December 2013

In This Issue:


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

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SummaCare is Requiring Providers to use Plan Central

In order to improve efficiencies and reduce lengthy hold times, SummaCare is requiring providers who call for basic plan information to use Plan Central.

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Molina- Clear Coverage Monthly Online Training Sessions

Molina Healthcare of Ohio offers monthly training sessions for the provider network that will cover both the Web Portal and Clear Coverage. No registration is required for these 1.5 hour long training sessions. Join using the appropriate month's log on information.

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BCHP: Billing Guidelines for HealthChek (EPSDT) Services

On an annual basis, the Ohio Department of Medicaid (ODM) is federally required to report the number of EPSDT visits and referrals for follow up or corrective treatment for all Medicaid eligible recipients ages 0-20 years. ODM requires providers and all Medicaid Managed Care Plans to submit these visit and referral codes for all encounters. To comply, Buckeye required the appropriate referral field indicator be included for billing all 2013 EPSDT screening services. Claims submitted without the required referral indicators will be recovered or rejected and will require resubmission.

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WellCare Will No Longer Utilize Magellan Health Plans to Manage Behavioral Health Services

Effective December 1, 2013 WellCare is integrating its behavioral health and medical services to further their goal of creating an integrated care management approach for their members' medical and behavioral health needs. As of November 30th, WellCare will no longer utilize Magellan Health Plans to manage their members' behavioral health services. 

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Medicaid Primary Care Physician Rate Increase - Update

In accordance with the Patient Protection and Affordable Care Act (PPACA), managed care Medicaid plans have begun funding additional payments to primary care providers as applicable.  SHN plans have provided updates on the status of their payments as below. For more information on these increased payments, reference the Ohio Department of Medicaid Frequently Asked Questions document which was published in July at: www.medicaid.ohio.gov/Portals/0/Providers/PCP-Rate-Increase-FAQ.pdf

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PQRS- It's Not Too Late to Avoid the Penalty and Earn the Incentive

Please see the following information from eCW regarding PQRS:

Even though you may not have reported Quality Data Codes on claims this year, it's not too late to avoid the penalty OR to earn the incentive. 

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The Summa Learning Center has Moved

The Learning Center has moved to the Corporate Services Center. The new address is:1077 Gorge Blvd. Akron, OH 44310

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