Connect Archives

February 2014

Thursday, February 13, 2014

HEALTH FIRST NETWORK, INC. APPLYING FOR URAC NETWORK/CREDENTIALING PROGRAM ACCREDITATION

Health First Network, Inc. announced today that it is applying for Network/Credentialing Program Accreditation from URAC; a Washington, D.C. based health care accrediting organization that establishes quality standards for the health care industry. By becoming URAC Accredited, this ensures that HFNI has systems, committees, policies, and procedures in place that assures providers, facilities, contractors, and the like that HFNI is a quality, focused Network with the consumer (patient) safety in mind.

Providers of the Network stand apart from other Networks due to their diligence in pursuing URAC accreditation.

Accreditation is an evaluative, rigorous, transparent, and comprehensive process in which a health care organization undergoes an examination of its system, processes, and performances by an impartial external organization (accrediting body) to ensure that it is conducting business in a manner that meets predetermined criteria and is consistent with national standards.

“By choosing to seek URAC Network/Credentialing Program Accreditation, Health First Network, Inc. has displayed leadership through a commitment to quality and accountability,” said William Vandervennet, URAC Chief Operating Officer.

URAC, an independent, nonprofit organization, promotes health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system and provides a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry.

PATIENT HEALTH MAINTENANCE AND WELLNESS NEEDS

As the health care delivery system moves progressively towards preventive care, wellness, and quality based reimbursement, the importance of staying current with our patients takes on a level of significance that just wasn’t really appreciated in the past. Physicians must now focus well beyond taking care of our patients when they are sick, to the point of anticipating their health maintenance and wellness needs.

The bottom line is that for this to work well for the patient, the physician, and the community we will not be able to wait for the patient to present with an illness, and try to catch up on the rest of the needs then.

All of us should plan on seeing our patients at six month intervals specifically to assure and document that health maintenance and wellness needs are being met. This is especially true for the older and more complex patients, but also applies to younger patients as well who tend not to present as regularly for illness. If you have any questions, please contact Dr. Whibbs at 850-438-8147.

ID CARDS

To help with the loss of continuity that was unintended but inevitable with the increasing use of Hospitalists to deal with acute inpatient care, Health First Network, Inc. will be distributing to our Primary Care Physicians’ offices cards that should be distributed to all of our patients that will link the patient and Primary Care Physician together, with HFNI contact information on the other side. The card is designed to be shown anytime the patient shows their insurance ID.

Information especially concerning admission to any facilities for Inpatient, Emergency Department, or even Outpatient services can be funneled through HFNI to each of our physicians on a daily basis, allowing for better coordination of care, and initiation of needed transitional care in a real-time environment. The cards are health plan agnostic, and we encourage their use for ALL patients. If you have any questions, please contact Dr. Whibbs at 850-438-8147.

PAYMENT ADJUSTMENT INFORMATION FOR MEDICARE EPS

Eligible professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based on meaningful use data submitted prior to the 2015 calendar year. EPs must demonstrate meaningful use prior to 2015 to avoid payment adjustments.

Determine how your EHR Incentive Program participation start year will affect the 2015 payment adjustments:

If you began in 2011 or 2012:

If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015.

If you began in 2013:

If you first demonstrated meaningful use in 2013, you must demonstrate meaningful use for 90 day reporting period in 2013 to avoid the payment adjustment in 2015.

If you plan to begin in 2014:

If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and EPs must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment.

Avoiding Payment Adjustments in the Future:

You must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare of Medicaid.

If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.

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CAQH UNIVERSAL PROVIDER DATASOURCE (UPD)

The CAQH Universal Provider Datasource (UPD) is the trusted source and industry standard for collecting provider data used in credentialing, claims processing, quality assurance, member service and more. By streamlining data collection electronically, UPD is reducing duplicative paperwork and millions of dollars of annual administrative cost. HFNI supports CAQH as the national resource for provider self-reported data.

To better serve you, if you are currently submitting your credentialing data though CAQH, please submit your CAQH I.D.# to Deborah Gant, Director of Health Services at 850-434-6087 by April 1, 2014. If you are interested in obtaining Information or how to sign-up for CAQH, log-on to the CAQH website below.

