SuperMed Network Aligned Across Service Area

Transcription

1 Mutual News Volume 2/Issue 2 2nd Quarter 2009 SuperMed Network Aligned Across Service Area You will see the new SuperMed network logo on member identification (ID) cards for all of our affiliates, including Medical Mutual of Ohio, Carolina Care Plan and Consumer s Life Insurance Company. SuperMed will be prominently displayed on the front of the ID cards with a plan type indicator (e.g. PPO, POS, HMO, Access) and verbiage describing the member s coverage. A consistent look and feel to our carrier logos and the placement of the SuperMed logo on the front of the ID cards allows you to easily identify our covered members. Over the next year, new ID cards will be issued to our employer groups at the time of plan renewal. As with our current ID cards, these new cards will continue to display important information such as contact numbers and claim submission instructions. During this transition period, continue to submit claims as directed by the member s ID card to ensure timely processing. See page 4 of this issue of Mutual News for a sample ID card and logo examples and descriptions. Index Electronic Check Conversion...2 Endoscopic Billing Procedure...2 Locating Corporate Medical Policy Revisions...3 Claims Billing Reminders...3 New SuperMed ID Cards...4 Members Can Now Find You Via Text Message...6 Verify Your Provider Information...6 Provider Contracting Offices...7 Breathe Easy! Save Time, Steps, Paper with the NEW Provider eportal...8 This material is considered part of the Provider Manual Medical Mutual of Ohio, Consumers Life Insurance Company and Carolina Care Plan PROFESSIONAL & INSTITUTIONAL Medical Mutual of Ohio and its Family of Companies have moved to a single name for its provider network in Georgia, Indiana, Ohio, Pennsylvania and South Carolina. Our members now have broad access to cost-effective, quality care throughout our multi-state service area via the SuperMed network.

2 Electronic Check Conversion Electronic check conversion, also referred to as Back Office Conversion, is the process where a check is scanned by its recipient to provide the check number, account number and the financial institution identification or routing number used to make a one-time electronic Automated Clearing House (ACH) debit, or Electronic Funds Transfer (EFT). Checks issued by Medical Mutual and its subsidiaries are INELIGIBLE to be converted according to National Automated Clearing House Association (NACHA) rules. Providers can still scan our checks and transmit them to their bank without conversion to an EFT. Direct deposit of claim payments via Electronic Funds Transfer (EFT) is available today! By registering for the EFT service, providers can: Receive claim payments electronically Have payments directly deposited into your bank account Soon, providers enrolled in EFT will receive Electronic Remittance Advice (era). This service will provide: Remittance Advice statements ed to you with each instance of electronic deposit Electronic itemized claim statements Online access to your history of claims payments Visit the Provider section of MedMutual.com, ConsumersLife.com, or CarolinaCarePlan.com for more information! Endoscopic Billing Procedure When billing any of the HCPC, CPT and ICD9 surgical codes for routine or medically necessary endoscopic services codes listed below, providers must submit claims with the diagnosis code V Doing so ensures the Covered Person can receive the highest level of coverage according to their benefit design. This requirement is consistent with CMS guidelines. Anoscopy 00902, , 46.85, 49.21, 49.23, 49.31, Colonoscopy G0105, G0120-G0121, 00810, , , , 45.28, , 46.79, 46.85, 48.24, Proctosigmoidoscopy 00902, , 45.24, , 46.79, 46.85, , 48.36, Sigmoidoscopy G0104, G0106, 00810, , 45.22, , 45.28, , 46.79, 46.85, Contact your contracting representative with any questions.

3 Locating Corporate Medical Policy Revisions To allow easy identification of new or revised policies, the list of Corporate Medical Policies has been updated to include a New or Revised notation. For the most current Corporate Medical Policies, consult the provider section of MedMutual.com, ConsumersLife.com or CarolinaCarePlan.com. D Deep Brain Stimulation Dermatoscopy and Total Body Photography for Early Detection of Melanoma Destruction of Cutaneous Vascular Lesions: Laser Technique Disabled Dependent Medical Necessity Determination Guidelines Disc Biacuplasty - Revised Doppler Velocimetry (CPT Code Uterine Artery) Corporate Medical Policies updated January 2009*: Policy Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions Carpal Tunnel, Tendon Sheath or Ligament, Tendon and Trigger Point Injection Whole-body Computed Tomography for Screening Unicondylar Interpositional Spacer Uterine Artery Embolization Uterine Fibroids 2004-F Prolotherapy Human Amniotic Membrane Transplantation-Ocular Disease 2005-F Radiofrequency Therapy Female Urinary Stress Incontinence Vagal Nerve Stimulation for Treatment of Depression 2008-B Disc Biacuplasty *Corporate Medical Policies are regularly reviewed, updated, added or withdrawn and therefore, subject to change. Claims Billing Reminders Providers are required to bill with their service address in box 32 of the CMS 1500, if different from the billing address in box 33. When billing using the UB-04, the provider s service address should appear in box 1, and the billing address in box 2 if different from box 1. When billing for Durable Medical Equipment services, be sure to utilize a valid modifier that specifies the rental or purchase status (i.e. NU should be used for purchased items and RR should be used for those that are rented). Submit claims to the address or electronic payer ID instructed on the inside of the member s ID card. Electronic claims can be submitted through Emdeon with the listed number. Contact your local contracting representative with any questions. 3

