spring 2013 provider workshop cog - pacificsource › provider › 2014-ihcc-idaho.pdfthe cms 1500...
TRANSCRIPT
![Page 1: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/1.jpg)
Spring 2014 PacificSource Provider Workshop Idaho
Presented by: The PacificSource Provider Service Team
PacificSource Community Health Plans, Inc. is an HMO/PPO plan with a Medicare contract.
Y0021_PR2385_Plan Approved 04082014
![Page 2: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/2.jpg)
Agenda
• Organizational Updates o NCQA o Locums Tenens o HEDIS o ICD 10
• Commercial o Healthcare Reform - Exchange
• Medicare • PacificSource Websites
o InTouch Provider Portal
![Page 3: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/3.jpg)
Organizational Updates
Organizational Updates
![Page 4: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/4.jpg)
Idaho Provider Service Team
Southwest Idaho - Saint Alphonsus Health System [email protected] (208) 780-2060
Northern Idaho - St. Luke’s Health Services [email protected] (208) 333-1517
Eastern Idaho [email protected] (208) 780-2065
![Page 5: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/5.jpg)
PacificSource Total Membership
Total Membership: 259,323
Commercial Membership: 169,582
Medicare Membership: 37,736
Medicaid Membership: 52,005
Organizational Updates
![Page 6: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/6.jpg)
Current Membership for Idaho
Total Membership: 47,685 Covered Lives
Commercial Membership: 27,038
Medicare Membership: 20,647
Organizational Updates
![Page 7: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/7.jpg)
Organizational Updates
National Committee for
Quality Assurance (NCQA)
![Page 8: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/8.jpg)
Organizational Updates
PacificSource and NCQA • PacificSource began the accreditation
process in January of 2013. • Anticipate seeing PacificSource Health
Plans on the NCQA website in May or June. • We would like to thank you for your
patience and assistance.
![Page 9: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/9.jpg)
Organizational Updates
Examples of NCQA requirements • Required information on all rosters:
o Effective and termination dates for all licensure
o Provider directory enhancements −Hospital affiliation
−Board certification
−Language spoken
• PacificSource is required to notify members 30 days in advance of a provider leaving a practice.
![Page 10: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/10.jpg)
Organizational Updates
Provider Changes • Provider groups shall use their best efforts
to notify PacificSource and/or their IPA promptly and in advance of the addition or termination of a provider. o We need notification from providers at least 45-
60 days prior.
![Page 11: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/11.jpg)
Organizational Updates
Locum Tenens
![Page 12: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/12.jpg)
Organizational Updates
Locum Tenens Policy • For Locum Tenens providing coverage for 60 or
fewer consecutive days, we will require: o A Locum Tenens application
o Current DEA certificate
o Copy of professional liability coverage
![Page 13: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/13.jpg)
Organizational Updates
Locum Tenens Policy • For Locum Tenens providing coverage for longer
than 60 consecutive days, we will require: o A full and complete practitioner credentialing
application.
• Locum Tenens must be credentialed prior to being paid under the absent provider’s contract.
• This policy applies to all PacificSource lines of business.
![Page 14: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/14.jpg)
Organizational Updates
Billing for Locum Tenens • Each healthcare provider or supplier who is
rendering the service, must be listed in box 31 of the CMS 1500 form.
• PacificSource does not permit incident-to-billing.
• Claims billed prior to the locum tenens credentialing approval will be denied as provider write-off.
![Page 15: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/15.jpg)
Organizational Updates
HEDIS
![Page 16: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/16.jpg)
What is HEDIS? • Healthcare Effectiveness Data and Information
Set • Required by CMS • Required for NCQA certification for any line of
business • PacificSource does HEDIS for Commercial and
Medicare • Set of standardized performance measures
Organizational Updates
![Page 17: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/17.jpg)
HEDIS continued • Measure data sources: Admin (medical and
Rx claims), Hybrid (patient chart), and Survey • Measure Domains – Effectiveness of care,
Access, Availability, Cost of Care, Use of Services, and Health Plan Descriptive Info
• Measurement Year – Most look at care in most recent calendar year. Some look back >2 yrs
• HEDIS is a major data source for Medicare 5 Star Program and NCQA certification
Organizational Updates
![Page 18: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/18.jpg)
HEDIS continued • HEDIS medical record measures assess
compliance with accepted prevention and chronic condition guidelines.
• Some measures are calculated using claims data, some use medical record documentation, some use both.
• Many of the measure results are influenced or controlled by physicians.
• Members are randomly selected for medical record portion of HEDIS audits.
