS releases proposed changes to physician fee schedule methodology *
On June 21, the Centers for Medicare & Medicaid Services (CMS) released a 449-page notice proposing changes to the Medicare physician fee schedule intended to improve the accuracy of Medicare physician payments. The proposed notice includes changes to two elements of physician payment: physician work and practice-expense relative value units (RVUs). The changes made to these two components will apply to payments for services to Medicare beneficiaries furnished on or after Jan. 1, 2007.
The practice expense element of the physician payment equation accounts for physician and practitioner costs for furnishing services. For example, the practice expense RVU value includes office rent and wages of personnel, but not medical malpractice expenses, which are captured by a separate element. The changes proposed to the practice expense include:
This proposed changes to the method for calculating practice expense will occur over four years. During the transition period, CMS will calculate practice expense values by blending current and proposed methodologies. RVUs for new codes will be calculated using the proposed methodology and paid at the proposed level.
The impact of this proposed rule creates significantly fewer disparities among medical specialties than previous proposals.
Click here read the proposed rule
*From the 6/23/2006 MGMA Washington Connexion
- June 24, 2006 - Online Survey to Assess How Medicare Reimbursement Reductions Will Effect Medical Practices
From: Heather Post, ALT Provider Relations
To: ALT Provider and Office Staff
You will find information from the 6/23 issue of MGMA Washington Connexion below. Offices may want to participate in the survey by filling out the online questionnaire which will help the MGMA determine the effects of cuts in Medicare payments.
Still time to help MGMA assess the effect of cuts to Medicare payments
Medical Group Management Association (MGMA) members still have time to complete an online questionnaire to determine how medical practices will adjust to Medicare reimbursement reductions. In 2007, Medicare payments to physicians will drop 4.6 percent or more unless Congress acts once again to prevent the flawed sustainable-growth-rate formula from going into effect. The reduction is in addition to a payment freeze for 2006, which occurred despite rising practice costs.
The MGMA Government Affairs Department will use the questionnaire results in advocacy efforts to Congress. The results will highlight how inadequate Medicare reimbursement is reducing health care services for seniors. It is only with your participation and that of fellow MGMA members that we can make a strong argument to Congress about the impact the projected cuts will have on medical practices across the nation.
The survey will close July 1.
- June 12, 2006 - Texas Department of Insurance (TDI) Revised Standardized Credentialing Application
From: Carol Daniels, CPCS, Credentialing Coordinator
To: ALT Provider and Office Staff
We have recently learned that a revised standardized credentialing application form has been posted to the Texas Department of Insurance (TDI) website. This application is available for downloading from the website and is available to begin using immediately. However, beginning July 1 the revised TDI application will be required for all submissions. Physicians can use the new application form for initial credentialing and recredentialing by all public and private hospitals, PHOs, HMOs and PPOs. Some hospitals and health plans may continue to request additional information.
The application comes in three formats (Word, Rich Text Format (RTF) and Acrobat PDF) and two versions (1) an application package with seven attachments and (2) a separate application with each attachment available for downloading as needed. The link to the new form is:
http://www.tdi.state.tx.us/company/hmoqual/crform.html
Instructions for downloading are included on the website. Please download and review the new TDI application as soon as possible as there have been significant changes made to the new application.
The Word and RTF versions of the form allow you to complete the TDI application on your computer and save your data at any time. You can then open it and revise it as needed. When a complete copy is needed, print it and have the physician date and sign, and then mail to the individual that is requesting the application.
Also, remember to complete the new TDI application in its entirety. Any omissions of information or gaps in practice history since completion of Medical School could potentially lead to the incomplete application being returned to you, thus delaying the credentialing process.
If you should have any questions or have questions about downloading or completing the TDI application please contact us. Thank you.
Carol Daniels, CPCS
Credentialing Coordinator
- May 25, 2006 - NPI Request
- and have forwarded that information into our office, then we have already updated your profile. Thank you for your timely submission of this information.
- and have not yet forwarded the notification letter/email from NPPES, please forward that into our office at your earliest convenience. The notification that you received from NPPES could be a hard copy you received in the mail, or simply an email from customer service at NPI Enumerator showing this information. You may either fax (903-735-5343) or email (heather.post@christushealth.org) whichever type of notification you received. Please include NPI Number in the subject area.
From: Heather Post, Provider Relations
To: ALT Providers
As all of you are probably aware, we continue to move forward toward the mandated deadline date required by the HIPPA Act of 1996 and CMS for all providers to obtain their NPI number. This process is very simple, and can be applied for on the internet. Some of you already have your NPI numbers, but have not yet forwarded that information on to Ark-La-Tex so that we may update your inforamtion in our database. The closer we get to the deadline, the more flooded the NPI enumerator system will be. Waiting until closer to the deadline may slow the processing of your request.
If you have already received your NPI number
If you have NOT yet applied for your NPI number, I have included a link below that will take you to the website to begin the online application process. I have had many office managers tell me how easy and quick this process is when applying online, and they state they received their number back very timely. Otherwise, I have included additional contact information for reaching the enumerator system. After you receive your notification either via email or hard copy in the mail, please forward a copy to me by fax (903-735-5343) or email (heather.post@christushealth.org). Please include NPI Number in the subject area.
NPPES - National Plan & Provider Enumeration System
About NPPES.... CMS has contracted with Fox Systems, Inc. to serve as the NPI Enumerator. The NPI Enumerator is responsible for dealing with health plans and providers on issues relating to unique identification.
The NPI Enumerator may be contacted as follows:
Fox Logo 1-800-465-3203 (NPI Toll-Free)
By phone1-800-692-2326 (NPI TTY)
By e-mail customerservice@npienumerator.com
By mail at:NPI Enumerator, PO Box 6059, Fargo, ND 58108-6059
Thanks to everyone in advance and have a safe Memorial Day Weekend!!
Heather Post
- May 24, 2006 - United Healthcare
From: Heather Post, ALT Provider Relations
To: ALT Physicians
Please see the below Network Bulletin from United Healthcare. The bulletin contains key information on policy changes from United pertaining to Reimbursement, Claims, and Clinical Resources. Additional information is also included. The information below is only a snapshot, and the full version of the Network Bulletin can be viewed on the United website at:
United Healthcare Online Please keep in mind that the contractual relationship with United through Ark-La-Tex Health Network terminates on June 1, 2006. We will continue to keep you updated on any information we receive.
Please let me know if you have any additional questions or concerns.
Thank you,
Heather Post
- May 24, 2006 - American PPO/Cigna Credentialing Packets
From: Heather Post, Provider Relations
To: ALT Physicians
Please be advised that you will be receiving a credentialing packet in the mail from American PPO for participation with their Cigna product. Ark-La-Tex continues to work with Cigna to obtain delegated credentialing, however you must return the credentialing packet included in the mail out if you wish to participate in the American PPO/Cigna offering at this time.
The reimbursement for the Cigna product will be the same rate you currently receive under American PPO -- 15% discount from billed charges.
ALT will forward ballots to those providers that respond to the mail out after credentialing packets have been returned to American PPO for processing.
If you should have a