Medicare Re-Validation

All Medicare providers who enrolled prior to March 25, 2011 will be required to re-validate their enrollment information.  The preferred method of re-validation is through the Internet based PECOS system at https://pecos.cms.hhs.gov but a paper application will also be accepted.  Providers are instructed to complete the re-validation process once they have been notified by their MAC (Medicare Administrative Contractor).  MAC's will be sending out notices to providers between now and 2015.  Failure to complete the re-validation process within 60 days after being contacted will result in deactivation of provider billing privileges.

GLHP Providers

Effective December 1, 2011, Great Lakes Health Plan Medicaid members will no longer require an authorization for routine outpatient behavioral health services.  Psychological testing will still need authorization.

UBH/OptumHealth Network has openings for NJ providers

United Behavioral Health/OptumHealth is expanding their network for NJ providers who work with developmentally disabled individuals.  They are seeking psychiatrists and therapists of all licensure levels that have expertise in treating this population.  Follow the link for additional information.

NY Cigna Behavioral Providers

Effective August 1, 2011, NY Cigna Behavioral providers will have 120 days for timely filing of claims.  Participating provider agreements require claims be submitted with 60 days from the date of service but in accordance with NY state law, Cigna Behavioral gives NY providers an additional 60 days to submit claims.  Questions can be taken directly at Cigna Behavioral by calling 800.926.2273.

Online recredentialing for Value Options

Providers are now able to access their recredentialing application online when logging onto ProviderConnect at http://www.valueoptions.com/providers/Providers.htm.  Value Options recredentials providers on a tri-annual basis and contacted providers several months prior to their recredentialing date.  Use your user id and password for access to ProviderConnect and your recredentialing application once contacted by Value Options.

New 5010 standards

Are you getting ready???? More posts to come......

CV's required for Magellan Re-Credentialing

In addition to an up to date file with CAQH (Council for Affordable Quality Healthcare), Magellan is also requiring providers submit a detailed CV for completing the credentialing/re-credentialing process.  Magellan feels the information contained in your CV will assist them in matching your skills with the needs of their members.  For more information visit www.magellanprovider.com and review the latest provider focus newsletter.  For CAQH file updates visit https://upd.caqh.org/oas/

Great Lakes Health Plan has a new behavioral health vendor

UBH has become the new behavioral healthcare vendor and affiliate company for GLHP effective 1/1/2011.  GLHP began sending letters out to providers in December inviting them to participate in the UBH network.  Courtesy par status with UBH will be extended to all GLHP providers until 3/31/2011.  Providers can contact customer service at 800.903.5253

Harvard Pilgrim Providers

Outpatient authorizations are no longer required for patients seeing an in network provider. For those that aren't aware, behavioral health services are managed by United Behavioral Health.

MHN's New Outpatient Management Process

Starting 10/15/2010, MHN eliminated the re authorization process and introduced a new registration process.  All MHN providers seeing clients on an outpatient basis have had to deal with those re authorization "kits".  These kits were used for requesting more outpatient authorized sessions.  Well, no more!  MHN has done away with the kits/outpatient treatment request forms.  Providers will now be required to only notify MHN that a patient is in treatment.  No forms will be mailed to provider.  The client will be able to utilize all sessions available on their plan without requiring an authorization.

Retrieving those Value Options EOB's

By now I'm sure you are aware Value Options has discontinued mailing paper provider summary vouchers(eob's).  Unfortunately there are still providers out there that have no idea how they can retrieve the eob's in order to reconcile patient accounts.  You can call 866.409.5958 to have those printed eob's faxed to you.  The process is very simple.  Just follow the prompts and in no time you'll have the information you need.  You can also go online to www.valueoptions.com and register on Provider Connect.

Changes at Ceridian for EAP reimbursement

I am late with this information and do apologize.  I wanted to make sure I had all correct information before putting it out for everyone.  Beginning January 3, 2011 Ceridian Lifeworks and Military OneSource transitioned to a new system for processing EAP claims.  Providers were only informed in December of 2010 of the upcoming changes.  Ceridian now requires providers to use their new intake assessment, session/progress notes and case closure forms for all Lifeworks and Military OneSource clients.  The session/progress notes form doubles as an invoice and is required to be submitted within (3) days of the client session.  Ceridian mailed out copies of the new forms for providers to submit invoices via fax or mail.  Providers can also use the Web portal on Ceridian's website to submit the required forms.  You may contact Ceridian directly with any questions at 800.367.3920 or email provider services at pnsinquiries@ceridian.com.