Organizational Updates
![Page 19: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/19.jpg)
HEDIS continued • Information for HEDIS audit completion will
either be requested directly by PacificSource or on our behalf by our vendors: Outcomes Health for Commercial and Verisk for Medicare.
• Any questions regarding the HEDIS audit should be directed to: o Provider Network (800) 624-6052 ext 2580 o Outcomes Health (855) 767-2650 o Verisk Health (877) 489-8437
Organizational Updates
![Page 20: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/20.jpg)
Organizational Updates
Billing Updates
![Page 21: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/21.jpg)
Organizational Updates
New CMS 1500 Form (Rev 02/12) The CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting.
Changes on the form include: • Fields 8, 9b, 9c, 11b, and 30 • Other fields were changed to
reflect usage. • 12 lines now available for
diagnosis codes.
![Page 22: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/22.jpg)
Organizational Updates
New CMS 1500 Form • Effective April 1, 2014, PacificSource Medicare
is only accepting claims billed using the revised form (02/12). This includes corrected claims that were previously submitted on the (08/05) version.
• PacificSource Health Plans will continue to accept both versions, however we highly encourage providers to use the updated version.
![Page 23: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/23.jpg)
Organizational Updates
ICD-10 • Implementation pushed to October 1,
2015 (at the earliest). • PacificSource has completed:
o System upgrades
o Impact assessments
o Translation Mapping ICD-9 to ICD-10
o End to end testing with several large health systems
![Page 24: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/24.jpg)
Organizational Updates
Has your organization begun ICD-10 planning?
Yes, 76.8%
No, 23.2%
151 People Surveyed • Yes – 116
• No – 35
• Skipped Question – 16
![Page 25: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/25.jpg)
Organizational Updates
Please estimate how much of the planning process your organization has completed.
47%
36%
13%
4% Answer Options
Response Percent
Response Count
0-25% 46.8% 51
25-50% 35.8% 39
50-75% 12.8% 14
75-100% 4.6% 5
![Page 26: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/26.jpg)
ICD-10 Tip and Tricks • AAPC crosswalk from ICD-9 to ICD-10
http://www.aapc.com/ICD-10/crosswalks/pdf-documents.aspx.
• Visit AAPC for more helpful tools, such as: o Searchable databases
o Educational webinars
o Educational articles
o ICD-10 conversion issues and trends
Organizational Updates
![Page 27: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/27.jpg)
ICD-10 Resources • If you have questions regarding
PacificSource and ICD-10, please email [email protected].
• Visit CMS’s website for another great resource on the ICD-10 transition: cms.gov/ICD10.
• If you are interested in end-to-end testing with us, please complete our brief survey at SurveyMonkey.com/s/T3CTNL6.
Organizational Updates
![Page 28: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/28.jpg)
Commercial Updates
Commercial Updates
![Page 29: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/29.jpg)
Commercial Updates
PacificSource Administrators (PSA) • Effective April 1, 2014, PSA claims will be
payable via EFT. • If you are already set up to receive EFT
and/or ERA, you do not need to do anything. • New EFT enrollees will now be getting
payments for commercial, Medicare, and PSA members.
• Updated EFT/835 enrollment form now available on our website.
![Page 30: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/30.jpg)
Commercial Updates
Dedicated Provider Customer Service Phone Number
(855) 896-5208 *Benefit questions, claims inquiries, etc.
![Page 31: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/31.jpg)
Healthcare Reform
Healthcare Reform – Your Health Idaho
![Page 32: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/32.jpg)
ACA Employer Mandate Changed • Although mandate was effective in 2014,
the enforcement was delayed until 2015.
• Under the final rules, businesses now have even more time to comply. o Large groups (100+) have until 2015 to
comply.
o Mid-size groups (50-99) have until 2016 to comply
Healthcare Reform
![Page 33: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/33.jpg)
Pediatric Vision Benefit • Members through 18 years of age.
• Licensed ophthalmologist or optometrist
• One vision exam per year* including refraction
• One pair of non-collection glasses (lenses and frames) per year*
• Contact lens services and materials per year* *Benefits/frequencies are per calendar or per plan year. Limits on hardware also apply.
