Search

October 2019

Featured Story: Verify member eligibility and claims status through the provider portal

We know that your time is valuable and that you expect a quick response when you call us. In order to reduce the time it takes to connect you with a provider service representative, we will direct all routine claims and eligibility inquiries to the provider portal beginning on January 1, 2020.

In this Issue


 

Verify member eligibility and claims status through the provider portal in seconds

We know that your time is valuable and that you expect a quick response when you call us. In order to reduce the time it takes to connect you with a provider service representative, we will direct all routine claims and eligibility inquiries to the provider portal beginning on January 1, 2020.

After January 1, 2020, we will no longer be able to respond to these requests by phone. On the portal, you can instantly validate member eligibility and see the real-time status of any claims 24 hours a day, 7 days a week.

Please share this important update with your staff and with third-party billers who call us on your behalf.

Registering for the provider portal

Getting setup with the provider portal is easy. Here are useful resources to help you get started today.

For registration support, contact prweb@allwayshealth.org.

Register for the provider portal

 


 

How are we doing? Take the annual satisfaction survey

Each year, we conduct a Provider Network Satisfaction Survey to better understand your experience when doing business with us. Your feedback will be useful to determine ways we can better serve you and your staff. All completed surveys will be entered into a lottery drawing to win a prize.

Take the survey.

 


 

New in 2020: No copays for the first three pediatric sick visits

Starting on January 1, many AllWays Health Partners plans will include $0 cost sharing for the first three pediatric sick visits with an in-network PCP. Check out our provider blog for more information.

 


 

Register for electronic funds transfer and get paid sooner

AllWays Health Partners offers FREE electronic funds transfer (EFT) for your claims payments. EFT transactions are the fastest way to receive payment. Funds are sent securely and directly into your account. Check out these useful instructions today to begin registration.

EFT registration guide.

 


 

Payment policy guidelines

The following payment policy guideline updates are effective September 1, 2019:

  • Preventative Services

View all payment policies

 


 

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.

 


 

Formulary updates

AllWays Health Partners regularly reviews and updates our formulary to ensure alignment with the industry. The following formulary updates are effective December 1, 2019:

  • Sancuso - no longer considered a formulary medication

For the latest information on our pharmacy programs, visit our online formulary today.

 


 

Medical policy

The following medical policy updates are effective September 1, 2019:

  • Gender Affirming Procedures -
    • Added language to specific exclusions “unless specified in the Member Handbook or Amendment”.
    • Removed language “commercial accounts only” throughout document.
    • Added coverage criteria for Facial Feminization/Masculinization for MassHealth members.

The following medical policy updates are effective October 1, 2019:

  • Enteral Nutrition Formulas and Supplements - Annual review. On Page 1: added "Prematurity" to list of conditions when AllWays Health Parters may cover nutritional formulas and supplements.
  • Durable Medical Equipment - Annual review.
  • Specialty Medication Administration - Site of Care - Annual update. Language edited in Overview section. MassHealth definition removed from Definitions section.
  • Non-Emergency Medically Necessary Transportation - Edited prior authorization table on page 1 for clarity. Added language below table on page 1 for clarity. Removed footnote.

The following medical policy updates are effective December 1, 2019:

  • Bariatric Surgery - Annual review. References updated. Exclusions added.

View all medical policies.




Contact Information

We are here to help! Contact us today:

Provider Service:

Provider Portal

Provider Blog

Join the Network

Subscribe Here

Recent Posts