[Ohioaap-practicemanagers] [SOAPM] Hassle factor form

Fri Sep 28 11:06:42 EDT 2018

Dr. Lopez,

Can you please tell me if CareSource will be going back and reprocessing all denied claims?

Thanks,

Theresa

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

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________________________________
From: Lopez, Karim H. <Karim.Lopez at caresource.com>
Sent: Thursday, September 27, 2018 3:52 PM
To: Theresa Vonhoene; Price, Jonathan; Ohioaap-practicemanagers at lists.deltaforce.net
Cc: jennifermiller79 at gmail.com; rlempg at gmail.com
Subject: RE: [SOAPM] Hassle factor form

Dear colleagues:

CareSource has recently revised its policies on PCR testing including flu.  These will be posted 10/1 and go into effect 12/1 - giving us time to configure and test thoroughly as well as time for feedback.  In the meantime, flu claims should flow thru without any issue as we are pulling the old policy/configuration.

Please read the new policies carefully.  As it is nearly impossible to know every possible diagnosis for which flu testing is being done, we have chosen a very limited diagnosis set.  These are essentially diagnosis codes for flu.  I know that isn’t ideal but it is the compromise.

Please also be aware that we do not consider PCR testing as first line testing most of the time and unfortunately there are providers in Ohio who use these tests to drive reimbursement.  Clinical judgment combined with rapid non-pcr tests is preferred first line screening.  However, we do acknowledge that PCR testing has a role and want to pay for them.  Providers will need to be aware of the diagnosis codes and CPT codes that are in our policy.  We will also be auditing providers who are outliers in terms of utilization through chart audits.

If you have ideas around one general code that would be better to use for each type of PCR testing for these, let me know and I will see if we can adjust the policy.

From: Theresa Vonhoene [mailto:tvonhoene at ahpediatrics.com]
Sent: Wednesday, September 26, 2018 3:11 PM
To: Lopez, Karim H. <Karim.Lopez at caresource.com>; Price, Jonathan <Jonathan.Price at nationwidechildrens.org>; Ohioaap-practicemanagers at lists.deltaforce.net
Cc: jennifermiller79 at gmail.com; rlempg at gmail.com
Subject: Re: [SOAPM] Hassle factor form

EXTERNAL MESSAGE - TREAT LINKS/FILES WITH CARE

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

This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity  to which it is addressed. If the reader of this e-mail is not the intended  recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is  prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.

________________________________

From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net<mailto:ohioaap-practicemanagers-bounces at lists.deltaforce.net>> on behalf of Price, Jonathan via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net<mailto:ohioaap-practicemanagers at lists.deltaforce.net>>
Sent: Wednesday, February 21, 2018 2:18 PM
To: karim.lopez at CareSource.com<mailto:karim.lopez at CareSource.com>
Cc: jennifermiller79 at gmail.com<mailto:jennifermiller79 at gmail.com>; rlempg at gmail.com<mailto:rlempg at gmail.com>; Ohio AAP Prctc Mngr Listserv (ohioaap-practicemanagers at lists.deltaforce.net<mailto: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=>

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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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