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2012 Molecular Pathology Codes
Date Published:
Midlands Choice will follow in line with CMS in not recognizing molecular pathology CPT codes 81200 - 81408.

American Enterprise Services
Date Published:
Coverage for American Enterprise Services Company employees will be moving from Principal to Aetna effective January 1, 2012.

City of Cedar Rapids
Date Published:
Coverage for City of Cedar Rapids employees is moving from Principal to PreferredOne effective January 1, 2012.

Pella Regional Health Center
Date Published:
Coverage for employees of Pella Regional Health Center will move from Principal to Auxiant effective January 1, 2012.

Palo Alto County Health System
Date Published:
Coverage for employees of Palo Alto County Health System will move from Principal to Auxiant effective January 1, 2012.

Aetna Clinical Payment, Coding and Policy Changes
Date Published:
Several Aetna clinical payment, coding and policy changes are effective March 1, 2012.

Meritain Health Acquired by Aetna
Date Published:
Aetna recently completed its acquisition of Meritain Health, a subsidiary of Prodigy Health Group.

New Aetna Radiology Accreditation Requirements
Date Published:
Aetna will have new radiology accreditation requirements for their commercial business effective January 1, 2012.

Aetna Reviews Medical Drug Claims
Date Published:
Aetna validates the number of units administered and the submitted charges of medications with a dosing algorithm.

Aetna's Preferred FSH Infertility Drug Coverage Changes
Date Published:
Beginning January 1, 2012, Aetna will allow coverage for several Follicle Stimulating Hormone (FSH) preferred injectable infertility drugs.

Aetna's Coverage for Private Rooms
Date Published:
Aetna provides coverage for private hospital rooms only when medically necessary for the patient.

Aetna to Require Precertification for Polysomnography
Date Published:
Effective March 1, 2012, Aetna will require precertification for polysomnography.

Clarification of Aetna's Stop-Loss Calculation
Date Published:
Aetna has changed it calculates reimbursement under stop-loss provisions for participating facilities when inpatient days are denied as "length of stay not necessary" for all Aetna plans, with the exception of the Traditional Choice plan.

Lincoln Electric System
Date Published:
Coverage for employees of Lincoln Electric System will move from Auxiant to PreferredOne, effective January 1, 2012.

5010 Reminders and Updates
Date Published:
On January 1, 2012, all electronic 837 claim files must be transmitted using the 5010 version.

Send Assurant Claims to Midlands Choice
Date Published:
All claims for Assurant members should be sent to Midlands Choice, including claims for members of John Alden, Time and Fortis.

New Payment Vendor for Trustmark
Date Published:
Trustmark/Starmark is offering electronic payment options through their vendor ECHO.

Cigna's New Brand
Date Published:
Cigna has launched a new brand that will be introduced in the coming months.

Holiday Office Closings
Date Published:
Midlands Choice offices will be closed in observance of upcoming holidays.

Aetna Notification Program Update
Date Published:
Aetna outpatient surgical scope procedures that were previously noted as requiring precertification are part of a notification program.

Aetna Global Benefits to Become Aetna International
Date Published:
Aetna Global Benefits will become Aetna International.

Aetna Clinical Payment, Coding and Policy Changes
Date Published:
Several Aetna clinical payment, coding and policy changes are effective December 1, 2011.

ENCOMPASS Changes Name to Telligen
Date Published:
Effective August 18, ENCOMPASS has changed its name to Telligen.

Payers with EFT Capabilities
Date Published:
The use of payers' Electronic Funds Transfer (EFT) capabilities can result in faster claims payment.

Aetna Requests Registration of NPIs
Date Published:
Aetna is requesting that all healthcare providers register their NPI with the company to avoid future customer service delays and be compliant.

Aetna Changes Stop Loss Calculations
Date Published:
Beginning September 1, Aetna will change how it calculates reimbursement under stop-loss provisions for participating facilities.

