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Tricare Contracting and Credentialing Change

Tricare West recently announced a change that will take effect in the middle of this month. MHN (Managed Health Network), a sister company to Health Net Federal Services (HNFS) will no longer be managing the TRICARE West mental health provider network, which includes applied behavior analysis (ABA) providers. Providers currently contracted with MHN as a […]

California updates laws on protected health information

Effective Jan. 1, 2020, the California Consumer Privacy Act of 2018, officially called AB-375, grants consumers the right to request a business to disclose the categories and specific pieces of personal information it collects about a consumer. The AB-375 requires entities that meet the following criteria to comply with the law: annual gross revenue in […]

December 18, 2017
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On April 1, 2018, CMS will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to everyone with Medicare. The MBI will replace the Social Security Number (SSN)-based Health Insurance Claim Number for transactions like billing, eligibility status, and claim status after a transition period. You must be ready to accept the MBI beginning […]

September 14, 2017
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Today, the Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number. CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the […]

Look out for the new CMS 1500 forms

The new CMS forms were designed to change over from ICD9 to ICD10 diagnosis codes. During the implementation period when both versions are accepted, there will be an indicator added to designate which version of diagnosis code you are using, ICD9 or ICD10. Another major change is that the new forms will be able to […]

Caremore Healthplan of California

For well over a year now, we have been receiving EOBs from Caremore Healthplan of California with numerous under-payments and over-payments errors. Take for example, one check that we received: They processed 31 claims and only 4 of them were processed correctly! :O That’s an 87% margin of error on one check for one doctor! […]

California chosen by CMS as one of the 12 States For Emergency Psychiatric Care Demonstration

On March 13, 2012, the federal Centers for Medicare and Medicaid Services (CMS) Center for Innovation launched the Medicaid Emergency Psychiatric Demonstration (MEPD) project in 12 states—Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia, and the District of Columbia. The three-year MEPD will enable Medicaid to pay for […]

Medicare Part B Secondary Payer Deductible Issues

Medicare Part B claims processed after Friday, April 1, 2011, for which the beneficiary has a Medicare deductible remaining and Medicare is the secondary payer, are erroneously issuing payment despite the beneficiary’s deductible not being satisfied or despite the total Medicare Allowed Amount being applied towards the deductible. The recovery of overpayments made during this […]

Medicare physician payment may be reduced by a third

Providers can expect a reduction in Medicare payment of more than 30 percent in 2011 unless Congress grants a reprieve. In the Medicare physician fee schedule (MPFS) final rule that the Centers for Medicare and Medicaid Services has placed on display, providers paid under the MPFS are looking at a 2011 conversion factor of $25.5217, […]

November 30, 2010
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It used to be that if you need to check patient Medicare eligibility or claim status, you have only two options: Call the Interactive Voice Response (IVR) system at (866) 931-3903 Use the ANSI 270/271 Beneficiary Eligibility Inquiry transaction at the CMS data center Anybody who has used the IVR system knows it’s an annoying […]

Tricare Contracting and Credentialing Change

California updates laws on protected health information

New Medicare Card – Transition begins April 1, 2018

CMS Reveals New Medicare Card Design

Look out for the new CMS 1500 forms

Caremore Healthplan of California

California chosen by CMS as one of the 12 States For Emergency Psychiatric Care Demonstration

Medicare Part B Secondary Payer Deductible Issues

Medicare physician payment may be reduced by a third

Medicare Egilibility via Palmetto GBA

Tricare Contracting and Credentialing Change

California updates laws on protected health information

New Medicare Card – Transition begins April 1, 2018

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