Tag Archives: Health Care

I am going to save you six hours of phone calls to insurance companies. Aren’t I wonderful?

One of our providers recently moved. Those of you who have gone through this can commiserate with me.

Six hours of phone calls,faxing, and emailing later, her address was updated with the insurance companies. Mostly.

So, I am going to give you the results of our efforts in blog form and again in spreadsheet form. Yay, spreadsheets! If any of you out there have other contact info for the provider relations/ credentialing/provider demographic update departments for any other insurances, please leave a comment or shoot me a quick email.

Medicare and Medicaid require that you send them an application form to update your servicing location. If you are an individual provider, send Medicare a cms855i and if you are a group, send in a cms855b. If you don’t know whether you are an individual or a group, call provider enrollment. For Medicaid, I suggest calling your individual state Medicaid and having them direct you to the proper form. I also put the Medicare forms on the new and improved links and tools page.

The rest of the insurances simply need an updated W9 form.

Aetna – Update on Aetna.com. Here is the direct link: http://www.aetna.com/docfind/custom/provider/data_correction.html

Blue Cross – Fax W9 to (818) 234-2836, attn: Anthem Provider Database Management.

Blue Shield – Fax in a W9 to (916) 350-8860, attn: Blue Shield Provider Contracting

Caremore – Fax W9 to (562) 977-6141, Attn: Caremore

Cigna – Email attached W9 to intake_pbm@cigna.com, subject line: Provider Practice Address Change

Health Net – Fax form to (877) 897-7910, Attn: Health Net PDM

IEHP – Email the provider Service Representative for your city. You will need to call them and get that info. The only one I have is for Montclair, CA and that probably won’t help most of you.

Inland Valleys IPA – Fax in your W9 to (213) 830-1815, Attn: Inland Valleys IPA

ProMed/Upland Medical Group – Even if you have more than one IPA contract with a group that ProMed administers, one fax will update everything. So, fax the W9 to (714) 667-8156, Attn: ProMed

United HealthCare – You can either fax or email the update. The email is phshpdemo@uhc.com and the fax is (855) 314-6844

I have also included all this information in beautiful spreadsheet form. Here is the Health plan updates spreadsheet.

You’re welcome  🙂

As always, if you have any questions or anything to add, email or comment.

 

 

 

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Filed under Billing, Doctor's Office, Medical Billing, Office policy

Quick Workers Comp Tools

Have you ever wished that you could have a list of all the lists and tools and links you need for Workers Comp in one place? Well now you can! You’re welcome.

Doctor’s First Report

PR-2 Report

OMFS Schedule

OMFS DME Prices

NDC Numbers for substances

OMFS Fee schedule for pharmeceuticals

EAMS

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Filed under Claims, CPT, Doctor's Office, Follow up, Health Care, Medical Billing, OMFS, Workers Compensation

Everything you ever wanted to know about pap smears

**DISCLAIMER**  

***This post was written in 2014 and the rules have changed since then. I am going to be putting up a new post with the new rules updated to ICD10 very soon. There are some major changes to the way the insurances accept the charges and this an old post with the old rules. If you have any questions, and can’t wait for the new post, please email me directly and I will try and help you out.*** 

The first thing about paps is that every insurance pays them differently. To tell the truth, I don’t have most of it memorized. What I do have is a binder, with one page per insurance, and all of the pap rules are laid out there, in alphabetical order.

Of course, I’m going to give those to you. I suggest you do what I do and put them all in a three ring binder. However, I can only give you the PPO pap smear rules, because your HMO contracts will not be the same as the contracts for my doctors. I can show you a few of my HMO rules, though, so when/if you make your own reference sheets you know what the necessary information is.

You CAN get an office visit and a pap smear paid on the same date on the same claim. You just need to use proper modifiers. Also, most insurances allow patients to self refer for their annual exam, so you shouldn’t have to worry about authorizations.

Here are the Pap rules for PPO insurances. For your HMO insurances, all you need to do is call the provider relations department and get a copy of the doctor’s contract. The contract will be fairly short, and very clear about which codes are paid. However, you will need to ask the provider relations people which diagnosis they need to see on the claims.

If you want to review the high risk rules you can find those on the MR website. Here is a link, for the curious.

Remember to follow the blog; you’ll get an email every time I get a new post up. Also, if you have a specific question, please don’t hesitate to email me.

 

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Filed under Billing, Claims, CPT, Doctor's Office, Health Care, ICD9, Medical Billing, Modifiers, Pap smears, Well woman exam