Methodist Health System and Jennie Edmundson Hospital
Date Published:
Coverage for employees of Methodist Health System and Jennie Edmundson Hospital will move from Principal to FMH CoreSource as of August 1.

Floyd Valley Hospital
Date Published:
Coverage for employees of Floyd Valley Hospital will move from Principal to DakotaCare, effective July 1.

City of West Des Moines
Date Published:
Coverage for employees of the City of West Des Moines will move from Principal to Coresource, effective July 1.

Winneshiek Medical Center
Date Published:
Winneshiek Medical Center, Decorah, Ia., will move its coverage from Principal to Midwest Group Benefits, effective July 1.

Spruced-Up Revenue Cycle Precedes Construction Plans
Date Published:
By implementing a combination of strategies, clinic and billing office staffs at Physicians Clinic Iowa in Cedar Rapids have significantly reduced their claim denial rate and lag time between service and payment.

UNMC Student Plan
Date Published:
The University of Nebraska Medical Center student plan will access the Midlands Choice network with Macori, Inc., as payer.

Progressive Swine Technologies
Date Published:
Progressive Swine Technologies will begin accessing the Midlands Choice network on July 1.

Christian Brothers Services is New Midlands Choice Payer
Date Published:
Effective September 1, 2011, Christian Brothers Services will replace Principal as the payer for the Diocese of Grand Island and Divine Word College.

CIGNA Preventive Care Payment Policy Changes
Date Published:
CIGNA has changed how it administers preventive care claims.

CIGNA Clinical, Reimbursement and Administrative Policy Updates
Date Published:
Read a summary of recent updates to CIGNA's coverage policies.

CIGNA Contracts with MedSolutions
Date Published:
Effective during the second half of 2011, MedSolutions will provide radiology benefit management services for CIGNA nationwide.

Aetna Electronic Precertification
Date Published:
Aetna offers electronic precertification transactions and tools on its secure provider website.

Aetna Clinical Payment, Coding and Policy Changes
Date Published:
Several Aetna clinical payment, coding and policy changes are effective September 1, 2011.

New Aetna Precert Requirements Effective July 1
Date Published:
Effective July 1,2011, Aetna requires precertification for outpatient endoscopy, arthroscopy and laparoscopic cholecystectomy.

5010: Don’t Assume “Someone Else” is Responsible
Date Published:
All parties associated with the transmission and processing of EDI transactions must ensure that their systems are properly converted to the new requirements.

New Groups Effective Jan. 1, 2011
Date Published:
Four new Iowa-based groups had January 1, 2011, effective dates.

ICD-10 Update
Date Published:
The CMS website ICD-10 page includes numerous documents that address a variety of ICD-10 topics.

CIGNA Address Change
Date Published:
Addresses for mailing paper claims and correspondence to CIGNA and three of its TPA partners have changed.

V-Pay Cards
Date Published:
Three Midlands Choice payers are reimbursing providers with V-Pay debit cards rather than checks.

Include Patient Date of Birth on Claims
Date Published:
After April 30, claims submitted without the patient’s date of birth will be returned for correct resubmission.

SL Modifiers
Date Published:
When providing vaccinations, physicians may charge for administering the service, but not for state-supplied injectables.

Midlands Choice EDI Contacts
Date Published:
Providers who currently are submitting Midlands Choice claims electronically, or need assistance with converting their processes from paper to EDI, may contact our EDI staff.

Aetna Electronic Funds Transfer (EFT)
Date Published:
Providers' use of EFT for Aetna claims is strongly encouraged.

Aetna Electronic EOBs
Date Published:
Providers with high claim volume with Aetna will no longer receive paper EOBs.

Aetna Signature Administrators “Cheat Sheet”
Date Published:
Aetna has published a list of Aetna Signature Administrators TPAs with claim and web addresses, logos and EDI routing numbers.

Aetna Alternatives to Paper for When EDI Isn’t Practical
Date Published:
Aetna has several alternatives to paper claims, including two free of charge to providers.

