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January 2020

Featured Story: 2020 reminders

Happy new year from all of us at AllWays Health Partners! As this is the time of year when many patients have changes to their health insurance coverage, we have a few reminders to help you and your staff.

In This Issue

 


 

2020 reminders

Happy new year from all of us at AllWays Health Partners! As this is the time of year when many patients have changes to their health insurance coverage, here are a few reminders for you and your staff:

  • No copays for the first 3 pediatric sick visits – Many AllWays Health Partners plans now include $0 cost sharing for the first three pediatric sick visits with an in-network PCP and $0 cost sharing for the first three pediatric visits with an in-network behavioral health provider. Check out the latest Clinical Digest for more information about this benefit and other ways we are removing barriers to care. 
  • Verify member eligibility and claims status - Remember to verify eligibility prior to the service to ensure you have the latest coverage information. The provider portal gives you real-time access to validate this information in seconds. As of January 1, all phone calls to verify member eligibility or check claims status are directed to the provider portal. 
  • ID cards – Check out the latest samples of our member ID cards. 

 


 

Welcome to the AllWays Health Partners network

As one of the fastest growing health plans in the region, we continue to expand our provider network throughout Massachusetts, New Hampshire and Rhode Island. Welcome to all the new providers to our network, including: 

  • O'Brien Chiropractic Offices
  • Marshfield Speech & Language Therapy, LLC
  • Whole Body Healing, Acupuncture & Wellness, LLC
  • Bravo Holistic Healing, LLC
  • Slak Chiropractic
  • Chiropractic Care of Randolph
  • Korb & Associates, PLLC
  • The Learning Center for the Deaf
  • Amy Mager
  • Five Points Acupuncture & Wellness, LLC
  • Acton Chiropractic & Rehabilitation, Inc
  • New Beginnings Family Chiropractic, LLC
  • Kate McDonough 

If you are not yet contracted with AllWays Health Partners, submit your online request today to get started. 

 


 

Provider satisfaction survey

Thank you to everyone who recently completed the annual provider satisfaction survey. We've received nearly 800 responses. Providers rated AllWays Health Partners as one of the easiest health plans to do business with. We’ve received high marks for our easy-to-use provider portal and fast claims processing. For areas of improvement, providers have indicated that they would like to see additional functionality available in the online experience. We appreciate all your feedback and will use your feedback to identify ways to improve the provider experience.   

All completed entries were entered into a raffle drawing. Congratulations to the following winners:

  • Virginia Bucci, Visiting Nurse of Hope Health ($100 Wahlburgers gift card)
  • Agnes Nunziato, Mount Auburn Professional Services (Basecamp® laptop backpack)

 


 

Check out our new provider website

Based on your feedback, we've improved our website and our Best Practice blog! Our new site gives you fast access to the tools and resources you use the most.

Here's what to look for:

If you are not automatically redirected, please visit our new site at provider.allwayshealthpartners.org. You may have to clear your browser's cache in order to be redirected automatically. 

We hope the changes make it even easier for providers to join our network and do business with us. 

 


 

Medical policy

The following medical policy updates are effective January 1, 2020:

  • Breast Surgeries – Annual review. References updated. 
  • Phototherapy and Photochemotherapy for Dermatologic Conditions – Added Alopecia areata to conditions under UVA Photochemotherapy or PUVA. Added Vitiligo criteria under UVB Excimer Laser Therapy. References updated. 
  • UVB Home Phototherapy Units for Skin Disease – References updated
  • HIV Associated Lipodystrophy Syndrome – References updated
  • Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea – New medical policy. Guidelines AllWays Health Partners utilizes to determine medical necessity for implantation of an FDA approved hypoglossal nerve stimulation (HGNS) device, for obstructive sleep apnea (OSA)

The following medical policy updates are effective March 1, 2020

  • Enteral Nutrition and Supplements – Ad-hoc review to reflect new MassHealth guidelines
  • Reconstructive and Cosmetic Procedures - Annual review. Added liposuction for lipedema as a general exclusion. References updated.

VIew all medical policies.

 


 

Reminder: verify practice information and submit updates through the provider enrollment portal 

To ensure that your patients and prospective patients have access to the correct information for your practice, it is important to regularly validate your practice information in the Provider Directory and your provider roster report on the Provider Portal

Submitting a provider information update request to AllWays Health Partners is easy. Through the Provider Portal, you have 24/7 access to provider enrollment requests. 

 


 

Code updates

Stay current on the latest code and reimbursement updates. Check out the January 2020 updates for more information. 

 


 

Annual updates to physician and outpatient reimbursement

AllWays Health Partners reviews its physician and outpatient fee schedules quarterly to ensure that they are current, comprehensive and consistent with industry standards, to the extent supported by its systems. In most cases, changes involve adding fees for new or existing codes to supplement the fees already on the fee schedule

Consistent with prior years, AllWays Health Partners will update its Commercial/PPO physician, ambulance, drug, DME, laboratory, radiology and outpatient hospital fee schedules to incorporate new codes, effective January 1, 2020. Rate updates to existing CPT and HCPCS codes will now occur on July 1, 2020.

With a few exceptions, AllWays Health Partners will continue to base fees on the Centers for Medicare & Medicaid Services (CMS) and MassHealth fee schedules, adjusted to achieve the contracted level of reimbursement.

Commercial/PPO Physician Fee Schedules

  • AllWays Health Partners will continue to base physician reimbursement on CMS RVU’s and conversion factors
  • AllWays Health Partners will continue to base drug, vaccine and toxoid reimbursement on CMS Part B levels, as indicated on the CMS Part B drug quarterly notices. If no CMS pricing is available, drug pricing will be set in relation to average wholesale price (AWP). Reimbursement for vaccines and toxoids will continue to be updated on a quarterly basis.
Commercial/PPO Outpatient Fee Schedules
  • Consistent with prior years, reimbursement will be based on a combination of outpatient, ancillary and surgical fee schedules.
  • AllWays Health Partners will continue to base drug, vaccine and toxoid reimbursement on CMS Part B levels, as indicated on the CMS Part B drug quarterly notices. If no CMS pricing is available, drug pricing will be set in relation to average wholesale price (AWP). Reimbursement for vaccines and toxoids will continue to be updated on a quarterly basis.

Medicaid Fee Schedules

  • AllWays Health Partners will continue to base physician reimbursement on MassHealth published rates, where a published rate exists. 
  • Consistent with prior years, AllWays Health Partners will update its Medicaid physician, ambulance, drug, DME, laboratory, radiology and outpatient hospital fee schedules to incorporate new codes, effective January 1, 2020.  Rate updates to existing CPT and HCPCS codes will occur within 30 days of receipt of notification of rate change from MassHealth.

If you have questions about the fee schedule changes, please contact your AllWays Health Partners Provider Network Account Executive.

 


 

Hospital inpatient utilization report

The latest quarterly hospital inpatient utilization report is now available. To review this report, click on the Reports tab in the Provider Portal and select Clinical Reports. If you do not have access to the Provider Portal, you may register online at allwaysprovider.org.

Topics: Administrative News




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