News
| Great-West Accesses Midlands Choice in South Dakota | |
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| Effective April 1, 2010, approximately 70 groups administered by Great-West Healthcare will begin accessing the Midlands Choice network in South Dakota. | |
| Highlights of 2010 CPT Changes | |
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| For 2010, there are 219 new CPT codes, 141 that have been revised and 63 that were deleted. | |
| South Dakota Group Accesses Midlands Choice Network | |
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| Priests of the Sacred Heart, a 250-employee group primarily located in Chamberlin, S.D., began accessing the network January 1, 2010. | |
| CIGNA and Great-West Healthcare Precertification | |
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| Combined precertification requirements for CIGNA and the former Great-West Healthcare have been updated to incorporate 2010 Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. | |
| Note to Bariatric Surgery Providers for CIGNA Patients | |
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| For services to be covered, some CIGNA plans require bariatric surgery to be provided in a facility certified by CIGNA. | |
| Aetna Student Health Plans Addresses Have Changed | |
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| Send claims and appeals for Aetna Student Health Plans to the correct addresses. | |
| Aetna Online Resources | |
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| Aetna provides convenient online tools for precertification,as well as frequent updates of clinical policy information. | |
| Keep Us Up to Date on Demographic Changes | |
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| Payment errors caused by mis-matches between information on claim forms and records in our database cause delays that can take two or three billing cycles to get corrected. | |
| Staff Profile | |
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| Pat Woodman, client specialist, is responsible for provider relations in South Dakota, Colorado, Wyoming, Kansas, Missouri, Illinois, Wisconsin and Minnesota. | |
| 2009 Provider Survey Results | |
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| Combined responses from separate 2009 surveys of Midlands Choice hospitals and physician offices show an overall satisfaction rate at nearly 94 percent, with 9 percent responding with a rating of excellent, 45 percent very good and 46 percent good. | |
| NaviNet Link Includes Access to Both Aetna and CIGNA | |
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| With a single username and password, physicians, clinicians, office managers and staff can obtain access to financial, clinical and administrative information for both Aetna and CIGNA through the NaviNet website. These services are available at no cost to providers. | |
| President’s Message | |
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| Our industry is anticipating changes for 2012 and 2013, by which time we must be prepared for HIPAA version 5010 claim transactions and the implementation of a much larger set of diagnosis codes, ICD-10. | |
| Aetna Reconsiders ARNP Payments | |
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| Due to a mapping problem, providers may have experienced services of Advanced Registered Nurse Practitioners (ARNP) denied for payment by Aetna. | |
| Great Western Bank | |
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| Effective February 1, 2010, approximately 400 Nebraska and Iowa employees of Great Western Bank and Affiliates began accessing the Midlands Choice network through the Sanford Health Plan. | |
| Nebraska Law Impacts Lab Billing | |
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| A Nebraska law (LB 394) that is effective Jan. 1, 2010, requires changes in laboratory billing practices. | |
| Watch for Online Claim Entry in 2010 | |
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| For network providers whose Midlands Choice claim volume doesn't justify submitting these claims through an EDI vendor, beginning in 2010 we will have online claim entry functionality on our website. | |
| New Great-West ID Cards | |
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| Beginning with January 2010 account renewals, Midlands Choice network members with coverage previously administered by Great-West Healthcare will receive new ID cards. | |
| Access to Information During the Credentialing Process | |
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| As a current or prospective Midland’s 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. | |
| President's Message | |
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| On the 2009 survey that was recently completed, 94 percent of physicians said they are satisfied with the service they receive from Midlands Choice, an opinion shared by 93 percent of the hospitals. | |
| 2010 ICD-9-CM Update | |
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| Highlights of 2010 ICD-9-CM codes that became effective October 1, 2009. | |
| Aetna Policy and Practice Updates | |
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| Six coding and policy changes are effective in November. | |
| Correct Phone Number for Principal Radiology Pre-Cert Program | |
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| The correct telephone number to call for precertification of radiology procedures for Principal members is (888)899-7805. | |
| CIGNA/Great-West Reimbursement Policy Integration | |
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| CIGNA is continuing the process of integrating Great-West Healthcare policies to help simplify the administrative process. | |
| Cost of Care Estimator Added to CIGNA Website | |
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| A new feature on CIGNA's website allows providers to estimate patients' out-of-pocket costs for professional and outpatient services.
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| Assurant Offers Online Information | |
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| Assurant Health's online resource includes 24/7 access to eligibility, benefits and claim information. | |
| Aetna Policy and Practice Updates | |
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| Six coding and policy changes are effective in August. | |
| Payers Add EFT Capabilities | |
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| For quicker receipt of claims payments, use of payers’ Electronic Funds Transfer (EFT) capabilities is highly recommended, including those that have become available during the past year. | |
| Tools for CIGNA Claims | |
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| ClaimCheck® is a code auditing software that can expedite accurate claim processing. CIGNA plans to implement ClaimCheck 8.5 Knowledge Base Version 43 with National Correct Coding Initiative (NCCI) Version 15.2 beginning August 17, 2009. | |
| NCCI Implementation Planned | |
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| Effective October 1, 2009, Midlands Choice will implement National Correct Coding Initiative (NCCI) edits when repricing physician claims. | |
| Principal Radiology Pre-Certification Program | |
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| Effective September 1, 2009, Principal is asking physicians to pre-certify CT/CTA scans, MRIs/MRAs, PET scans and nuclear cardiology. | |
| Questions About Our Website? | |
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| To assist providers with navigating this site, we have posted a Web Guide to answer many of the questions you may have. | |
| Whirlpool | |
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| [Summary] | |