4 New JOHN DOE Name Identification Number Group Number ABC CORPORATION Group Name Identify one of our Family of Companies for membership. Logos will vary based on carrier and will look like one of these examples for Medical Mutual of Ohio, Consumers Life Insurance Company or Carolina Care Plan. 4

5 ID Cards The SuperMed network logo. For easy identification of our members. Type of coverage indicator. May indicate Medical, Vision, Dental or any combination thereof. Plan type indicator. Identifies the member s type of benefit plan. May be PPO, HMO or POS. EMPLOYER GROUP NAME XYZ To verify coverage, claims inquiries or Precertify all Hospital Admissions call TPA ABC OFFICE VISIT COPAY $15 SEND SUPERMED CLAIMS PO BOX CLEVELAND, OH PAYER ID: SEND PHCS CLAIMS: PO BOX 9999 TALLAHASSEE, FL PAYER ID: Medical Plan Group #469 To find a SuperMed Provider: SuperNet 1st Medical Network Premier Health Systems, Inc. Medical Mutual and its Family of Companies provides Network Access Services (NAS) for various accounts throughout our service area. These types of accounts include self-insured groups, third-party administrators (TPA) and other insurance companies. A coverage indicator of Access indicates members utilizing the SuperMed network via a Network Access Services account. 5

6 Members Can Now Find You Via Text Message! We now have an added feature to our online directories. Members can search our directories and view a detailed map of a provider s location and receive a text message directly to the their cell phone indicating the provider or facility name, address and phone number. Visit the home page of MedMutual.com, ConsumersLife.com or CarolinaCarePlan.com under Find a Doctor to see how our Company continues to simplify services. Verify Your Provider Information 6 We appreciate the network providers who have checked our directories to ensure we have your accurate service locations and current information. For an even easier way to verify, update and maintain your information, we encourage you to use the Provider eportal. Updating your records through the Provider eportal allows you to quickly and efficiently add, edit or remove providers associated with your practice, as well as identify any changes to your service location(s) and reimbursement address(es). Visit MedMutual.com, ConsumersLife.com or CarolinaCarePlan.com to enroll. Providers can also update their records by completing the Provider Information Form (PIF) located in the provider section of our Web sites.

7 Provider Contracting Offices Georgia Contracting Office: 800/ Provider Inquiry/Voice Connect: 800/ Indiana Contracting Office: 888/ Provider Inquiry/Voice Connect: 800/ Ohio Contracting Offices: Central (Columbus) Phone: 800/ Fax: 614/ Northeast (Cleveland) Phone: 800/ Fax: 216/ Pennsylvania Contracting Office: 800/ Provider Inquiry/Voice Connect: 800/ South Carolina Contracting Offices: Columbia Phone: 800/ Fax: 803/ Greenville Phone: 800/ Fax: 864/ Provider Inquiry: 800/ Northwest (Toledo) Phone: 888/ Fax: 419/ Southwest (Cincinnati/Dayton) Phone: 800/ Fax: 513/ Ohio Ancillary Providers Phone: 216/ Fax: 216/ Provider Inquiry/Voice Connect: 800/

8 2060 East Ninth Street Cleveland OH X7902 R4/09 PRSRT STD U.S. POSTAGE PAID CLEVELAND OH PERMIT NO. 199 Breathe Easy! Save Time, Steps, Paper with the NEW Provider eportal. Sign-up for the secure Provider eportal to receive publications electronically, giving you the information you need while reducing the amount of paper at your service location. To receive this newsletter and other provider materials electronically register in the provider section of MedMutual.com, ConsumersLife.com or CarolinaCarePlan.com Upon registering you select a Primary Access Administrator (PAA) who has legal signatory authority for your organization. The PAA approves new users and is responsible for what they can access and receive electronically. View an instructional demo on our Web sites and sign-up today! This material is considered part of the Provider Manual Mutual News, Volume 2, Issue 2, 2nd Quarter 2009 Published by the Provider Communications Department 2060 E. Ninth Street, Cleveland, OH Medical Mutual of Ohio, Consumers Life Insurance Company and Carolina Care Plan