[Ohioaap-practicemanagers] Fw: FW: [SOAPM] Hassle factor form

Thu Feb 15 14:07:52 EST 2018

Hi Dr. Miller and AAP Private Payer Advocacy Committee and Ohio Pediatric Council colleagues,

   I wrote to Dr. Donald Wharton, our most recent CareSource medical director (Melanie, please let me know if there is a different, more recent director) to ask for an expedited look at this since the flu is only forecast to get worse during the remainder of this long season.

  This is the first report of this issue so thanks for filling the Hassle Factor Form.

   Dr. Miller, can you keep a copy of the explanation of the denial in case we need it?

   Ohio Practice Management Listserv, do any of you have any workarounds or solutions for this?

   Jon Price, MD FAAP

   Ohio AAP Pediatric Council Co-chair

________________________________
From: Jon Price <njnprice at gmail.com>
Sent: Wednesday, February 14, 2018 9:25 PM
To: Price, Jonathan
Subject: Fwd: FW: [SOAPM] Hassle factor form

[WARNING: External Email - Use Caution]

---------- Forwarded message ----------
From: Terranova, Lou <LTerranova at aap.org<mailto:LTerranova at aap.org>>
Date: Wed, Feb 14, 2018 at 4:16 PM
Subject: FW: [SOAPM] Hassle factor form
To: "njnprice at gmail.com<mailto:njnprice at gmail.com>" <njnprice at gmail.com<mailto:njnprice at gmail.com>>
Cc: "Edwards, Anne" <aedwards at aap.org<mailto:aedwards at aap.org>>

Hi Dr. Price:

Sharing the email thread below for your thoughts.  Per the highlighted text below, Dr. Jennifer Miller of Pediatric Associates of Lancaster, Inc.
(jennifermiller79 at gmail.com<mailto:jennifermiller79 at gmail.com>) is having issues with Medicaid managed care in Ohio over payment for the in-office Liat flu test.

Has the chapter or pediatric council addressed this?

Thank you

lt
Louis A. Terranova
Senior Health Policy Analyst
Divison of Health Care Finance
American Academy of Pediatrics
345 Park Blvd., Itasca, IL<https://urldefense.proofpoint.com/v2/url?u=https-3A__maps.google.com_-3Fq-3D345-2BPark-2BBlvd.-2C-2BItasca-2C-2BIL-25C2-25A0-2B60143-26entry-3Dgmail-26source-3Dg&d=DwMFaQ&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=anTctJhkpqxmDnVS8isg6A3DFpkdXkHUmhm1G4xLxDjLJXy4c4XsjwCZ6bfhjUOI&m=uHrTdT4wWH3D3ggO2O2OHvnJv1NFwhnCGWMlUtTaph0&s=X9vLVI7iqDiX1OCv8aR0g0_hJdmerGyxJb8MfhDEJm4&e=>  60143<https://urldefense.proofpoint.com/v2/url?u=https-3A__maps.google.com_-3Fq-3D345-2BPark-2BBlvd.-2C-2BItasca-2C-2BIL-25C2-25A0-2B60143-26entry-3Dgmail-26source-3Dg&d=DwMFaQ&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=anTctJhkpqxmDnVS8isg6A3DFpkdXkHUmhm1G4xLxDjLJXy4c4XsjwCZ6bfhjUOI&m=uHrTdT4wWH3D3ggO2O2OHvnJv1NFwhnCGWMlUtTaph0&s=X9vLVI7iqDiX1OCv8aR0g0_hJdmerGyxJb8MfhDEJm4&e=>
Email: lterranova at aap.org<mailto:lterranova at aap.org>
Phone: 1-630-626-6633<tel:(630)%20626-6633>
Fax: 847-434-8000<tel:(847)%20434-8000>

From: Edwards, Anne
Sent: Wednesday, February 14, 2018 3:09 PM
To: Terranova, Lou <LTerranova at aap.org<mailto:LTerranova at aap.org>>
Subject: FW: [SOAPM] Hassle factor form

See below.  Perhaps connect with Jon Price?

Anne R. Edwards, MD FAAP
Senior Vice President, Primary Care & Subspecialty Pediatrics
American Academy of Pediatrics
Office: 630.626.6717<tel:(630)%20626-6717>
Cell: 612.532.3879<tel:(612)%20532-3879>
aedwards at aap.org<mailto:aedwards at aap.org>

From: richard lander [mailto:rlempg at gmail.com]
Sent: Wednesday, February 14, 2018 2:49 PM
To: Edwards, Anne <aedwards at aap.org<mailto:aedwards at aap.org>>; mark.hudak <mark.hudak at jax.ufl.edu<mailto:mark.hudak at jax.ufl.edu>>
Subject: Fwd: [SOAPM] Hassle factor form

fyi
richard
---------- Forwarded message ----------
From: All Star SOAPM <allstarsoapm at gmail.com<mailto:allstarsoapm at gmail.com>>
Date: Wed, Feb 14, 2018 at 12:25 PM
Subject: Re: [SOAPM] Hassle factor form
To: SOAPM at listserv.aap.org<mailto:SOAPM at listserv.aap.org>

