February 2013

In This Issue:

Contact Your Summa Health Network Staff

For assistance with any questions or concerns, please contact any of the Summa Health Network Team by clicking the link below.

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2013 Save the Dates

Please see our Save the Dates for our 2013 Events.

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Summa Health Network
168 E. Market St.
Akron, OH 44309
P: 330-996-8959
F: 330-996-8695

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Summa Health Network is pleased to continue offering you seminars in 2013. Please view our Save the Dates document to see the full schedule of events.

Ohio Enacts New Requirement to Notify Patients Upon Termination of Physician’s Employment

Effective March 22, 2013, physician groups, hospitals and certain other health care entities will be required to send notice of the termination of a physician’s employment to patients who received services from the physician during the two-year period preceding the termination. The health entity may also provide a list of patients to the physician and require the physician to send the notice.

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Anthem Provider Alert: A Number of Claims Must be Reprocessed

On November 5, 2012, the Anthem claims processing unit encountered a system issue impacting approximately 35,000 claims under all product lines. The claims were created with incorrect pricing and provider contracting status information.

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Buckeye Community Health Plan Prior Authorizations

Recently Hematologists and Oncologists have experienced issues with J9035 and J9355 authorizations. Effective February 1, 2013 all Hematologists and Oncologists participating in Buckeye Community Health Plan will be required to receive prior authorization before administrating injectable drugs with costs over $250.

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UnitedHealthcare Community Plan Webinar- New Online Tools

UnitedHealthcare Community plan is offering a webinar on February 27, 2013 and March 5, 2013. This webinar will introduce new physicians and other health care professionals to UnitedHealthcare Community Plan's convenient online tools.

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UnitedHealthcare Points of Interest

The current points of interest in the UnitedHealthcare (UHC) newsletter:

  • UHC will be implementing a new provider manual effective April 1, 2013.
  • UHC prior authorization list will be updated effective April 1, 2013. Note changes for SNF, private duty nursing and nutritional services for home care coverage.
  • Effective April 1, 2013 UHC will require prior authorization for proton beam radiotherapy service.
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MultiPlan’s Online Customer Service: A Convenient Alternative to Calling the Toll-free Number

MultiPlan offers a web-based Provider Portal, which can be used for all your claim and network-related cases. The Provider Portal is free to use with no downloads required or software to install. You can easily track cases and also upload attachments to your cases.

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CMS Acknowledges Transitional Care Management as Separate Service from E/M

In recognizing that care coordination is a key component to achieving better health for individuals as well as reducing cost, CMS has implemented several new programs to provide payment for such services including post-discharge transitional care management (TCM) payments.

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Cigna Physician Directory Update

Cigna has completely redesigned their online physician directory to offer members an easier, faster way to search for physicians and other types of health care professionals.

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Take Advantage of New Enhancement Added to Availity

The Benefit/Service Description Box now displays for Anthem Blue Cross and Blue Shield. To access, select the appropriate benefit type from the Benefit/Service Type field. A description of the associated service type information will display in the “Includes These Benefit Details” box.

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