2009 Volume 1 Issue 4
June 22, 2009
Issue No. 1
In This Issue
Authorization Requirements
Scheduler Training
Scam Alert!
Summer Vacation
Taking a vacation?  Please let us know so we can effectively manage our work flow.
HealthPac Pro
On July 1st, IPC will begin upgrading our billing system.  The new system will help us increase our efficiency so we can serve you better.  We will do everything we can to make this a fast and smooth transition.  Please bear with us while we make this conversion.
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A number of payers require either an authorization or a PCP referral in order to get paid.  Not following payer guidelines will affect your income.
Prior Authorization Requirements 
One of the top five reasons for claim rejections for IPC clients is a lack of proper authorization or referral.  Not having a required prior authorization or referral greatly reduces the likelihood of receiving payment.  Obtaining an authorization requires clinical information which is why it must be done by your office.  While IPC cannot obtain authorizations for you, we are here if you have questions.  Keep reading for insurance specific tips to assist office staff with referrals and authorizations.
Online Scheduler Training to Come in July
As we upgrade our billing software, new functions will become available in scheduler.  One of the major changes is that your demographic information will now be live!  This means you will be able to view and update patient contact information from the scheduler.  Some of the other changes will include:
  • Enhancements to the template creatorSignatureScheduler
  • Right-click menu on the appointment book
  • Additional shortcuts
  • Additional department configuration options
  • Schedules within specific time ranges
  • Updated detailed appointment schedule report
IPC will be providing online training seminars to introduce you to the new scheduler features.  This live training will allow you to ask questions and see the answers on your own screen.  Classes will be scheduled as needed, so contact rachel@ipcbilling.com to sign up.
AuthAuthorization Cont'd
Aetna - Most Aetna patients in West Michigan are PPOM and - as long as you partipate - you may see patients without a referral.  However, certain plans such as Aetna Select, Elect Choice, and Managed Choice POS require a referral by the PCP.  The PCP is responsible for notifying Aetna and if they have not done so, your services will be denied.
CareSource - CareSource is a Medicaid HMO and requires a primary care authorization in order to be paid.  This payer can be very difficult to work with so we advise getting the auth BEFORE you see the patient.  Click to access the
CareSource prior authorization request form.
Health Plan of Michigan - Referral from the PCP is required for ALL specialty services.  The authorization form can be obtained on the
Health Plan of Michigan website.
Molina - The name of the PCP and a referral are required for all claims.  If the patient is unable to provide this information, call 1-888-437-0606. 
Referral and service request (authorization) forms can be found in the resources tab of the Molina website.

Priority Medicaid - Not only do you as a specialist need a PCP referral to see Priority Health Medicaid patients, you may also need to obtain an authorization directly from Priority Health for certain services you provide.  If you do not participate with Priority Health Medicaid you must have all of your services preapproved in writing.
Priority Health - Click to
view a list of services requiring authorization. Priority Health also requires a referral from a Spine Center of Excellence for certain services.  Authorizations can be requested and tracked easily online at the Priority Health Provider Website.
Don't jeopardize your payments!  When in doubt, obtain an authorization or PCP referral.
Medicare Scam Alert!
CMS is warning providers of a scam where perpetrators posing as a Medicare Carrier fax fraudulent questionnaires to physicians.  The fax instructs physician staff to respond to prevent a gap in Medicare payments.  This is a fraud!  Do not respond to this questionnaire.
IPC warns clients to always verify identities before giving out any information.  Scams like this one can be carried out not only by fax, but also by e-mail or phone.  If you receive a request for information, please check with IPC before responding.
About Us
If you have any questions regarding this newsletter, you can contact us at:

         Mary Ellen Duffy
         Patricia Nevala pat@ipcbilling.com

or call us at 616-459-6867 or 800-606-1455

Please feel free to forward this newsletter to your staff and peers.

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