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REVISED CMS 1500 PAPER CLAIM FORM: VERSION 02/12

CMS began receiving claims on the revised CMS 1500 claim form (02/12) on January 6, 2014. The CMS 1500 claim form is the required format for submitting professional and supplier claims to Medicare on paper, when submitting paper claims is permissible

Features of the Revised Form
The revised form, among other changes, notably adds the following functionality:

• Indicators for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes.

• Expansion of the number of possible diagnosis codes to 12.

• Qualifiers to identify the following provider roles (on item 17):
o Ordering
o Referring
o Supervising

Note: although the revised CMS 1500 claim form has functionality for accepting ICD-10 codes, do not submit ICD-10 codes on claims for dates of service prior to October 1, 2014.

Instructions for Completing the Revised Form
Instructions for completing the revised CMS 1500 claim form (02/12) are provided in the Medicare Claims Processing Manual (Pub. 100-04).

Medicare will continue to accept the old CMS 1500 claim form (08/05) through March 31, 2014. However, on April 1, 2014, Medicare will receive professional and supplier paper claims on only the revised CMS 1500 claim form (02/12). Claims sent on the old CMS 1500 claim form (08/05) will not be accepted.

Note: The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless certain exceptions are met. Some Medicare providers qualify for these exceptions and send their claims to Medicare on paper. For more information about ASCA exceptions, please contact the Medicare Administrative Contractor (MAC) who processes your claims. Claims sent electronically must abide by the standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The current standard adopted under HIPAA for electronically submitting professional health care claims is the 5010 version of the ASC X12 837 Professional Health Care Claim standard and its implementation specification, Technical Report 3 (TR3). More information about the ASC X12 and TR3 is available on the ASC X12 website.

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HEALTH FIRST NETWORK DEPARTMENTAL FAX NUMBERS AND MAILING ADDRESS

Please note the departmental fax numbers listed below.
General Faxes 850-438-0298
Credentialing Dept. 850-438-0298
Medical Dept. (secure faxes) 850-290-4822
Provider Relations Dept. 850-434-8253

Health First Network’s mailing address is:
2929 Langley Ave., Ste. 103
Pensacola, FL 32504

*Please note that PO Box 6480, Pensacola, FL 32503 is no longer valid.

HEALTHSPRING MEDICARE ADVANTAGE HMO TRANSITION FOR CLAIM PROCESSING

Effective 1/1/14 Health First Network, Inc. (HFNI) / MED3000 is no longer responsible for processing claims for Healthspring Medicare Advantage HMO.

Health First Network, Inc. will continue to work with Healthspring; giving support to our providers for that product.

It is very important that all claims with dates of service prior to January 1, 2014 are filed to HFNI / MED3000 no later than June 30, 2014 at the address below.

HealthSpring Medicare HMO
P. O. Box 11547
Pensacola, FL 32524

All claims received after June 30, 2014 for dates of service prior to January 1, 2014 will be denied timely, NO EXCEPTIONS will be made.

All claims for dates of service after December 31, 2013 should be filed to:

Healthspring Medicare Advantage HMO
P.O. Box 981804
El Paso, TX 79998
Electronic claims: Emdeon Payor ID 63092

Please contact Jenny Caillouet at 850-438-4487 if you have any questions.


NEW JOB POSTINGS PAGE

HFNI has created a new “Job Postings page” in an effort to help our physician offices fill job vacancies.

If you would like to advertise open employment opportunities on the HFNI website, please contact Jenny Caillouet at 850-438-4487.

NEW PHYSICIANS JOINING THE NETWORK

Health First Network would like to welcome the most recent physicians to join the Network:

Evaldas Giedrimas, M.D. Cardiology/Cardiovascular Disease
Scott Moore, M.D. Family Practice
Leslie Sanders, M.D. OB/GYN
David Smith, M.D. Orthopaedic Surgery
Sarah Waite, M.D. Pediatrics
Patrick Gatmaitan , M.D. General Surgery

** To determine which health plans each physician is participating in check the “Find A Doctor” section on the HFNI website.