WCH Issue January 2020

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Merit-Based Incentive Payment System (MIPS) Reporting – Year 4

If you are eligible for the Merit-Based Incentive Payment System, you should ensure that you report accurate data on time to avoid facing issues. Learn more about making timely reports as you read along.

Your Questions Answered

A new provider in our group still pending to get a Medicaid number. Please verify if it is possible to start HMOs enrollments while Medicaid is pending? What is the difference between addressable and required implementation specifications in the HIPAA Security Rule?

BUSINESS CORNER

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WCH ACCOMPLISHMENTS

WCH Wins a Case Regarding Modifiers; Client Gets Full Payment

Last March 2019, FidelisCare updated its system, which resulted in issues in payments for health providers. WCH dealt with this issue for our client to get full repayment. Read more to understand the details surrounding this case.

INFORMATION FOR PROVIDERS

A Reminder for NY State Providers: Medicaid and Medicare Part B Coinsurance Reimbursement

It should be reiterated that after Medicare Part B pays its 80%, Medicaid of NY is no longer pays the remaining 20% in most cases. To know if your specialty is part of the exception or when Medicaid covers Part B coinsurance, read along.

What’s new

Reminder: EmblemHealth Reduces Preauthorization Requirements

In an effort to streamline services and improve the efficiency of service-delivery, EmblemHealth has reduced the number of preauthorization requirements to be approved before delivering care. This applies to all members in EmblemHealth plans, including Medicaid managed care and Medicare Advantage, among others. Know more about this change by reading along.

Ended collaboration with Montefiore ACO IPA and Montefiore Care Management

Effective January 1, 2020, Montefiore CMO’s selected administrative functions will fall under Empire BlueCross BlueShield HealthPlus (Empire), following the dissolved collaboration with Montefiore ACO IPA and Montefiore CMO. To know how to move forward with prior authorization requests, claims processing, and credentialing process, read along.

Reminder: New Radiology Benefits Manager – eviCore healthcare

Effective January 1 2020, Horizon NJ Health and Horizon NJ TotalCare’s utilization management programs for radiation therapy/radiology/cardiology will now be under eviCore healthcare. Read along to find out more details regarding the changes.

Privileging of Providers to Offer Telehealth Services

In its bid to widen access to healthcare, HealthFirst has established a new policy and application process to enable its network of providers to offer telehealth services. Learn more about HealthFirst’s policy change and see how it affects your practice!