On Jan 31, 2018 3:32 PM, "richard lander" <rlempg at gmail.com<mailto:rlempg at gmail.com>> wrote:
jen
have you spoken with your aap chapter and their connections with Medicaid?
the aap is looking to have a ppaac-like structure to handle Medicaid issues but we are not there yet
Richard lander

On Tue, Jan 30, 2018 at 3:12 PM, Jennifer Miller <jennifermiller79 at gmail.com<mailto:jennifermiller79 at gmail.com>> wrote:
Are Hassle factor forms only for problems with private insurance companies?   We have never submitted one before, but are having problems with one of our managed medicaid plans in Ohio.  They will only pay for the in office Liat Flu test if the associated diagnosis is influenza.  If the test is negative and the CPT is attached to another ICD-10 code (such as fever R50.9) they will not pay for the test.  This seems absurd to only pay for a test if the result is positive.  I would not be even ordering the test if I knew what the result was going to be before billing for it.  We have already contacted our rep for the insurance plan, but they are notoriously slow at resolving issues and paying for old claims that they originally deny and then later decided to cover.

--
Jennifer Miller, MD
Pediatric Associates of Lancaster, Inc.
www.palsmds.com<https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.palsmds.com-26data-3D02-257C01-257Caedwards-2540aap.org-257C555280eb0f5c43c1611608d573ec5935-257C686a5effab4f4bad8f3a22a2632445b9-257C0-257C0-257C636542381313847288-26sdata-3DIqiYtH-252BYG86-252B9Q78BJjNz0OnOB5UKdYFVNojJ-252B1BKE0-253D-26reserved-3D0&d=DwMFaQ&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=anTctJhkpqxmDnVS8isg6A3DFpkdXkHUmhm1G4xLxDjLJXy4c4XsjwCZ6bfhjUOI&m=uHrTdT4wWH3D3ggO2O2OHvnJv1NFwhnCGWMlUtTaph0&s=SAff2YNGbfUcbDD0kbgQQ7DoJ992kN9yubD8I6bL7zY&e=>
1550 Sheridan Dr <https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttps-253A-252F-252Fmaps.google.com-252F-253Fq-253D1550-252BSheridan-252BDr-2525C2-2525A0Suite-252B102-252BLancaster-252C-252BOH-252B43130-2526entry-253Dgmail-2526source-253Dg-26data-3D02-257C01-257Caedwards-2540aap.org-257C555280eb0f5c43c1611608d573ec5935-257C686a5effab4f4bad8f3a22a2632445b9-257C0-257C0-257C636542381313847288-26sdata-3D901Wyqf7WYAXx9vfpqqLHtInxpQIKD1i90RNoDXNnTo-253D-26reserved-3D0&d=DwMFaQ&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=anTctJhkpqxmDnVS8isg6A3DFpkdXkHUmhm1G4xLxDjLJXy4c4XsjwCZ6bfhjUOI&m=uHrTdT4wWH3D3ggO2O2OHvnJv1NFwhnCGWMlUtTaph0&s=kB7i6N6x4mvJax62LTWDktP1h3T1yDq_p--u6gYltss&e=>
Suite 102<https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttps-253A-252F-252Fmaps.google.com-252F-253Fq-253D1550-252BSheridan-252BDr-2525C2-2525A0Suite-252B102-252BLancaster-252C-252BOH-252B43130-2526entry-253Dgmail-2526source-253Dg-26data-3D02-257C01-257Caedwards-2540aap.org-257C555280eb0f5c43c1611608d573ec5935-257C686a5effab4f4bad8f3a22a2632445b9-257C0-257C0-257C636542381313847288-26sdata-3D901Wyqf7WYAXx9vfpqqLHtInxpQIKD1i90RNoDXNnTo-253D-26reserved-3D0&d=DwMFaQ&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=anTctJhkpqxmDnVS8isg6A3DFpkdXkHUmhm1G4xLxDjLJXy4c4XsjwCZ6bfhjUOI&m=uHrTdT4wWH3D3ggO2O2OHvnJv1NFwhnCGWMlUtTaph0&s=kB7i6N6x4mvJax62LTWDktP1h3T1yDq_p--u6gYltss&e=>
Lancaster, OH 43130<https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttps-253A-252F-252Fmaps.google.com-252F-253Fq-253D1550-252BSheridan-252BDr-2525C2-2525A0Suite-252B102-252BLancaster-252C-252BOH-252B43130-2526entry-253Dgmail-2526source-253Dg-26data-3D02-257C01-257Caedwards-2540aap.org-257C555280eb0f5c43c1611608d573ec5935-257C686a5effab4f4bad8f3a22a2632445b9-257C0-257C0-257C636542381313847288-26sdata-3D901Wyqf7WYAXx9vfpqqLHtInxpQIKD1i90RNoDXNnTo-253D-26reserved-3D0&d=DwMFaQ&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=anTctJhkpqxmDnVS8isg6A3DFpkdXkHUmhm1G4xLxDjLJXy4c4XsjwCZ6bfhjUOI&m=uHrTdT4wWH3D3ggO2O2OHvnJv1NFwhnCGWMlUtTaph0&s=kB7i6N6x4mvJax62LTWDktP1h3T1yDq_p--u6gYltss&e=>
740-687-6386<tel:(740)%20687-6386>

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