Beacon Health and MagnaCare OSCAR providers

Oscar insurance and it's affiliates have decided to contract with Optum to manage the behavioral health benefits under their EPO health plans in New York and Texas.  This change takes effect January 1, 2017.

Providers currently in the Beacon Health Options or MagnaCare networks will be receiving letters informing them of this change and their termination with Oscar effective December 31, 2016.

If you are a provider who participates with Beacon Health Options or MagnaCare AND Optum, your Oscar patients should be unaffected by this change.  You will begin sending claims with dates of service January 1, 2017 and after directly to Optum.  Providers who participate with Beacon Health Options or MagnaCare but DO NOT participate with Optum will have to contact Optum Network Management to become credentialed.  Call 877-614-0484 or email bnsproviderupdates@optum.com.

Oscar will be offering patients in treatment with non participating Optum providers (90) days of continuity of care beginning January 1, 2017.  Claims will be paid as IN network for that time period. Any further questions about the Oscar provider network changes can be answered by calling 855-OSCAR-55.

AETNA EFT ENROLLMENT REQUIREMENT

Effective January 15, 2017, Aetna will require all providers to adhere to their electronic payment policy.  This policy requires providers to enroll in an electronic payment option from Aetna directly or Payspan.   To receive EFT payments via Aetna register at https://connect.NaviNet.net/enroll. To receive EFT payments via Payspan register at www.payspanhealth.com.

HBH T2017 Network

Humana was awarded the contract for Tricare Northeast military product. This new network is accepting applications for a 2017 effective date. Those interested can contact T & T for credentialing assistance.

Getting ready for ICD-10

Most of you should now be aware that the ICD-9 code sets will be a thing of the past.  CMS has decided the old code sets are outdated and obsolete.  The ICD-10 code sets are to be utilized beginning 10/1/2015.  These new codes will provide clinicians greater detail in measuring quality, safety and efficiency of care.  They will also better identify illness and earlier warning signs of bigger issues.  T & T has provided a link for an easy transition from ICD-9 to ICD-10 codes.  The table 10.01 crosswalk gives mental health providers all the coding information needed.

The Empire Plan Changes

Attention NY Empire Plan providers.  Effective October 1, 2014, Value Options has announced prior authorization will no longer be required for the Empire Plan enrollees for routine outpatient mental health and substance abuse services.  The exception would be for psychological testing, outpatient electroconvulsive therapy and transcranial magnetic stimulation.  This is GREAT news!

New CMS 1500 forms

Beginning 4/1/2014, all providers must use the new CMS 1500 (version 02/12) claim forms when submitting paper claims to insurance companies.  Having trouble with your claims?  T & T is here to help.  Visit the contact us tab for more information!

ICD-10 Behavioral Health codes

***UPDATE***President Obama signed into law legislation (HR-4302) that delays the conversion to ICD-10 diagnostic and procedure codes until at least October 1, 2015.

Providers, will you be ready for the transition to the ICD-10 coding system?  The compliance date is 10/1/2014.  Contact T & T for any questions you may have!