Healthcare Reform
![Page 34: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/34.jpg)
Oregon
PSN
SmartHealth
Prime
Idaho
PSN
SmartHealth
SmartAlliance
BrightIdea
Montana
PSN
SmartHealth
Healthcare Reform Networks
![Page 35: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/35.jpg)
TIER
3
TIER
2
TIE
R 1
SmartHealth Contracted Providers
PSN Providers
Non-participating Providers
Healthcare Reform SmartHealth Network Northern & Eastern Counties
![Page 36: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/36.jpg)
Healthcare Reform
TIE
R 2
TIE
R 1
St. Alphonsus MDs and Hospitals Independent providers part of St. Alphonsus Alliance
Non-participating providers
SmartAlliance Network Treasure Valley
![Page 37: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/37.jpg)
Healthcare Reform
TIER
2
TIER
1 St. Luke’s
MD’s and Hospitals Independent BrightPath providers
Non-participating providers
BrightPath Network Treasure & Magic Valley
![Page 38: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/38.jpg)
Becoming a contracted provider:
• BrightPath (Southwest Idaho) o Contract and credentialing completed by BrightPath o For any contract questions, please contact BrightPath at
(877) 814-5505 or http://yourbrightpath.com/
• SmartAlliance (Southwest Idaho) o Contracting completed by the Saint Alphonsus Health
Alliance o For any contract questions, please contact their provider
network committee at (208) 367-8698
Healthcare Reform
![Page 39: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/39.jpg)
Becoming a contracted provider:
• SmartHealth (Northern and Eastern Idaho) o Contracting completed by PacificSource o For any contract questions, please contact
Provider Network at: (800) 624-6052 or [email protected].
• PSN o Contract and credentialing completed by IPN o Contact (208) 333-1513 or visit their website at
http://ipnmd.com/ipn/.
Healthcare Reform
![Page 40: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/40.jpg)
Nominate a Provider
![Page 41: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/41.jpg)
Nominate a Provider
![Page 42: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/42.jpg)
Healthcare Reform
2013 vs 2014
G = Commercial group coverage N = Individual policy GE = Group Exchange NE = Nongroup Exchange (individual member)
![Page 43: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/43.jpg)
Medicare Updates
Medicare Updates
![Page 44: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/44.jpg)
Risk-Adjustment Chart Review • Please remember that Medicare Advantage
providers must participate in our risk-adjustment chart review.
• The reviews are conducted by Altegra Health, a PacificSource Medicare vendor.
• Data validation is submitted to CMS for a portion of risk-adjustment payment.
Medicare Updates
![Page 45: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/45.jpg)
Risk-Adjustment Chart Review • Chart reviews may be requested
throughout the year as we prepare for our CMS submissions, which are due in January, March, and September.
• Provider offices are notified of chart requests in writing and by phone.
• Applies to Medicare Advantage products only.
Medicare Updates
![Page 46: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/46.jpg)
Outbound Member Call Program • PacificSource Medicare has partnered with Eliza, a
vendor, to develop and implement a targeted member outreach effort.
• Part of our Medicare 5-star program.
• Call topic examples include: o Preventive screening reminders o Diabetes care o Heart health o Post-hospital discharge o Medication Adherence
Medicare Updates
![Page 47: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/47.jpg)
Outbound Member Call Program • Purpose is to improve the overall health
and satisfaction of our members.
• Member questions should be directed to our Medicare Customer Service Department at (888) 863-3637.
Medicare Updates
![Page 48: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/48.jpg)
Post payment review • As part of a CMS requirement, PacificSource
Medicare will begin conducting post payment audits May 1, 2014.
• Audits will focus primarily on: o Medical necessity
o Proper utilization
o Appropriateness of services
o Accuracy of claims submitted
Medicare Updates
![Page 49: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/49.jpg)
Post payment review • Providers selected for audit will be notified in
writing.
• Notifications will include:
o type of audit
o applicable claims
o required documentation
o due date
Medicare Updates
![Page 50: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/50.jpg)
Post payment review • If records are not received, we will request refunds
on the claims until records are received.
Note: records will be obtained electronically if EHR access has been granted.
• Future audits may focus on the overuse of modifiers billed 59 and 25.
Medicare Updates
![Page 51: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/51.jpg)
2014 CMS OPPS Changes • Outpatient Lab Tests o Packaged – Bill Type 13x − When performed on same date as primary service − Ordered by same practitioner who ordered
primary service o Not Packaged – Bill Type 14x − The only service performed on that date − Ordered for purpose separate from the primary
procedure and ordered by different provider
Medicare Updates
![Page 52: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/52.jpg)
CMS OPPS Changes Scenario A • Patient scheduled for eye surgery by an ophthalmologist • On same date of service patient received unrelated lab tests
ordered by cardiologist. • Payment for the lab tests not packaged; hospital reimbursed
separately for each service.
