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Paramount Health Options (PHO)
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Health Net Federal Services – TRICARE

Health Net Federal Services (HNFS) is now administering contracted services to TRICARE West Beneficiaries. PHO encourages all participating provider offices to attend a TRICARE webinar. Click here for dates and times: http://cedarrapidspho.cmail19.com/t/t-i-ulirok-l-n/


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Medicare New Card Design -

CMS has announced a new Medicare card design which will contain a unique, randomly assigned number that replaces the current Social Security-based number. CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. Click here for additional information regarding this upcoming change.
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UnitedHealthcare Payment Integrity

UnitedHealthcare recently shared a presentation on their Payment Integrity department. Payment Integrity's mission is to ensure UnitedHealthcare pays what it owes and to comply with CMS and state program integrity program guidelines. Click here to view that presentation which goes into detail on their medical record request process.
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2018 Medica Plans on the Iowa Exchange

Medica is offering three individual and family business (IFB) health plan products in Iowa and Nebraska that will be effective January 1, 2018. Medica Insure, Inspire by Medica, and Medica with CHI Health.

Click here to view Medica's product brochure with additional information regarding the plans and where each plan is available. http://cedarrapidspho.cmail19.com/t/t-i-kullwy-l-n/

Click here to view additional information on availability, specialty networks, benefits, and claim submission. http://cedarrapidspho.cmail19.com/t/t-i-kullwy-l-p/
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PA Supervisory Training

Physicians who supervise physician assistants are required to have a written agreement that defines the nature and extent of the supervision provided under new administrative rules that the Iowa Board of Medicine will begin enforcing on January 1, 2018. To help implement the new rule, the Board is providing a sample agreement and a list of frequently asked questions about supervisory agreements along with online interactive training. Click here to view the press release, the sample agreement, frequently asked questions, and the schedule of trainings. http://cedarrapidspho.cmail20.com/t/t-i-khiyal-l-n/
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Medicaid Cost Containment Strategies

IME has announced two new cost containment strategies. The first impacts out-of-network reimbursement for MCO claims and is effective immediately. If a provider sees an MCO-enrolled member which the provider is not enrolled with, the out-of-network provider will be reimbursed at 80% for all services. Click here to read the informational letter announcing this change. http://cedarrapidspho.cmail20.com/t/t-i-kdjtgl-l-n/

Effective 10/01/2017, IME will increase the reduction percentage for multiple diagnostic imaging procedures payment reduction from the current 25% to 50%. IME announced that they are making this change to be consistent with Medicare and other payers. Click here to read the informational letter explaining this change. http://cedarrapidspho.cmail20.com/t/t-i-kdjtgl-l-p/
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Health Alliance

Health Alliance will have eviCore begin managing additional preauthorization services for commercial and Medicare members. Effective August 1, 2017, the below services will require authorization through eviCore. Providers may start to use eviCore to submit these request on July 14, 2017. The training options available are listed below. Click here to view the slides that will be covered in the training. http://cedarrapidspho.cmail20.com/t/t-i-kjhytry-l-n/

Medical Oncology
• Thursday, July 20 at 11 a.m.
• Wednesday, July 26 at 9 a.m.

Radiation Therapy
• Monday, July 17 at 1 p.m.

Musculoskeletal Services: Pain/Joint/Spine and MSK Therapies
• Thursday, July 13 at 11 a.m.
• Tuesday, July 18 at 10 a.m.
• Friday, July 28 at 3 p.m.

Sleep Management
• Friday, July 14 at 10 a.m.
• Wednesday, July 19 at 11 a.m.
• Friday, July 21 at 9 a.m. – DME Providers Only
• Thursday, July 27 at 1 p.m.

To register for training please go to eviCore.webex.com, choose the training center tab and find the time and date of the session you would like to attend.
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Wellmark Clear Coverage Tool

Wellmark has a vendor relationship with McKesson for their Clear Coverage Tool. Effective June 30, 2017, McKesson has made updates to the minimum browser settings required to access the Utilization Management Tool (UM Tool). These updates were made to enhance security when using the UM Tool. Users who attempt to access the UM Tool through an unsupported browser will experience disruptions in access and should consider upgrading to a supported browser as soon as possible. The following minimum browser settings have been updated in the Inpatient Services User Guide, Procedures, Imaging and DME User Guide, and the Out-of-Network Services User Guide.

UM Tool Browser Requirements:
• Microsoft Internet Explorer® 11
• Google Chrome™ (38 and higher)
• Mozilla Firefox® (27 and higher)
To view the updated minimum browser settings in the User Guides, click here. http://cedarrapidspho.cmail19.com/t/t-i-kjudkty-l-n/
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Office Express June Specials

Click the link below to view the Office Express June Specials. Office Express works with the top manufacturers to help reduce overhead on supplies, paper, janitorial, technology, and furniture products.
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Health Alliance Sleep Management Prior Authorization Changes

The Health Alliance preauthorization requirements for Sleep Management, C-PAP and related supplies have changed. Effective 08/01/17, Sleep Management services, C-PAP and related supplies will require preauthorization through eviCore. Health Alliance and eviCore recently presented webinars regarding the new preauthorization requirements.

Health Alliance postponed the effective date from 06/01/17 to 08/01/17. Click here to view the Sleep Management presentation specific to C-PAP and supplies. http://cedarrapidspho.cmail19.com/t/t-i-krhdutt-l-n/
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