Medclaims
PREVENTING DUPLICATE AUTHORIZATIONS – TRIWEST HEALTHCARE ALLIANCE
PREVENTING DUPLICATE AUTHORIZATIONS
Once an authorization for your requested service(s) is received by TriWest Healthcare Alliance, please do not send in another request containing the same diagnosis and CPT/HCPCS codes. If you need to add additional services later, you should submit an additional authorization request listing only the additional services. This helps expedite authorization for all services. Otherwise, if the new request is submitted with previously submitted codes with the same diagnosis, it will be automatically rejected as a duplicate.
In order to get the quickest response possible, submit your referral and authorization requests through the secure provider website at TriWest.com. Most requests can be processed immediately when submitted online.
If you’re not registered for the secure provider website at TriWest.com, you can’t take advantage of this and the many other features that registered users enjoy 24/7/365. Set up an account on TriWest.com to:
- Verify patient eligibility
- Research covered benefits and check referral/authorization and medical review requirements for specific codes
- Submit referrals/authorizations online and check their status regardless of how the request was submitted
- Submit claims online and check claim status regardless of how the claim was submitted
- Download remittance advices
- Download claims status reports
- Submit corrected claims
- Submit claims correspondence/Webmail
Source: http://www.triwest.com/en/provider/news/2012/02/preventing-duplicate-authorizations/
HOW WILL MEDCLAIMS IMPROVE MY CASH FLOW?
Clients see immediate improvement in cash flow. This is because our total focus is billing. Unlike office billers, we are compensated based on what we collect. Therefore, we work very hard to maximize collections. We also have state-of-the-art tools and we are experts in medical billing. This means that the job gets done correct the first time. We have also fostered good relationships with our business partners. So, when problems arise, we take care of them fast and seamlessly.
WHY SHOULD I OUTSOURCE MY BILLING?
Why should I outsource my billing?
This question is best answered with another question: Why do you pay an accountant to do your taxes? Professional billers know the industry inside out and have the right tools to get the job done. In addition, office billing-costs (salary, Workman Compensation insurance, etc) can be eliminated or substantially reduced. You no longer have to worry about the billing getting done, when your biller calls in sick. In summary, cash flow will improve while certain costs will be reduced or eliminated.
ALL MEDICARE PROVIDER AND SUPPLIER PAYMENTS TO BE MADE BY ELECTRONIC FUNDS TRANSFER
Providers and suppliers, that expect to receive payment from Medicare for services provided, are required to agree to receive Medicare payments through electronic funds transfer (EFT) at the time of Medicare enrollment, enrollment change request or revalidation.
SHORTAGE OF GERIATRIC DOCTORS
COMPENSATION NEEDS TO CHANGE TO MEET GROWING DEMAND FORSERVICES; COUNTRY NEEDS TO LEARN TO SACRIFICE AGAIN.
Source: http://www.medicareresources.org/blog/2010/12/15/shortage-of-geriatric-doctors/
INSURANCE ALLOWED AMOUNTS
Fact: When providers participate (are contracted with) insurance carriers, they can not bill patients for balances above the insurances’ allowed amounts.
NEW ICD-10 IMPLEMENTATION HANDBOOKS NOW AVAILABLE
NEW ICD-10 IMPLEMENTATION HANDBOOKS NOW AVAILABLE
CMS has developed four Implementation Handbooks as additional resources to assist the health care industry with the transition from ICD-9 to ICD-10 codes. Each guide provides detailed information for planning and executing the ICD-10 transition process. Use the guides as a reference whether you’re in the midst of the transition or just beginning the process.
The appendix of each handbook references relevant templates which are available for download in both Excel and PDF files below. The templates are customizable and have been created to help entities clarify staff roles, set internal deadlines/responsibilities and assess vendor readiness.
Source: https://www.cms.gov/ICD10/02b_Latest_News.asp#TopOfPage
MEDICARE’S PROVIDER ENROLLMENT REVALIDATION PROCESS
12/19/2011
By Eileen Turner, Senior Technical Advisor, CMS
Over the coming months and years, CMS’s Medicare Administrative Contractors will begin to request that practitioners revalidate their Medicare provider enrollment information.
The revalidation effort will require that each practitioner submit a complete and up-to-date provider enrollment application with all of their current information. Providers will be able to submit either an appropriate paper application (CMS 855) or electronically through internet-based PECOS. CMS urges all providers to use internet-based PECOS for responding to the request for revalidation — and for most other updates that may need to be made to your provider enrollment records — because PECOS will already contain all information currently on file for you.
Between now and April 2012, CMS will continue to improve internet-based PECOS to make it easier for the providers to update their information and submit their revalidation application. We have already streamlined the application process with fewer screens and new helpful prompts to let you know if information is incomplete. You are now also able to pay the application fee (if applicable) during the online submission process.
Soon, internet-based PECOS will also include:
- A new “My Enrollments” page that will allow the provider to easily manage and search his or her enrollment applications
- A new “Fast Track” tab that will enable a provider to view all application data on a single screen, reducing data entry and duplication of data
- A bulk upload process that will allow large providers to upload multiple applications at one time
- A simplified registration process for Authorized Representatives who submit provider enrollment applications on behalf of physicians
- The ability for individual practitioners to assign office managers as Authorized Representatives who can complete the Provider Enrollment action on behalf of the individual practitioner
- Digital document upload capability so that providers can submit any support documents electronically rather than by mailing them in
- Integration of the electronic funds transfer forms (CMS 588), and the Participating Provider Agreement forms CMS (460)
- New E-Signature capability so an enrollment application can be electronically submitted without the need to send a certification statement in the mail
We urge providers use internet-based PECOS to view your records and update any information. Use PECOS web — it is faster, safe, and secure.
Source: HBMA – http://www.hbma.org/news/public-news/n_medicares-provider-enrollment-revalidation-process
CMS QUARTERLY PROVIDER UPDATE
CMS Quarterly Provider Update.
The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update.
HHS ADOPTS HIPAA STANDARD FOR ELECTRONIC FUNDS TRANSFERS/REMITTANCE ADVICE
HHS Adopts HIPAA Standard for Electronic Funds Transfers/Remittance Advice.
The Department of Health and Human Services (HHS) is adopting two standards for the health care Electronic Funds Transfers (EFT): the CCD+Addenda implementation specifications in the 2011 National Automated Clearing House Association (NACHA) Operating Rules & Guidelines and the TRN Segment implementation specifications in the X12 835 TR3 for the data content of the Addenda Record of the CCD+Addenda. Please share with appropriate staff.