Scenario B • Patient scheduled for eye surgery by an ophthalmologist • Ophthalmologist orders lab tests as a part of preoperative testing. • Tests performed on the same date of service as the eye procedure. • Payment for the lab tests packaged into payment for the surgical
procedure under OPPS.
Medicare Updates
![Page 53: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/53.jpg)
2014 CMS OPPS Changes • G0463
o Applies to CAH and Acute hospitals o Applies to hospitals reimbursed based off
of OPPS only.
oReplaces E&M codes 99201-99205 and 99221-99215
Medicare Updates
![Page 54: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/54.jpg)
2014 CMS OPPS Changes
• CMS Bundling o Drugs, biologicals, and radiopharmaceuticals
that function as supplies when used in a diagnostic test or procedure
o Drugs and biologicals that function as supplies or devices when used in a surgical procedure
o Clinical diagnostic laboratory tests (except molecular pathology) when provided on the same date of service as another service
o Procedures described by add-on codes o Device removal procedures
Medicare Updates
![Page 55: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/55.jpg)
Referral vs. Authorization
• A “referral” is the process by which the member's primary care provider (PCP) directs a member to obtain care for covered services from other health professionals in an office setting.
Please note: The referral must be submitted directly to PacificSource Medicare by the PCP.
• A “Prior authorization” is defined as a request for a specific service that requires a review to determine medical necessity. Services that require prior authorization are outlined on our website at www.Medicare.Pacificsource.com.
Medicare Updates
![Page 56: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/56.jpg)
Referrals required for Essentials Plans (HMO) • Referrals are not required for the following:
o Urgent care/Emergent Care o Chiropractic/Physical Therapy o Routine women’s healthcare (mammograms) o Routine colonoscopies o Routine Eye Exam o Flu shots o Pneumonia vaccinations o Diabetes self-management training o Kidney dialysis
Medicare Updates
![Page 57: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/57.jpg)
Referral Scenarios: Question: When is a referral needed?
Answer: Before seeing an in-network specialty provider*, a member must obtain a referral from his or her PCP. If additional services from another specialty provider are needed, the PCP will coordinate a referral to the appropriate specialist.
Question: What if the member had a previously scheduled office visit before becoming eligible with PacificSource Medicare?
Answer: In this situation, a referral from the member’s PCP is still required. * Requests to see an out-of-network provider must be submitted via the prior authorization process and are not considered a referral.
Medicare Updates
![Page 58: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/58.jpg)
Referral Scenarios: Question: Is an approved referral request limited to the specialist designated by the member’s PCP? Answer: No. The approved referral covers services from any provider that practices in the same group and has the same specialty as the provider approved on the request.
Question: How will I know my referral request has been approved? Answer: Notification method is determined on how the request is submitted.
o Faxed requests: the determination notice will be mailed and/or faxed to the referring provider and specialist.
o Online requests: the determination notice will be viewable on InTouch.
Medicare Updates
![Page 59: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/59.jpg)
Referral Scenarios:
Question: Do facilities billing for urgent care services on a UB-04 claim form require a referral?
Answer: No. Referrals are not required for services rendered in an urgent care setting when billed accordingly.
Question: Does follow-up care for specialty services, as a result of an urgent care or emergency room visit, require a referral from the member’s PCP?
Answer: Yes. A referral is required from a PCP for follow-up services provided outside of an urgent care or emergency room setting.
Medicare Updates
![Page 60: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/60.jpg)
Health Services Update • Urgent Preauthorization and Referral
Requests o Two methods for submitting Urgent Requests: − PacificSource Medicare Authorization and Referral
Request Form Clearly annotate on the request form that you are submitting an
“urgent request”
− Via In-Touch Ensure you choose “yes” under Urgent Request
o In order to expedite processing, call our Health Services after you submit the request
Medicare Updates
![Page 61: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/61.jpg)
Vision Benefits • Routine Services
o No prior authorization is required for routine (refractive) eye exams
o Limited to one exam every 2 years o Hardware/contacts- $100 every 2 years
• Medical Services o Referral is required, no prior authorization is required o One pair of glasses or contacts after each cataract
surgery including intraocular lens
Medicare Updates
![Page 63: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/63.jpg)
PacificSource.com
![Page 64: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/64.jpg)
PacificSource.com
![Page 65: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/65.jpg)
Organizational Updates
Provider Bulletin
![Page 66: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/66.jpg)
Organizational Updates
Provider Bulletin • PacificSource has combined our two
provider newsletters; CommunityCare (Medicare and Medicaid) and Provider Bulletin (Commercial).
