Messages from the Clinicians....

November 1999

Billing Update

Billed Units: There was a system problem with billed units. Original claims were returned to the provider in error. If you have billed units issued, please contact Wausau’s Claims Unit at 1-800-826-9761, extension 8528.

Remittance Advice (RA) Update: If your RA shows “correction” in the charge amount field, left hand column, this means that Wausau is reviewing your claim. THIS IS NOT A DENIAL!

If you have billing questions concerning the new Michigan Uniform Procedure codes, please contact Marie at the Plan.
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DME/ Medical Suppliers Update

Orthotics/Prosthetics DO NOT need prior authorization if the following criteria are met:

• In-plan provider.
• Item is on the fee schedule.
• Member is on UPHP.
• Must follow MSA Policy limitations/exclusions.

DME/Medical supplies DO NOT need prior authorization if the following criteria are met:

• In-plan provider.
• Item is on fee schedule.
• Member is on UPHP.
• Must follow MSA Policy limitations/exclusions.
• Fee Schedule reimbursement MUST be under $500.00 per item.
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Sterilization Update

Although a REFERRAL from the PCP to the specialist is still REQUIRED, effective immediately, NO PRIOR AUTHORIZATION is required for the sterilization procedure itself, male or female. To receive reimbursement, follow MSA Policy and submit a signed sterilization consent form along with the facility and physician claims.

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Authorization Clarification

Just a reminder: A specialist needs a referral from a PCP or a referring specialist to see an enrollee or to order any testing services.

And did you know: When you request a diagnostic test from cardiology and rehabilitative specialists, it includes a consultive visit, therefore, a referral is necessary.                               Top                          

CEO Corner

The Upper Peninsula Health Plan and the Upper Peninsula Health Care Network (UPHCN) have established a Credential Verification Organization (CVO). A goal of the CVO is to reduce the number of times a physician is subjected to the multiple credentialing processes involved in participating at multiple hospitals. A single credential file will be built that can be used by all UPHCN hospitals. This file will be maintained and updated at the Upper Peninsula Health Plan. In all likelihood, the CVO will follow the JCAHO guidelines and accommodate all the requirements of the 14 UPHCN hospitals. If approved, the anticipated start date for the CVO is January 2000. We will inform you of the progress in the Dec/Jan Newsletter. Any questions or concerns can be directed to Jayne Stein, Credentialing Coordinator, at (906) 225-7500 or (888) 904-7526.

Correctional Medical Services (CMS) has terminated their contract with Upper Peninsula Health Plan as of September 28, 1999. Their termination is cited for multiple reasons but is primarily because they have signed with Blue Cross/Blue Shield of Michigan.(BCBSM) to serve the prison population statewide under the BCBSM PPO contract. CMS and/or BCBSM should have already communicated with you regarding any changes in billing instructions.

We have served them well and provided them with a complete range of services throughout the Upper Peninsula. We thank you for your participation with us in our short-term success in capturing this market for the UPHP. This experience demonstrates my ongoing concern that we must be able to offer a UP wide alternative to current significant market holders, and your willingness to participate in this contract had helped us in that objective. Once again, thank you for participation with the Upper Peninsula Health Plan.

William J. Streur, CEO                             Top

Credentialing Reminders

PROVIDER CHANGES
Anytime a provider changes their address, phone number, moves out of the area or retires, they should contact me either by writing, calling or faxing, so I can update our system.

NEW PROVIDERS
A new provider should contact me as soon as possible to start the credentialing process. The credentialing process is lengthy and can take up to 90 days. I have been receiving applications after the providers have started working. This causes delays in the providers seeing our members. UPHP wants new providers to be able to see our members as soon as necessary. Receiving the application before the provider starts will be much more efficient for everyone.

KEEPING YOUR CREDENTIAL FILE UPDATED
Please don’t forget to send your updated licenses and malpractice insurance. This information is needed to update our providers’ credential files. For your convenience, this information can be faxed to me at (906) 225-7690.

LOCUM TENENS
Before a Locum Tenens arrives at a facility to provide services to UPHP members, an application for credentialing must be submitted and approved by the Credentialing Committee. As soon as your hospital or clinic becomes aware of a potential need for Locum Tenens support, please contact me immediately so we can begin the process of credentialing. There have been numerous problems in the past with reimbursement to Locum Tenens for services provided, as they have been considered non participating until they complete credentialing. We want to prevent these problems by credentialing the provider and entering them in the system before their start date whenever possible. The credentialing process for Locum Tenens can take up to 30 days, so the sooner you contact me the better. If you have any questions or concerns, please contact me.

Credentialing Coordinator
Toll Free (888) 904-7286
Fax (906) 225-7690
bmrivord@uphp.com                               Top

Doctors Saving Money on Their Professional Liability

The Med-Reward Program that UPHP has made available to its providers through ProNational Insurance Company and Hetrick &  Associates Insurance Agency has been very successful. According to Scott White at Hetrick & Associates Insurance Agency, a number of physicians have joined the plan to take advantage of the savings. Member physicians have converted their professional liability insurance to ProNational. Member physicians already with ProNational have converted to the Med-Reward group to take advantage of premium discounts. Read below what one satisfied physician has experienced.

I recently received a mailing introducing the MedMal program for UPHP member physicians. The insurance program is sponsored by ProNational Insurance Company (formerly PICOM) and is marketed by Scott White of Hetrick & Associates Agency in Marquette. I contacted Scott for information regarding the program.

He provided an insurance proposal for me, subject to my joining UPHP, which resulted in significant premium savings over my present insurance carrier. Scott then referred me to UPHP and I immediately joined the plan. In addition to saving money, I now control my consent to settle, and I am able to take advantage of ProNational’s free risk management seminars and can utilize its interest-free payment plan.

I strongly recommend that my fellow UP physicians look into the member benefits of UPHP. The MedMal program alone is a benefit we all should take advantage of.

                       Mervin J. Specht, M.D.

Please contact Scott White at Hetrick & Associates Insurance Agency at             (800) 562-9773 to find out more or to obtain a proposal.
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