Private Payer Round-Up, April 2013

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy@texmed.org for help. Read more.

Claims | Contracts | National Provider Identifier | Policies | Prompt Pay | Ranking | Resources   

Claims  

• Blue Cross Paying for New Codes 
• Clear Claim Connection tool from BCBS-TX  NEW  
• Clean Claims 101: Read and Follow the Instructions  
• Claims Workflow Assistant from AMA  NEW 
• Coverage Coordination Through Availity  
• Get a Window on Blue Cross Code Auditing Rationale  
• CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15  
• Humana Consolidates Claims Edits  NEW 
• Insurance Company Transitions: UniCare and TRICARE  
• Second-Tier Claims Resolution Unit Can Help UnitedHealthcare Participants  
• Take Action on Stale Clean Claims  
•  Use Mail Log to Keep the Clock Ticking With Insurance Carriers  
• Verify Auditor Credentials   

Contracts  

• Monitor Payer Contracts to Help Manage Revenue  
• Physicians Can Get Paid During Credentialing Process  
• Physician Prices, Fee Schedules, and Managed Care Contract Offer and Acceptance (PDF)
• Rights Upon Plan Termination (PDF 3-31-12)
• E&M Cover Letter Template - Initial Notice (PDF) 

National Provider Identifier  

• More Answers to Your NPI Questions   

Policies  

• Auditors May Be Coming Your Way for Information Gathering  
• Blue Cross Blue Shield Coding Provisions in Effect  
• CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15  
• Coverage Coordination Through Availity  
• ERISA or TDI? Verify Which Health Plans Are Exempt From Prompt Pay Laws  
• ERS to Switch to United (Action, Mar. 15, 2012)
• Get out! Humana Kicks Physicians Out of Its Networks  
• Health Plan Requests for PHI (E-Tips, Feb. 11, 2013)  NEW 
• Insurance Company Transitions: UniCare and TRICARE  
• Physicians Can Get Paid During Credentialing Process  
• Preauthorization: What If the Diagnosis Changes?  
• Respond to This Informational Audit Request - UnitedHealthcare HEDIS audits for 2011 are coming up.
• TDI Fee Schedule Disclosure Rules  
• Verify Auditor Credentials  
• Write Off or Collect From the Patient?  
• Your DEA Number, Insurance Plans, and You   

Prompt Pay  

• ERISA or TDI? Verify Which Health Plans Are Exempt From Prompt Pay Laws  
• Late Fees Under Prompt Pay — How Much and When  
• New Prompt Pay Rules Curb Payment Delays   

Ranking  

• Physician Ranking  
• Blues Ranking Letters on the Way (Action, Dec. 3, 2012)

Resources  

• CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15  
• Clean Claims 101: Read and Follow the Instructions  
• Coverage Coordination Through Availity  
• ERISA or TDI? Verify Which Health Plans Are Exempt From Prompt Pay Laws  
•  Medicaid Offers Help Paying for Private Insurance  
• Monitoring Managed Care  
• Second-Tier Claims Resolution Unit Can Help UnitedHealthcare Participants  
• TDI Fee Schedule Disclosure Rules  
• TMA Knowledge Center: Got Questions?  
• Write Off or Collect From the Patient?
   

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