Have you checked Patient ID Cards lately?  

When a member joins a health insurance plan, they receive an ID card which identifies them and/or their dependents as plan participants.

Because AFMC is the network of providers, a member ID card does not guarantee they have coverage.  Instead, it lists the information necessary for your office to verify benefits and eligibility through your patient's plan administrator and also identifies the member can access an AFMC contracted provider, which is extremely helpful when issuing a referral to other AFMC providers.  

It is important to review your patient's ID cards routinely to insure correct billing and network addresses. AFMC recommends checking ID cards at every visit to ensure a patient's file contains current and correct information. 

Should you need information regarding benefits, eligibility or payment on a claim, contact the patient's plan administrator using the eligibility verification number printed on the back of the patient's ID card.  For a detailed listing of administrators that AFMC works with, please visit our Web site at www.azfmc.com.  

GEHA Helps Members Quit Smoking with 100% Coverage

Government Employees Health Association, Inc. (GEHA) now offers its members 100% coverage to help quit smoking once and for all with no copays, coinsurance, deductibles or dollar limits. These benefits apply to all GEHA members of an FEHB (Federal Employees Health Benefits) plan. Covered family members are also eligible if the GEHA member has a Self and Family enrollment.  

Benefits are paid at 100% of the plan allowable with no deductible for in-network or out-of-network providers. GEHA's smoking cessation benefits cover:

• Up to four sessions of counseling for each attempt to quit, with two attempts to quit covered each year;
• Over-the-counter (with a physician's prescription) and prescription drugs approved for smoking cessation.  
• Nicotine gum is covered, but a member must get a prescription from his or her doctor for it to be covered with no copays and coinsurance.

Members can find an in-network provider to prescribe cessation medication or to provide counseling by using GEHA's online Provider Search on www.geha.com. For more on GEHA's smoking cessation benefits, please see the GEHA Plan Brochure, which is available online at www.geha.com, or call GEHA Customer Service at (800) 821-6136.

New Pediatric CPT Terminology Codes 

There is new Current Procedural Terminology (CPT) codes for reporting immunization administration in the pediatric patient population. The new codes became effective on January 1, 2011, and will replace codes 90465-90468.  

The new CPT codes are as follows:

• 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; first vaccine/toxoid component.
• +90461- Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure).
• Codes 90460 and 90461 should only be used when a physician or qualified healthcare professional provides face-to-face counseling to the patient/family during the administration of a vaccine.
• Code 90460 is reported once for the first component of each vaccine administered by any route. The reporting of code 90460 includes counseling for the first vaccine component*. Code 90461 is additionally reported for the counseling associated with each additional component of any combination vaccine.

For additional information regarding the 2011 Pediatric Immunization Administration Codes check out the AAP Web site. They offer an abundance of information on the topic and provide a detailed vaccine component chart for easy reference.   

*A component refers to each antigen in a vaccine that prevents disease(s) caused by one organism.  Combination vaccines are those vaccines that contain multiple vaccine components.

Enrollment Search

AFMC offers providers online patient enrollment verification. This information does not guarantee coverage or payment, but rather indicates that the specified patient has access to AFMC for the date of service, according to enrollment records.

To verify benefits and eligibility, physicians or their office staff MUST contact the Administrator listed on the enrollment screen, from the patient's health plan member ID card, or on the AFMC Administrator Listing. To access online enrollment verification log onto azfmc.com, then log into the secure area. Enter the providers TIN and PIN, then the Member's ID number or Last Name and Date of Birth. Please note, the fields are case sensitive and the date should be entered in this pattern: MM/DD/YYYY. 

Updated Provider Reference Guide 

AFMC has updated our Provider Reference Guide. The Guide is designed to assist contracted providers and their office staff in the

administration of AFMC's network plans. Whenever you have a question about any aspect of AFMC's operations as it pertains to your

practice and administering of benefits to AFMC members, first check the appropriate section of the Guide. If you don't find the answer to

your question, contact us. We are always willing to help.

The updated Provider Reference Guide can be accessed by going to

AFMC's Web site. The guide is in a secure area of the AFMC Web site. You must be a registered AFMC Web site user to access this information.