• Beginning with the Spring 2014 edition, providers can expect to see topics related to all lines of business in the Provider Bulletin.
![Page 67: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/67.jpg)
Organizational Updates
Provider Bulletin • The Provider Bulletin will be distributed
quarterly to those who have opted in to receive the newsletter as well as those who were on the distribution to receive the CommunityCare newsletter.
• Current and past newsletter editions may be found on any of our three websites.
![Page 68: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/68.jpg)
PacificSource.com
![Page 69: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/69.jpg)
PacificSource.com
![Page 70: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/70.jpg)
PacificSource.com
![Page 72: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/72.jpg)
Medicare.PacificSource.com
![Page 73: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/73.jpg)
Medicare.PacificSource.com
![Page 74: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/74.jpg)
Medicare.PacificSource.com
![Page 75: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/75.jpg)
Medicare.PacificSource.com
![Page 76: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/76.jpg)
InTouch Provider Portal
InTouch Provider Portal
![Page 77: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/77.jpg)
InTouch Provider Portal InTouch for Providers • Secure, interactive website for providers o Commercial and Medicare Advantage members o Online eligibility o View and submit referral and preauthorization
requests o Online claim status o Explanation of payment
• Point of service direct o Access real-time patient liability information
and your actual charges for each procedure billed
![Page 78: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/78.jpg)
InTouch Provider Portal
InTouch – OneHealthPort • InTouch for Providers is accessed through
OneHealthPort.
• OneHealthPort is a web portal that provides access to secure health plan websites with a single user ID and password.
• If you are already an OneHealthPort user, you do not need to register again to access InTouch.
![Page 79: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/79.jpg)
InTouch Provider Portal
InTouch – OneHealthPort • Register for OneHealthPort via their website:
www.OneHealthPort.com/Register/Index.php.
• Providers who need to use “Forgot My Password” or “Forgot My UserID” links can find them on the OneHealthPort sign in page.
• For questions or assistance with the registration process, please contact:
OneHealthPort’s Help Desk: (800) 973-4797
![Page 80: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/80.jpg)
InTouch Provider Portal
![Page 81: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/81.jpg)
InTouch Provider Portal
![Page 82: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/82.jpg)
InTouch Provider Portal
![Page 83: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/83.jpg)
InTouch Provider Portal
![Page 84: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/84.jpg)
InTouch Provider Portal
03/01/1938 03/01/1938 03/01/1938
The search feature returns active member records only. Referral requests for terminated members must be submitted to PacificSource via fax.
![Page 85: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/85.jpg)
InTouch Provider Portal
Not all PacificSource plans require referrals. Please reference the member’s ID card to verify if referral requirements apply.
![Page 86: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/86.jpg)
InTouch Provider Portal
Populate the online referral form with the appropriate referral information. Fields marked with an asterisk* are required.
![Page 87: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/87.jpg)
InTouch Provider Portal
Submitting supporting documentation online speeds up the processing time for requests.
![Page 88: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/88.jpg)
InTouch Provider Portal
Once the referral is generated, the requesting provider and the referred to provider will be able to view and track the referral request via InTouch.
![Page 89: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/89.jpg)
InTouch Provider Portal Example of referral approval
![Page 90: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/90.jpg)
Online Pharmacy Prior Authorization Requests • Effective April 1, 2014, providers can now
submit pharmacy prior authorization requests online via the InTouch web portal.
• This includes requests for both Commercial and Medicare members.
Organizational Updates
![Page 91: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/91.jpg)
Organizational Updates
![Page 92: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/92.jpg)
Organizational Updates
![Page 93: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/93.jpg)
Organizational Updates
![Page 94: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/94.jpg)
Organizational Updates
![Page 95: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/95.jpg)
InTouch Provider Portal
Explanation of Payments (EOPs) can also be found by selecting the “Billing” tab on the InTouch home page.
![Page 96: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/96.jpg)
InTouch Provider Portal
EOP Schedule • EFT delivery - Wednesday • Paper EOPs - mailed
Wednesday • InTouch EOP delivery -
Thursday • Holidays will delay delivery • EOPs are available for two
years
![Page 97: Spring 2013 Provider Workshop COG - PacificSource › provider › 2014-ihcc-idaho.pdfThe CMS 1500 form has been updated to align with 5010 837P and accommodate ICD-10 reporting. Changes](https://reader034.vdocuments.net/reader034/viewer/2022042401/5f0fb2fe7e708231d44572dc/html5/thumbnails/97.jpg)
Thank you!
Questions?