August 2013

In This Issue:

Save the Dates: 2013 Events

Please see our upcoming events for 2013

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Contact Your Summa Health Network Staff

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

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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.

BCHP: Prior Authorization to Include Genetic Testing

As of October 1, 2013 genetic testing will require prior authorization from a provider.

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BCHP: Asthma Education

The National Asthma Education Program Expert Panel Report-3 recommends additional therapy with an inhaled corticosteroid in conjunction with a short acting beta2-agonist (SABA), if a person uses a SABA more than 2 days per week. 

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SummaCare: Notice of New Claim Editing Software

SummaCare is upgrading their claim adjudication system and as a result, the current claim editing software is no longer compatible. Therefore, SummaCare will be implementing iCES, a new claims editing tool for claims processed on or after August 26, 2013.

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Paramount: Provider Direct COB Upgrade

Paramount’s interactive website, Provider Direct has been upgraded so that providers may view a member’s coordination of benefit information.

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Molina: Monthly Online Training Sessions

Molina Healthcare now offers monthly online training sessions for their provider network that will cover both the Web Portal, a secure website offering providers self-service functions 24 hours a day, and Clear
Coverage, a web-based application that allows for the auto-approval of specific prior authorization

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Critical Change for Anthem Members on Service with CuraScript - Medical Benefit Specialty Drugs

If Anthem members receive specialty medications at your office, and are receiving drugs dispensed by CuraScript, Express Scripts Specialty Pharmacy, and these drugs are covered by the member's medical benefit, please note this important information.

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Anthem: Health and Behavior Assessment Reimbursement Policy

In August 2013, Anthem notified providers that the new Anthem Blue Cross and Blue Shield Health and Behavior Assessment/Intervention reimbursement policy would become effective on December 6, 2013 for Indiana, Kentucky, Missouri, Ohio and Wisconsin.

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Cigna: Request for NPI on Claims

Cigna uses NPIs to process electronic claims to ensure that transactions are handled efficiently and payments are processed quickly and accurately. 

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The Sunshine Act

The Physician Payment Sunshine Act, made into law in 2012 and put into effect on August 1, 2013, requires manufacturers and group purchasing organizations to “report payments or other transfers of value” to physicians and teaching hospitals to the Centers for Medicare and Medicaid Services

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HIPAA Updates

On January 25, 2013, the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) published the final privacy and security regulations (the Final Rule) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Final Rule implements the changes required by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

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Medicare Fraud, Waste, and Abuse Fact Sheet

Beginning in 2009, the Centers for Medicare and Medicaid (CMS) mandated that all healthcare providers, practitioners, and their staff who render health services to Medicare (and Medicare Advantage) enrollees or who administer Medicare Part D, must complete an annual training on the prevention, detection and correction of Fraud, Waste and Abuse (FWA). Records of completion of this training for yourself and your staff must be maintained by your office as CMS or any Medicare Advantage or Part D payer may ask for proof of training at any time. Additionally, SHN must now maintain records for all SHN provider members and their staff on FWA training as SHN contracted Medicare Advantage payers may request copies of these records at any time.

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