July 2014

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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Fee Survey Reminder

  • It is time for the annual update of your Summa Health Network (SHN) exhibit, called “Fee Selections/Contracting Authorization,” which is also referred to as your “Fee Survey.”
  • Providers should have received a Fee Survey the week of June 30.
  • Fee Surveys were due to Summa Health Network by July 25.
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PECOS Update

  •  If you have a demographic change within your office, please be sure to update the CMS Medicare Provider Enrollment, Chain and Ownership System (PECOS).
  • Please take a moment to log into PECOS and update your provider information to ensure that Summa Health Network is providing CMS with an accurate representation of the providers (physicians and mid-levels) who are currently billing to your TIN.

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Changes to Provider Appeal Process for SummaCare

  • Recent communications with the Centers for Medicare and Medicaid Services (CMS) require that SummaCare change the appeal process in order to better comply with federal regulations.
  • Effective June 21, 2014, once SummaCare issues a certification denial to your office, any requests made to reconsider the denial determination must go through the appeal process.
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Bundled Services, Supplies and Modifier 59

  • As of July 19, 2014, Anthem Blue Cross and Blue Shield (Anthem) will update their professional reimbursement policies to reflect that CPT code 76499 (unlisted diagnostic radiographic procedure) when reported as digital breast tomosynthesis (DBT) is incidental to mammography codes 77055, 77056, 77057, 77058, 77059, G0202, G0204, and G0206.
  • In these cases, it is not eligible for separate reimbursement.
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Molina Healthcare Portal Registration

  • The Molina Healthcare web portal is live and ready for providers to access.
  • Services available include checking member eligibility and benefits, searching provider service requests, managing of claims and other helpful information.
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Changing the Way Aetna Providers Are Paid

  • Aetna is moving to electronic funds transfer (EFT) as their exclusive payment method. If you're still receiving paper checks from Aetna, they are urging providers to enroll in EFT.
  • Providers can enroll using the EFT Enrollment utility from the Council for Affordable Quality Healthcare (CAQH).
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