The latest information is indicating that the visit threshold will be 5 visits whether a provider is in our out of network and allowances will be the same for in and out of network services. Patients may have lesser copays or deductibles for in-network providers. Self-funded plans under Blue Shield, Read more…
ASH Blue Shield of CA Update Blue Shield of CA will begin to utilize ASH for a âsignificantâ number of their PPO plans January 1, 2020. But the use of âsignificant numberâ is not clear as to what plans they are indicating is it more than 50% less than etc. Read more…
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…