WCH Issue December 2019

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BUSINESS CORNER

Telepractice Standards for OASAS Designated Providers

OSAS clinics who wish to perform Telepractice services should submit proper requirements and follow the established standards. Know more about Telepractice standards as you read along.

INFORMATION FOR PROVIDERS

The New York State Medicaid Payment Reductions

All fee-for service payments will receive a decrease to Medicaid checks for dates of services on or after January 1, 2020 through March 31, 2020. Learn more here.

Your Questions Answered

Is this allowed to bill a patient for services related to a Workers Compensation injury, in cases patient visited several Physical Therapy offices on the same day and our office got a denial as maximum allowable per patient/per day has already been reimbursed? How to locate a new Medicare ID if the patient states that they did not receive it?

WCH ACCOMPLISHMENTS

We have accomplished a lot this 2019, and we would like to share our success stories with you. Here’s a report on our improvements and developments this 2019! Read along to find out more!

What’s new

Empire BlueCross BlueShield Expands network in 2020

The Empire BlueCross BlueShield expands the network, as of January 1st, 2020. Know the prefixes used for the new plan IDs and confirm your participation status.

Empire BCBS HealthPlus to be removed from Availity’s Payer Menu

The Empire BlueCross BlueShield HealthPlus option will soon be removed from the payer drop-down menus on the Availity Portal. The eligibility still can be verified. Learn more here.

Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging furnished to Medicare beneficiaries.

A new program in run for ordering advanced imaging services for Medicare beneficiaries. Learn more to make sure you are ready and in compliance with the requirements.

2020 Annual Update to the Therapy Code List

The Therapy Code list has been updated. A number of different codes have been added/revised/deleted. Are you aware of the changes?

Claim Adjustments to be Performed: Clinical Laboratory Services

Horizon BCBSNJ determined erroneous denials of clinical laboratory services for the dates of services between January 1, 2019 and September 19, 2019. The issue has been resolved and impacted claims are to be adjusted.

Medicare members transitioning from Montefiore CMO to EmblemHealth in 2020

EmblemHealth is taking over management of Medicare members from Montefiore CMO as of 2020. It is imperative that all health care providers are aware of the new changes so that they can make the changes to their own processes, as may be necessary.

Affinity Health Plan has updated its pre-authorization requirements

Updates have been made to the Affinity pre-authorization requirements. Make sure you are aware of the changes.

UnitedHealthcare Members Migrating to a New System: Coverage Termination and Effective Dates

United Healthcare members will soon be transferred onto a new system, and this will potentially come with a number of impacts. It is imperative that all health care providers are aware of the changes. This change is to be made effective from September 2019, and will be continuing until February 2020.

iSmart EHR

iSmart EHR allows you to manage your billing and patient information all in one go. Maximize your time and reinvest it on patient care now. Read along to know more about this incredible system.