June 2014

In This Issue:


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

To view newsletter in your web browser please click the link below.

www.shnnews.org


Past Issues

Subscribe

Forward to a Friend


SummaCare Marketplace Products

SummaCare is offering four products that are sold on the Health Insurance Marketplace.

• SummaCare Individual Value
• SummaCare Individual 6350
• SummaCare Individual 5000
• SummaCare Individual 750

Read entire article...

Anthem: Outpatient Hysterectomies Now Require Prior Authorizations

• Effective 5/7/2014 all outpatient hysterectomies will require prior authorization.
• In the past, only inpatient hysterectomies required prior authorizations.
• This change does not apply to National Accounts, Medicare, Medicare Advantage (MA), Medicaid or Federal Employee Plan (FEP).

Read entire article...

Molina: Update to Pre-Service & Post-Service Claim Reconsideration Policy

• Molina has extended the provider submission time frame from 7 days to 14 days.
• The intent on this 14 day window is to allow providers the opportunity to submit additional clinical information for a final review.

Read entire article...

SHN Business Associate Agreements

• Recently published Health Insurance Portability and Accountability Act (HIPPA) final rules made changes in the responsibilities of Business Associates and their subcontractors.
• Summa Health Network (SHN) is required to have provider groups execute an updated Business Associate Agreement containing these changes.

Read entire article...

ICD-10 Update

• The U.S. Department of Health & Human Services will soon release an interim final rule that includes a new ICD-10 compliance date of Oct. 1, 2015.

• The rule will require HIPAA-covered entities to continue use of the ICD-9 code set through Sept. 30, 2015.

Read entire article...

SummaCare HCFA Forms

• Effective 4-1-2014, SummaCare is only accepting the new CMS HCFA 02/12 form per Medicare guidelines.
• Any claim submitted on an outdated form will be returned.
• The new CMS HCFA 02/12 claim form replaces the old 1500 08/15 claim form.

Read entire article...

Buckeye Community Health Plan-Laboratory Update

• Effective July 1, 2014, Lab Corp will no longer be a participating laboratory provider in the Buckeye Community Health Plan provider network.
• This termination is effective for all products- Medicaid, Medicare Advantage, Ambetter, and MyCare Ohio.
•LabCare Plus remains in network for Buckeye Community Health Plan.

Read entire article...

Medicare Advantage Update

The Centers for Medicare and Medicaid Services (CMS) published the 2015 Medicare Advantage benchmarks on April 7th . The final notice represents a major improvement over the February 45-day call letter, which proposed an average of 5.9% cuts to Medicare Advantage.

Read entire article...
Summa Health Network News All rights reserved, ©2014.