1. It is not all BS plans but specific PPO plans only. Note several plans currently do this but ASH is just the gatekeeper for medical necessity and does not follow ASH rates. 2. These plans will still have out of network benefits but clearly an incentive for patients to Read more…
Did you know the VA Community Care programs have timely filing limits for claims? The deadline for submitting claims for authorized care is 120 days from the date of service (DOS). With the recent transitions and changes to programs, VA has allowed TriWest to waive this timeline for a period Read more…
As Federal funding for the Veterans Choice Program ends, VA will no longer use Choice to furnish community care to Veterans. All community care will transition to the Patient-Centered Community Care (PC3) program effective June 6, 2019. The PC3 program will continue to provide access to chiropractic and acupuncture and Read more…
The Labor and Industry Commission of Washington state is ending the pilot program for acupuncture and treatment of low back for injured workers and now welcoming all licensed acupuncture providers to treat workerâs compensation patients for lower back pain June 1, 2019, and beyond. Providers that are new to treating Read more…
Where to Send Medical Documentation Changes May 1! Starting May 1, 2019, the Department of Veterans Affairs (VA) will begin requiring providers to send medical documentation to their authorizing VA Medical Center (VAMC) instead of TriWest. This change will affect providers in VA PC3 Regions 3, 5 and 6, which Read more…
United Health has made an update to billing for physical medicine codes for all plans. Now all billing for physical medicine codes 97010-97799 billed to any UHC plan must have modifier GP appended or will cause the claim to be denied. Note this prior was limited to Federal plans but Read more…
VA Community Care under Choice and PC3 will be changing to Optum Health June 2019 to manage care for veterans under the respective programs This affects only regions 1, 2, and 3. Regions 4, 5, and 6 will remain with Triwest Region 1 Connecticut, Delaware, District of Columbia, Maine, Maryland, Read more…
There have been many offices recently receiving denials for improper use of diagnosis. This is stemming not that the codes are incorrect but that they cannot be coded together on the same claim. This type of denial is due to âType 1 Excludesâ which is a diagnosis rule that does Read more…
Florida physical therapists cannot offer âdry needlingâ procedures to their patients, a state judge ruled in a legal challenge filed by a group representing acupuncturists. An Administrative Law Judge (ALJ) issued an order rejecting a proposed rule by the Florida Board of Physical Therapy that set minimum standards for physical Read more…
Network members please not the 2019 fees for workersâ compensation is available for states who publish fees. Note for California providers while there is a general fee schedule there is now some regional adjustments dependent on your location (Medicare localities) that increase the allowance. The network recommends to be aware Read more…