7/1/14 - FEP Pre-authorization List updated
We recently discovered that our FEP Pre-authorization List was outdated and incomplete with the FEP contract requirements. Therefore, we are updating our list immediately, eliminating codes and adding codes that require pre-authorization.
Following are the CPT/HCPCS codes that were missing from the list, these were added on July 1, 2014:
- Congenital abnormalities - Outpatient surgical correction:
- CPT codes 33813, 33814, 40703, 42000, 50070, 50135, 50405, 61680, 61682, 61684, 61686, 61690, 61692, 61710, 63250, 63251, 63252
- HCPCS C8921
- Oral/Maxillofacial surgery needed to correct accidental injuries to jaws, cheeks, lips, tongue, roof and floor of mouth:
CPT codes 21010, 21026, 21030, 21031, 21032, 21034, 21040, 21044, 21045, 21046, 21047, 21048, 21049, 21050, 21060, 21070, 21073, 21116, 21240, 21242, 21243, 21480, 21485, 21490, 29800, 29804, 40490, 40500, 40800, 40801, 40808, 40810, 40812, 40814, 40816, 40819, 40820, 41000, 41005, 41006, 41007, 41008, 41009, 41010, 41015, 41016, 41017, 41018, 41100, 41105, 41108, 41110, 41112, 41113, 41114, 41115, 41116, 41120, 41130, 41150, 41520, 42100, 42104, 42106, 42107, 42120, 42140, 42145, 42160, 42200, 42300, 42305, 42310, 42320, 42330, 42335, 42340
- Organ/tissue transplants:
CPT code 38243
Please review the updated list and pre-authorize services accordingly.
6/30/14 - Category III CPT codes for ABA treatment
The American Medical Association released a new series of Category III CPT codes, CPT 0359T-0374T, applicable to Applied Behavior Analysis (ABA) treatment effective July 1, 2014. We are reviewing how best to implement and cross-walk these new codes to currently available codes. Until that review is complete and these codes are fully implemented, they are non‑reimbursable.
Please continue to use the current codes defined in your participation agreement for the treatment of those members whose coverage includes an ABA benefit.
6/25/14 - Access secure emails through Securemailbox beginning June 25
Beginning on June 25, secure emails will be available through Securemailbox (instead of Tumbleweed). The new product will look slightly different; however, the functionality will be the same.
View the instructions (PDF) for creating a Securemailbox account and password to access any secure emails sent to you from our staff on or after this date.
Messages sent from Tumbleweed will be available until they expire (60 days after they were sent).
6/11/2014 - Complete our Behavioral Health Practitioner Survey
In an effort to connect our members with quality behavioral health providers who meet their needs, we have a Behavioral Health Practitioner Information Survey (PDF) form available to providers to share information about their practice, specialties and areas of expertise. This helps us to provide our members with the information they need to make informed decisions about their health care and who they select for behavioral health services.
If you have not yet completed a survey form, please take a few minutes to complete it now. The completed form can be faxed to 1 (800) 331-3505.
5/23/2014 - Records needed for spinal surgery post service pre payment claims review
Our spinal surgery utilization program is managed by CareCore National for our fully-insured Group and Individual products, including Medicare Advantage. One of the components of this program includes review for post service, prepayment claims review.
As part of this program, CareCore National reviews all surgical claims for spine surgery procedures from providers and facilities. CareCore National may be contacting you directly by fax to request documents that include, but are not limited to, operative notes, clinical medical records, and/or itemized bills/invoices to process claims. If you receive a request from CareCore National, please submit the information as soon as possible within the required forty-five days. Failure to submit the requested information within that time frame may result in a complete claim denial.
We thank you in advance for your cooperation and participation in our spinal surgery utilization management program and the post service pre payment claims review requests.
View additional program information.
5/19/2014 - Radiology claims incorrectly denied (Updated on 5/21/2014 with dates and reprocessing information)
(Updated on 6/12/2014 with system resolution and reprocessing information)
(Updated on 7/16/2014 with reprocessing completion date)
We identified a technical issue with certain types of radiology claims that require an approved order number to be in place through AIM Specialty HealthSM. This issue caused certain radiology claims with the date of service on or after April 1, 2014, to incorrectly deny. The system resolution was put into place the week of May 27.
We have identified all impacted claims and are automatically reprocessing. Reprocessing of all claims should be completed by the end of July. We apologize for the inconvenience this has caused for your office and patients. Please contact your provider relations team if you have any questions.
5/1/14 - Introducing the 2014 Medicare Quality Incentive Program
We are pleased to introduce our 2014 Medicare Quality Incentive Program to support our Medicare star ratings and Risk Adjustment Program, beginning May 1. This incentive program is designed to reward providers who ensure that identified medical care or diagnoses gaps for Regence MedAdvantage PPO patients are addressed and closed prior to the end of this year.
Participation in the program is voluntary; however, we hope providers will find it a valuable and helpful tool in improving care for Medicare Advantage patients. As the program is rolled out, we will distribute member rosters and member gap reports to the providers who meet the following basic eligibility criteria:
- You are a provider with a primary care specialty.
- You have an active Medicare Advantage PPO provider agreement.
- You are not a current participant in any other quality-based, risk share program with us.
- You have a minimum of 10 Regence MedAdvantage PPO members attributed to your practice.
Learn more about the Medicare Quality Incentive Program.
3/26/14 - Sarah Zannotti joins our Provider Relations team
Sarah Zannotti recently joined our team as a provider relations representative. Sarah comes to us from the PHTech office in Salem, where she worked in the claims department. She has many years of experience in the health care industry, assisting providers with claims, managed care plans, electronic transactions, coding and compliance.
As a Regence provider relations representative, Sarah will assist providers in Benton, Coos, Curry, Lane, Lincoln, Linn, Marion, Polk and Yamhill counties with questions related to:
- Complex billing or coding information
- Provider appeals and grievance process
- Explanations of specific medical and reimbursement policies
- Inquiries that cannot be resolved through our web portals or Customer Service
Please join us in welcoming Sarah to our team!
1/29/14 - 2014 codes added to our system edits - Please resubmit denied claims
3/12/14 - Update: We will automatically reprocess all denied claims referenced below so you do not have to rebill.
There was a delay in adding some of the new 2014 codes to our system editing software which may have created claim denials. If you received any claim denials (the upfront denials appear on submission reports), please resubmit any impacted claims.
Our editing software was updated on January 17 to include the new codes and claims are now being processed correctly. We apologize for any inconvenience.
For past announcements, please view the What's New archive.