May 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.

Paramount Advantage

Paramount Advantage is one of the new Medicaid plans that is entering our market on July 1, 2013. Summa Health System Hospitals are in-network providers for Paramount’s CFC and ABD members (does not include dual eligible).

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Molina Healthcare

Molina Healthcare of Ohio is one of the new Medicaid plans that is entering our market on July 1, 2013. Summa Health System Hospitals are in-network providers for Molina’s CFC and ABD and dual eligible members.

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Primary Health Choice

Effective June 1, 2013 Key Benefit Administrators, Inc. has selected MultiPlan as the payer administering the Primary Health Choice product. As a result Summa Health System and Summa Physicians Inc. are no longer considered network providers for the Primary Health Choice product as of June 1, 2013

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Buckeye Community Health Plan- New Process for Medicare Advantage Prior Authorizations

Effective July 1, 2013, Advantage by Buckeye Community Health Plan (HMO SNP) will be making changes to the prior authorization process for Medicare Advantage requests.

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Dates of Service: Is it ICD-9 or ICD-10?

The October 1, 2014  ICD-10 deadline is quickly approaching and many are wondering how a claim you are submitting in October 2014 for a service that your practice provided in September 2014 should be coded?

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UHC- Outpatient Radiology Notification Protocol

Effective July 1, 2013, Ordering providers who are subject to UnitedHealthcare’s Physician, Health Care Professional, Facility and Ancillary Provider 2013 Administrative Guide for Commercial and Medicare Advantage Products (Administrative Guide) must notify UnitedHealthCare prior to scheduling certain CT, MRI, MRA, PET scan, Nuclear Medicine, and Nuclear Cardiology procedures for UnitedHealthCare commercial members in accordance with the terms of the Outpatient Radiology Notification Protocol.

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CMS- Competitive Bidding Program

The Round 1 Rebid of the Medicare Durable Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program was successfully implemented in nine areas on June 1, 2011. Round 2 of the program is scheduled to go into effect in 91 metropolitan statistical areas, including Akron, Ohio, on July 1, 2013.

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Outpatient Physical Therapy Program Change

Effective July 1, 2013 General Motors will transfer its outpatient physicial therapy (PT) program for the Hourly Active membership to TheraMatrix. Coverage for outpatient PT services will no longer be provided through Anthem BlueCross, Blue Shield, or Medical Mutual

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“Let’s Talk!" Effective Communication Techniques to Improve Patient Activation and Medication Adherence

This interactive webinar will discuss methods used to overcome health literacy barriers and improve patient adherence to medications and self-care. The presenters will focus on proven communication techniques that health providers can use to enhance efforts in assessing patient understanding. They will explain how to ask effective questions to uncover health beliefs, reinforce messages, and create a more open dialogue while sharing personal experiences and successes.

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Healthcare Reform Update- Essential Health Benefits

During the month of May, SHN hosted two webinars focused on different aspects of the Affordable Care Act. One key component was National Minimum Benefits. This component sets comprehensive standards regarding health insurance coverage under a federal definition of “minimum essential coverage.”

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Update: Medicaid Increases

Primary Care Physicians who are approved by the Office of Medical Assistance (OMA) can expect to see increased payments beginning in July 2013, when the OMA anticipates that CMS will approve Ohio’s State Plan Amendment to implement the primary care rate increase. Qualified physicians approved by the OMA who contract with a Managed Care Plan (MCP) will receive the enhanced payment directly from the MCP. These payments may be made retrospectively.

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Reminder: Wellcare is Exiting the Medicaid Managed Care Business in Ohio

Effective 7/1/13, WellCare will no longer offer a Medicaid Plan in our region. However, the WellCare Medicare Advantage Plan will continue and Summa Health System Hospitals will continue as a participating provider.

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