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).

2 Prior imaging studies days from the receipt of Prior authorizations are re- all necessary clinical infor- quired for High Tech Imaging etc. 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.

3 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. 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.

4 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. 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.

5 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. 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).

6 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. reports The CIPA Practice Con- sultant for HCAP is CIPA will help each office with Patient Centered Medical Jacky Lagrace.

7 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.

8 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.

9 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. 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.

10 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. 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?