March 2014

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Summa Health Network
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Humana to Delay Implementation of Data Submission Requirements

Providers were recently notified that the Centers for Medicare & Medicaid Services (CMS) was changing the data submission requirements of Medicare Advantage (MA) networks for home health and skilled nursing facility services effective for claims with dates of service beginning December 1, 2013.

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Humana: Claims Process Improvements

As part of Humana’s ongoing efforts toward claims process improvements, they periodically update claims payment systems to better align with correct-coding initiatives, Centers for Medicare & Medicaid Services (CMS) guidelines, national benchmarks and industry standards regarding inpatient and outpatient claims. 

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Molina: New Provider Services Line and IVR System

Molina Healthcare of Ohio has launched a new Provider Services number in order to provide dedicated support to their provider network. In addition, Molina has implemented an enhanced Interactive Voice Response (IVR) system, the automated system that members and providers use to route their calls to the appropriate department to provide an improved customer experience.

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Molina Delays Enforcement of the Two Midnight Rule for Inpatient Status Determination

As you may know, the Center for Medicare and Medicaid Services (CMS) has delayed the enforcement of the Two (2) Midnight Rule for inpatient status determination for its Medicare lines of business until October 1, 2014. As a result, Molina Healthcare will also delay implementation for their Medicare members to remain consistent with CMS policy. In the interim, Molina Healthcare will continue to evaluate short stay admissions using the current observation policy.

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Buckeye Provides Questions and Answers for ICD-10 Transition

As you are aware, ICD-10 is scheduled for implementation on October 1, 2014. ODM and the Medicaid Managed Care Plans have been working together to ensure that the transition is as smooth as possible. Buckeye Community Health Plan has worked collaboratively to create a Q&A to educate their provider network regarding ICD-10.

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MMO to Contract Directly with Applied Behavioral Analysis Therapists

Beginning January 1, 2014, Medical Mutual has started contracting directly with Applied Behavioral Analysis therapists certified as Board Certified Behavior Analysts (BCBA) or as Board Certified Analyst-Doctoral (BCBA-D) for the treatment of Autism Spectrum Disorder (ASD).

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eCW – Electronic Referrals

Summa Health Network is working with our preferred EMR vendor, eClinicalWorks (eCW) to implement their electronic referral component, P2P, at a community level. Non-eCW users are also able to access this technology through eCW’s P2POpen which is EMR vendor neutral. P2P and P2POpen will allow providers to electronically exchange and track referrals among eClinicalWorks and non-eCW EMR users. Within the referral, providers will be able to electronically attach the patient’s medical summary, progress notes, labs and imaging results. The implementation of this product is underway and the pilot phase will begin soon. 

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