GHI HMO/HIP

Effective January 1, 2012 ( I realize I'm a little late with this one), Emblem Health replaces GHI HMO and HIP policies.  The mental health and substance abuse vendor for these plans are now Value Options.  Benefits and eligibility can be obtained by calling 800 235-3149.  The claims address is P.O. Box 803, Latham, NY 12110

ICD-10 Compliance postponed

CMS has just issued a press release indicating the compliance deadline for the implementation of the ICD-10 standards has been delayed one year.   ICD-10 compliance is now delayed until October 1, 2014.  For more information visit:  http://www.ofr.gov/OFRUpload/OFRData/2012-21238_PI.pdf

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.