June 2014

In This Issue:

Summa Health Network
168 E. Market St.
Akron, OH 44309
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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

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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).

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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.

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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.

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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.

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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• Any claim submitted on an outdated form will be returned.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.

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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.

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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.

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