Featured Story: RSVP Today For Our June 14 Provider Meeting
AllWays Health Partners Provider Relations is hosting our next meeting on Friday, June 14th at our headquarters in Assembly Row, Somerville. Join us to hear the latest news and updates.
In this Issue
- RSVP Today For Our June 14 Provider Meeting
- Provider Blog
- Important: Your Laboratory Claims Will Reject If the Referring Provider
Field is Incomplete
- Formulary Updates
- Medical Policy
- Code Updates and Reminders
- Contact Information
RSVP Today For Our June 14 Provider Meeting
AllWays Health Partners Provider Relations is hosting our next meeting on Friday, June 14th at our headquarters in Assembly Row, Somerville.
Join us to hear the latest news and updates.
Lunch will be served.
- Topics will include:
- Product updates and information
- Authorization updates/reminders
- Important websites and resources
- Date: Friday, June 14, 2019
- Time: Doors open at 11:30 AM, Presentation 12:00-1:00 PM
Location: Partners HealthCare campus
- 399 Revolution Drive
Assembly Room B
Somerville, MA 02145
- 399 Revolution Drive
- Parking: Visitor parking is available in the on-site parking garage. Parking is FREE without
validation for the first 3 hours.
- RSVP: Click Here
Through our Provider Blog, AllWays Health Partners shares a fresh and candid perspective on important health care topics and industry news. Get a behind the scenes look at AllWays Health Partners, or read about topics that matter to you.
Check out the Provider Blog today and don't forget to register to get the latest blogs delivered straight to your inbox.
Important: Your Laboratory Claims Will Reject If The Referring Provider Field is Incomplete
Federal regulations require that the referring provider be included on all laboratory service claim submissions. Please refer to the HIPAA X12 standards for additional information on
For facility and professional laboratory claims submitted on or after June 1, 2019 that do not include the referring provider, the claim will reject as noted below. To ensure your lab claims are processed appropriately, please identify the referring provider on all laboratory claims.
Claims submitted without a referring provider will reject with the following message:
A7 Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the
Status details and has been rejected.
21 Missing or invalid information.
DN Referring Provider
Please share this information with the appropriate billing staff within your organization.
AllWays Health Partners regularly reviews and updates our formulary. Check out the latest updates effective 7/1/19.
For the latest information on our pharmacy programs, visit our online formulary today!
The following medical policy updates are effective May 1, 2019:
- Arthrodesis, Sacroiliac Joint Pain - Annual review without substantial changes in medically necessary indicators. Updated references.
The following medical policy updates are effective June 1, 2019:
- Reconstructive & Cosmetic Procedures - Off-cycle review. Added MassHealth language to adopt MassHealth guidelines for Varicose Veins treatment.
Updated references section.
Click Here to view all medical policies.
Code & Benefit Updates
April 2019 Codes
The following codes/services are not covered as they are considered experimental/investigational:
|93740||Temperature gradient studies||7/1/19|
|S9034||Extracorporeal shockwave lithotripsy for gall stones||7/1/19|
|N/A||Central Auditory Processing Disorder Hearing Exam||N/A|
|N/A||Proton Beam Radiation Therapy for Prostate Cancer||N/A|
As a reminder, the following codes are not covered:
|S5165||Home modifications; per service|
As a reminder, the following codes are not covered for Commercial only:
|S5160||Emergency response system; installation and testing||1/1/19|
|S5161||Emergency response system; service fee, per month (excludes installation and testing)||1/1/19|
|S5162||Emergency response system; purchase only B||1/1/19|
Routine Foot Care
Routine foot care is not covered unless a member has a qualifying condition such as diabetes. As of 1/1/19, routine foot care for members with qualifying conditions will be covered and paid for claims submitted by a qualified provider; a specialty of podiatry is not required.
Zio Patch Authorization Lift (For Commercial)
Effective 5/1/19, Zio Patch remote monitoring will no longer require prior authorization.
AllWays Health Partners now covers the HPV vaccine through age 45 for all members.