Aetna Corrected/Voided EDI Claims
Date Published:
Aetna can now accept electronic information when a previously submitted claim needs to be corrected or voided.

Aetna Clinical Payment, Coding and Policy Changes
Date Published:
Eleven Aetna clinical payment, coding and policy changes are effective June 1, 2011.

CIGNA Changing Name
Date Published:
CIGNA is undergoing a name change to CIGNA Life and Health Insurance Company (CHLIC).

Delegated Payer Claims
Date Published:
As of early December, the number of delegated payer claims submitted incorrectly to Midlands Choice has dropped by half. We appreciate your continued cooperation with making the necessary changes in your processes to make this possible.

Access to Information During the Credentialing Process
Date Published:
As a current or prospective Midlands Choice provider, you have the right to review the information we gather during application processing, to ask about the status of your application while it is in process, and to correct any information submitted by another party you feel is incorrect.

United Security Life and Health Insurance
Date Published:
United Security Life and Health Insurance Company is changing administrators for members who access the Midlands Choice network. Claims submitted to CoreSource with dates of service after 2010 will be returned to the provider for correct resubmission.

Changing To Online Newsletter
Date Published:
Beginning with the first quarter of 2011, the provider newsletter will be published online, but not printed or mailed.

CIGNA Online Remittance Reports Available in 2011
Date Published:
Providers soon will be able to access CIGNA remittance reports and Explanations of Payment online.

Supporting Documentation for CIGNA Electronic Claims
Date Published:
Claims should continue to be submitted electronically to CIGNA, even if supporting documentation is required.

CIGNA's Use of Modifiers 59 and 25
Date Published:
CIGNA is significantly reducing the number of code combinations requiring supporting documentation, effective February 21, 2011.

CIGNA Code Auditing
Date Published:
CIGNA uses ClaimCheckTM, an automated code auditing tool developed by McKesson, to ensure correct coding (including appending modifiers appropriately) and to apply code editing guidelines to claims.

ICD-10 Code Translator
Date Published:
AAPC has published an online tool that allows users to compare codes from the ICD-9 and ICD-10 code sets.

5010 Address Requirements
Date Published:
Midlands Choice is on schedule to meet an important milestone in preparation for the new HIPAA version 5010 electronic standards, which is to complete internal testing by January 1, 2011.

New Aetna Radiology Preauthorization Requirements
Date Published:
Important changes in Aetna's preauthorization requirements for high-tech outpatient diagnostic imaging procedures will be effective February 15, 2011.

Great-West Website Has New Look, Upgraded Features
Date Published:
Great-West Healthcare's new CIGNA-branded secure provider portal offers many services and improvements of interest to providers.

Aetna Out-of-Network Benefit
Date Published:
The out-of-network benefit for many Aetna patients is now based on a percentage of the Medicare fee schedule for the service.

Aetna Offers Multi-Payer Transactions via NaviNet at No Charge
Date Published:
Through Aetna’s secure provider website via NaviNet, your office has access to multiple health plans and a variety of features that can simplify your workday.

Changes to 2011 Aetna Precertification List
Date Published:
Changes to Aetna's National Precertification List will be effective on January 1, 2011.

Aetna Publishes CT Scan, MRI and Ultrasound Payment Policy
Date Published:
Aetna has published important advisories regarding its CT scan, MRI and ultrasound payment policies.

Mennonite Mutual Aid Announces Name Change
Date Published:
Effective Nov. 1, 2010, Mennonite Mutual Aid is changing its name to Everence.

Paper Claims Must be Typed
Date Published:
Effective November 1, 2010, Midlands Choice will no longer accept handwritten claims.

Aetna Review of Hospital Acquired Conditions
Date Published:
Effective August 1, 2010, Aetna began reviewing inpatient claims to identify charges incurred due to a Hospital Acquired Condition.

5010 Preparation Under Way
Date Published:
The Department of Health & Human Services has mandated that the healthcare industry must use the new HIPAA version 5010 electronic transactions standards by January 1, 2012.