GLMS Practice Management Forums
 

GLMS hosts monthly Practice Management Discussion Forums as an opportunity for medical group managers* and others to meet regularly and discuss insurance hassles and current healthcare trends. 

  • When: 3rd Tuesday of each month at 8 a.m. 
  • Where:  GLMS / 328 East Main Street / Louisville, KY 40202
  • View dates and RSVP HERE

  • For more information, contact Practice.Support@GLMS.org.

*Only GLMS members and their staff are eligible to participate. For information on GLMS membership, call 502-736-6324

 



Recent Payer Updates:


Anthem Lab Fee Reductions effective 9/25/18

Anthem mailed letters to providers on June 26, 2018 notifying them of reductions in lab fees effective 9/25/18 along with an updated list of rates.  "The Anthem Blue Cross and Blue Shield PPO, HMO and POS fee schedules will be updated for services provided on or after September 25, 2018,* as identified on the enclosed document showing the new rates. As a reminder, drugs (J Codes) are updated on a quarterly basis as we receive new allowances and are priced at ASP+6%. HCPC codes are updated as part of an annual fee schedule notice if there are changes. If you have additional questions on specific codes or need further information, please contact your Network Relations Consultant at l-800-205-5870 or go to www.Avality.com to check code allowances electronically."


Anthem - The June 2018 edition of Network Update from Anthem Blue Cross and Blue Shield has just been posted online and the two items below are included in this issue.


Anthem Update on claim processing for services requiring AIM precert

Anthem recently discovered that some claims for services under the following programs are processing without the required precertification through AIM Specialty Health® (AIM), a separate company: Sleep management, Radiation

Oncology, Radiology benefit management (RBM), Cardiology Effective July 1, 2018, our claims systems will be updated to correct this issue. As a reminder, claims for sleep management, radiation oncology, radiology benefit management (RBM), and cardiology services continue to require precertification through AIM. For a list of the codes that require precertification, visit the AIM ProviderPortal?. 


Anthem Submit PA medication requests electronically 

Anthem accepts electronic medication prior authorization requests for commercial health plans. This feature reduces processing time and helps determine coverage quicker. Some prescriptions are even approved in real time so that your patients can fill a prescription without delay. Electronic prior authorization (ePA) offers many benefits:

Submit ePA requests by logging in at covermymeds.com. Creating an account is FREE. While ePA helps streamline the prior authorization process, if you must initiate a new PA request by fax or phone, please note that the following contact numbers for Commercial and Exchange plans will change on July 1, 2018. If you have other questions, please contact the provider service number on the back of the member ID card.

 


United Healthcare - The June 2018 network bulletin from United Healthcare has been posted online and the items below are included in this issue.


UnitedHealth Premium® Program Has a New Home

Say hello to the new Premium program online experience! In July 2018, we’ll launch our new website, UnitedHealthPremium.UHC.com.

Here you’ll find:

  • Premium program methodology materials organized by subject
  • A communication center for all your program emails and notifications (once you log in with your Optum ID)
  • Your Version 11 designation, evaluation results and access to your designation details (once you validate your personal ID number)

Registration instructions for the new site will be in your evaluation letter. You’ll need an Optum ID to validate your account. All Premium program communications will be sent to your Optum ID email. If you have questions, please contact the Health Care Measurement Resource Center at 866-270-5588.


Optum Outreach Helps to Eliminate Coding Confusion

During Optum’s Chart Review process, Optum may need additional coding clarification when reviewing a medical record. Optum requests that the care provider review, interpret and clarify the documentation for that encounter to allow for accurate code assignment. On June 1, 2018, Optum will begin outreach to care providers. A form is being sent to care providers that seek the clarification needed specific to a member, date of service (DOS) and condition. The care provider may choose to amend the medical record by clarifying as prompted by the provider query form. If the form is returned, the member’s record is coded again to determine if the additional information submitted by the care provider gives sufficient clarification to the ambiguous diagnosis code. For more information, please contact your provider advocate or the provider call center at 877-842-3210.