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

Wed Feb 21 14:18:01 EST 2018

________________________________

Hi Dr. Lopez,

   Since we're in the throes of flu season with more to come, I thought I'd ask if you can take an expedited look at this payment glitch wherein payment for flu testing is being denied unless the test turned out positive.

   Thanks in advance for your attention,

      Jon

      Ohio AAP Pediatric Council Co-chair

________________________________

[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=>
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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.
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