HCAP Highlights - myhcap.com

1 HCAP Highlights W i n t e r I s s u e J a n u a r y 2 0 1 2. 315 Mulholland St. Bay City, MI 48708. Phone: (989) 891-8820. HAP Moves radiology Management - Toll Free: 800-799-6172. (Michigan only). How Does This Affect You? Fax: (989) 891-8161 Recently, HCAP learned that authorization, diagnosis dures that will require Website: our business associate, code, clinical patient preauthorization. Health Alliance Plan, has data relevant to the re- moved their radiology man- quested study: signs, Non-expedited preauthori- agement to CareCore Na- symptoms, test results, zation decisions are ren- medications, dates of dered in 1-2 business tional (CCN). prior imaging studies days from the receipt of Prior authorizations are re- all necessary clinical infor- quired for High Tech Imaging etc.

2 Special mation exams such as: MRI/MRA, Points of CT, PET, Nuclear Cardiology Expedited requested deci- Interest RENDERING PHYSICIAN sions are made ASAP, but and Nuclear Medicine. RESPONSIBILITIES: - no later than 3 hours up- There are responsibilities for As with the ordering physi- on receipt of all necessary CIPA's Assistance the Ordering Physician as cian, there are requirements clinical information, not to well as the Rendering Physi- of the rendering physician, exceed 24 hours. Claims Submission cian. which are as follows: Expedited is defined by Educational They are as follows: Verify that the proce- clinical status of the pa- opportunities dure has been approved tient only.

3 And a valid and current ORDERING PHYSICIAN Expedited requests authorization number should be expedited by RESPONSIBILITIES: has been provided be- The ordering physician the telephone fore rendering the ser- Inside This are required to provide vice. See radiology page 2. Issue demographic and clini- cal information to CCN Conduct the procedure HCAP Network Area via telephone or web within the approved au- 3 Ps and a T 2 site. thorization timeframe. To expedite the process Rendering physicians radiology cont. 2 may call to change the you need to have the patient's DOB, Tele- location of the proce- phone number, and in- dure or may change the CIGNA 3. surance plan member ID CPT code(s) when medi- number.

4 Cally appropriate. Claims Submission 3. You'll need the ordering physician's name, ID PREAUTHORIZATION. number, tax and tele- TURN-AROUND-TIME: Welcome & Thank 3. You phone numbers. Preauthorization num- Also needed the render- bers are valid for 45. ing provider's infor- days from the date of CME Opportunity 4. mation including facility approval If you would like more information name, CPT code and/or about our company please contact Refer to the CPT code description of test re- Lori Frey at (989) 891-8820 or by list for an updated list- quiring pre- email at ing of imaging proce- P a g e 2. 3 P's and a T. As an HCAP physician, you par- Process Improvement cess from beginning to HCAP STAFF.

5 Ticipate in the BCBSM Physi- Improving office efficiency nomination and beyond cian Group Incentive Program through LEAN and other Elizabeth Schnettler, Technology President (PGIP) through Consortium for process improvement tech- Independent Physicians (CIPA). niques Preparing offices for meaningful use and Lori Frey, Account Executive and In addition to PGIP, CIPA also Performance Improvement population manage- Network Manager provides primary care physi- Application of evidence ment through e- cian practices (employed and based care and utilization prescribe, electronic independent) with tools to be benchmarks at the practice medical records, regis- successful in a constantly and community level sup- tries and web portals evolving healthcare environ- ported by payor data and ment.

6 Reports The CIPA Practice Con- sultant for HCAP is CIPA will help each office with Patient Centered Medical Jacky Lagrace. 4 different components of suc- Home (PCMH). cess that we call 3 P's and a T. Hands on assistance with Please contact him at: Become an HCAP putting together your These components consist of PCMH binder and educa- or 517-336-1400, ext. Participating the following: tion through the entire pro- 107. Provider Today! Just call: (989). 891-8820 or visit our website at radiology from page 1. CareCore National (CCN) the telephone, 7 7 appeal preauthorization offers convenient ways to MST, Monday-Friday denials obtain and/or verify an at 1-888-564-5487. authorization request.

7 Claim denials-disputes: Should you have any con- You can obtain web ac- cerns and/or disputes HAP Please contact the HAP. cess by registering at and CCN offers the follow- Claims Investigation and Assessment at 1-866-766- ing services to you: 4661 to request an appeal Peer to Peer Discussion: for related claim denials. Preauthorization requests At anytime during the pro- As always, HCAP is here to submitted online are han- cess, physicians can re- help you. Should you be dled as routine authoriza- quest a peer to peer dis- told that you are not a par- tion requests. cussion by dialing 1-888- ticipating provider and you Clinically urgent and expe- 564-5487 and select op- know for certain that you dited requests should be tion 5 are, please contact HCAP.

8 Initiated by telephone at 1- Appeal Process: at 1-800-799-6172 (in Michi- 800-889-8056. gan only) for assistance. If an ordering physician disputes a decision regard- You can also obtain au- ing a preauthorization re- thorizations and/or verify quest before the service the status of an existing has been rendered, authorization request via please: Contact CCN to H C A P H i g h l i g h t s W i n t e r I s s u e P a g e 3. CIGNA Moves East Central Michigan Members HCAP is pleased to announce and Open Access Plus products Claims should be submitted that CIGNA has moved their will be securing services to: east central Michigan mem- through HAP Preferred PPO who Need a Free bers, who reside in the follow- utilizes the HCAP PPO Network.

9 HCAP/HAP Preferred Quote ing counties, into the HCAP PO BOX 02399. The providers front-desk person- PPO Network effective August Detroit, MI 48202 On Healthcare nel, should watch for a change- 1, 2011. Those counties are Payer ID 38224 Benefits? over of Member ID cards. as follows: The ID cards for those members If the ID card indicates the Arenac, Bay, Huron, Iosco, Isa- HCAP logo, medical claims affected by this change will bella, Ogemaw, Sanilac, Sagi- should be paid at the have the HCAP logo on it. Contact the HCAP. naw, and Tuscola. HCAP Contracted Rates Office Today!! HCAP, through our relationship with HAP Preferred PPO and CuraNet, are now included in the CIGNA affiliation with HAP (989) 891-8820.

10 Preferred. CIGNA enrollees in its Man- aged Care, Referral Plan PPO/ HCAP Self-Funded Gatekeeper, PPO, Open Access Employer Groups: Arenac Castings . Claims Submission Reminder Auto Wares Axis Machining For those of you who are new ASR/Physician's Care Network Claim Questions Blue Chip Machining Box 6392 W: participants in the HCAP PPO. Grand Rapids, MI 49516-6392 OR Blue Diamond Steel Network and just for a refresh- T: (616) 957-1751 Providers & Casting er, Health Care Alliance Pool Local Calls HAP Preferred/CIGNA. (HCAP) is a Preferred Provider T: (800) 968-2449 Employee Calls Covenant HealthCare HCAP/HAP Preferred Organization Network. W: PO BOX 02399 Huron Castings &. OR Detroit, MI 48202 Huron Castings Corp HCAP does not process and/or Payer ID 38224 Services pay claims.