[Ohioaap-practicemanagers] [SOAPM] Hassle factor form

Wed Sep 26 15:10:42 EDT 2018

Has anyone gotten reimbursed yet from CareSource on the flu testing issue??

Last response I got from my provider rep was on 08/17/18 "The notes on the ticket state it will be going to committee next week."

Any help is appreciated?

Thanks,

Theresa

Theresa Von Hoene, CPEDC
Anderson Hills Pediatrics
Insurance Manager
513.232.8100 x3043

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________________________________
From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net> on behalf of Price, Jonathan via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net>
Sent: Wednesday, February 21, 2018 2:18 PM
To: karim.lopez at CareSource.com
Cc: jennifermiller79 at gmail.com; rlempg at gmail.com; Ohio AAP Prctc Mngr Listserv (ohioaap-practicemanagers at lists.deltaforce.net)
Subject: [Ohioaap-practicemanagers] FW: [SOAPM] Hassle factor form

________________________________

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=>

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>

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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