4/17/14 - Physical Medicine Program process improved
In response to the feedback we received from professional organizations and individual practices, the Physical Medicine authorization process has been streamlined. Process improvements include:
- Improved CareCore National (CareCore) phone and online performance
- Added a fax authorization option (in addition to online and phone authorization requests)
- Decreased the amount of patient/practitioner information required for subsequent care
- Reduced the amount of clinical information required and deleted duplicate clinical
You will also see specialty-oriented Treatment Request Clinical Worksheets that are tailored to specific conditions, which replaced existing forms. Use these new forms to better assist you in gathering information for submission to CareCore for clinical review or to fax the authorization to CareCore. Completed worksheets eliminate the need to submit attachments.
Please note: Tier A Chiropractic and Physical Therapy providers must continue to submit Notifications online. We also encourage all Tier B specialty providers to submit Notifications online.
View additional program information.
4/10/14 - Member gap reports coming soon
We are in the process of distributing updated provider reports that identify Medicare Advantage members who may have a gap in care or diagnosis reporting. The report includes details regarding what intervention is missing for your patient for each gap noted. We ask that you use these reports to close these gaps before the end of 2014.
We have contracted with Fuse Insight to distribute these reports via secure email. Fuse Insight may reach out to your office to verify contact information prior to sending the reports.
4/4/14 - Physical Medicine Code List update for CPT 92506 and CPT 97014
The Physical Medicine Program’s Medicare Advantage Physical Medicine and Therapies Code List (PDF) and Group and Individual Products Physical Medicine and Therapies Code List (PDF) have been updated to reflect the CPT Coding changes from the American Medical Association (AMA). CPT 92506 Evaluation of speech, language, voice, communication, and/or auditory processing is no longer a valid CPT code effective January 1, 2014, based upon the CPT Coding Manual. The CPT Coding Manual has terminated CPT 92506 and indicated that CPT codes 92521, 92522, 92523 and 92524 are to be used as replacement to CPT 92506.
CPT 97014 Application of a modality to 1 or more areas; electrical stimulation (unattended) currently requires authorization through CareCore National. The AMA’s HCPCS Coding Manual has added HCPCS G0283, which is an equivalent HCPCS code to CPT 97014. HCPCS G0283 has been added to the above lists.
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!
3/19/14 - AIM Specialty HealthSM retrospective order numbers no longer accepted
Effective immediately our Radiology Quality Initiative (RQI) program will no longer accept retrospective requests for an order number for any reason. Emergency room services continue to not require an order number. Outpatient elective diagnostic imaging services are typically non-urgent in nature and an order number can be obtained through AIM’s ProviderPortalSM or by contacting AIM’s call center at 1 (877) 291-0509
3/10/14 - Help ensure your high risk pool patients do not experience a gap in coverage
The state’s high-risk pool coverage ended December 31, 2013. This change happened because new coverage options became available in January through the health insurance exchange, Cover Oregon. However, due to delays in processing Cover Oregon applications, some high risk pool members’ new health coverage did not begin on January 1 as planned.
The Oregon Health Authority (OHA) created a temporary insurance program to ensure high risk pool members did not lose coverage. The short-term health plan provides coverage for up to 90 days. Any members remaining in the temporary high risk pool on March 31, 2014 will lose coverage when the temporary program ends.
You can help ensure your high risk pool members do not experience a gap in coverage. Encourage your patients to find new coverage that includes your provider network through a private health insurance company or the state’s health insurance exchange.
Individuals in Oregon can find information about the exchange Individual and Family products available through Cover Oregon. Individuals with questions or who are looking for more information can contact the consumer assistance center at 855-CoverOR (1-855-268-3767).
The temporary high risk pool coverage is month-to-month. Paying premiums one month at a time allows members to transition out of temporary coverage as soon as enrollment into a new plan is completed. For questions about this notification or the enrollment process, call 1 (800) 848-7280.
2/24/14 - Medicare Advantage members receive Passport to Health
This month, our Medicare Advantage members will receive their Passport to Health (PDF) – a list of preventive screenings available to them at no cost through their Medicare plan. We are encouraging members to bring this checklist to their providers as a tool to discuss their overall health and how to live a healthy lifestyle.
Members will also be able to download the Passport to Health online beginning February 28 by clicking on “View member information” after they enter their ZIP Code.
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.