WCH Issue October 2019

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Managing the Authorization Process. Major changes for PT, OT, and SLP under UHC and Fidelis Care payers

FidelisCare and UnitedHealthcare enforced recent changes regarding the authorization management for PT, OT, and SLP services. Learn more about this by reading on.

What’s new

Prior Authorization Requirements to be expanded for an outpatient hospital setting

New rules are coming into play from November 1, 2019. Certain procedures now require prior-approval when performed in an outpatient hospital setting.

Update to the Reimbursement Policy for Professional Component of Radiology Services in Facility Places of Service

As of November 1, 2019, Healthfirst no longer provides reimbursements for interpretations of radiology services in certain cases. All healthcare providers should strive to understand if the changes will affect them.

New AIM Rehabilitative Program to be Implemented

Delayed AIM Rehabilitative Program has come out since November 1, 2019. These changes affect physical, speech, and occupational therapy providers.

New Utilization Management Pre-authorization Rules Coming Into Effect

There have been a number of changes implemented for Emblem Health’s Utilization Management UM pre-authorization program. The changes will come into effect from January 1, 2020.

Announcement Regarding Chiropractic & Physical Medicine Services Program

Previously announced the collaboration of Horizon BCBSNJ with American Specialty Health (ASH) will not start on January 1, 2020.

Beacon Health Options will manage GHI members.

Beginning December 1, 2019 Beacon Health Options will manage behavioral health claims for GHI members. The exact start date for this transition will be member-specific. Read on to learn more.

Business Corner

Improving Reimbursement with a Good Eligibility Verification Process

Avoid lost or delayed reimbursements with a good eligibility verification process. Read on to learn more!

WCH Accomplishments

Franchise - Your Way to Success with WCH Service Bureau®

A franchise is a next step to grow! Read a story of why and how WCH Service Bureau, Inc. franchised its business.

Your Questions Answered

What must be included in medical records when administering therapeutic/prophylactic/diagnostic injections and infusions? Is there a cut in Medicare payments expected in 2020 for Physical and Occupational Therapy?

Information For Providers