Greetings
April 16, 2010 - Issue 4
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 New
Toll Free Number Supports Clinical Outreach
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To better encourage open communication
with Case Managers, ChiroCare has secured a new toll-free number specifically
for the Clinical Hotline. Effective immediately, ChiroCare providers seeking to
speak with a Case Manager may call toll-free by dialing (866) 525-5029.
If all Case Manager lines are busy, you
will be invited to leave a voice mail message which will be returned as soon as
the next case manager is available, or the next business day if left after
hours. As outlined in the February Provider Newsletter, ChiroCare's Case Managers are available to assist
providers with clinical questions from 7:30 a.m. to 7 p.m. Central Time.
Questions most often fielded by this
group of peer reviewers include:
- Why
was a particular service or visit denied authorization?
- What
is the best approach to a particularly difficult case?
Please note that the Clinical Hotline is
only to be used for outreach to a Case Manager regarding clinical inquiries.
Questions about general administration, including those related to eligibility,
claim status, authorization forms, appeal submissions, etc., should continue to
be addressed using online resources or by calling our Provider Service
Department at (888) 638-7719. Clinical Hotline calls received through the new
toll-free number can not be transferred to other departments.
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Save the Date! Durenburger Agrees to
Participate in Business Development Summit
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Former U.S. Senator, Dave Durenburger, has agreed to
participate in ChiroCare's first Business Development Summit on Thursday, Sept.
23, 2010. The former chair of the Health Subcommittee of the Senate Finance
Committee played a key role in establishing much of the health care legislation
passed in the 1980s and 1990s. Later, he founded the National Institute of
Health Policy and authored Prescription
for Change. Currently, he chairs Minnesota Citizens Forum on Health Care Costs and
is a member of several groups focused on public health and the delivery of
quality health care. Please mark your calendar and join us for this exciting event.
More details will follow.
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Revised
UCare Appeals Process
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Based on a health plan request, providers
will now receive a letter very similar to the member communication when
authorization and/or claim denials occur. These letters instruct providers to
submit appeals in writing to UCare rather than to ChiroCare/Landmark as
previous letters stated. Upon receipt of an appeal, UCare will work with
ChiroCare/Landmark to coordinate a review and notify the appealing party of the
determination.
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Important Change to Patient Choice
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Members covered under MTS
Systems Corporation (Group number 76030064) are no longer subject to standard
authorization requirements effective April 1, 2010. Contracted providers may
simply submit their claim to ChiroCare for processing and benefit
application. A revised Patient
Choice Plan Summary reflecting this update has been posted to ChiroCare Connect. |
Your
Opinion Matters: Possible EOB viewing enhancement
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Based on feedback from a small
number of providers, ChiroCare has secured a quote to revise its online search tool so remittance statements already viewed will be listed in gray
rather than black. To help determine if the cost off sets the value of this
enhancement, please notify ChiroCare by the end of this month if you expect this
change to simplify administration for you. Emails may be sent to info@chirocaremn.org or you may call Tab
Erck at (651) 389-2007.
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Protect
Your Family Through Clinic Planning
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It's often an uncomfortable topic
to think about and/or discuss but in the event of your disability or untimely
death, are you doing all you can to protect your family?
Northwestern Health Science
University (NWHSU), with sponsorship from the College of Chiropractic Alumni
Association and affiliated partners, offers a Family Protection Plan that
delivers two significant benefits in these difficult situations:
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Your loved ones are spared unnecessary stress
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Your clinic is sold for the maximum value
Through this program, providers
proactively execute a signed agreement that names a clinic representative. In the
event of your disability or death, this representative will facilitate the sale
of your clinic with assistance from NWHSU and other associated entities as
necessary, e.g., a licensed broker dealer and/or practice management group.
With the coordination of a timely and well organized sale, your clinic value
will be higher and more funds will be collected for your family.
There is no upfront fee to
participate in this program, and it is available to all licensed chiropractors.
For additional information, please visit NHSCU's web siteor call (952) 888-4777.
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Get to Know the Board of Directors:
Dr. Howard Johnson
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In addition to running a successful practice, Dr. Howard Johnson
has served in several professional leadership roles. He was appointed by
Governor Carlson to the first athletic trainers review committee for two years,
and later was appointed to American Chiropractic Network's (ACN)
Utilization and Management Committee. This led to his appointment to
ChiroCare's Board of Directors in 2001.
Dr. Johnson believes that working with ChiroCare presents a
unique opportunity to ensure that chiropractors have a voice within
the health care industry. "I wanted to help establish better
communications between corporate health care and chiropractic
providers. Being a board member gives me better insight to the much
larger world of local and national health care." He currently serves
on ChiroCare's Utilization and Management committee.
Dr. Johnson served in the Marine Corps from 1969 to 1973,
where he participated in base sports, self-defense programs, and deep sea scuba
diving, among other adventures. He taught basic electronics and worked
in ground to air communications while stationed in Okinawa, Japan.
Following his military service, Dr. Johnson attended college
and was treated by a chiropractor who eliminated most of the pain that resulted
from back spasms and migraines that had troubled him since age 12. This
experience inspired him to enroll at Palmer College of Chiropractic. Following
his graduation, he interned with the same provider who had successfully treated
him. Later, Dr. Johnson established his own practice in Elk River, Minnesota,
where he has served his patients for 32 years. "I became a chiropractor to
help others get the help that I experienced," he says. "What we
experience as chiropractors, healing people with just our hands, is an
incredible gift."
His wife of 33 years,
Rhonda, is a graduate of Palmer's Chiropractic assistant program. They have two
married daughters and are expecting their third grandson later this year. In
addition to spending time with family, he enjoys golfing, hunting and
participating with community-based organizations.
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Fast Facts
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March 2010
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Performance Goal
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Average speed to answer the phone
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18 seconds
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Less than 30 seconds
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Volume of calls answered within 30 seconds
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90%
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Minimum of 80%
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Volume of all claims received
electronically*
*Per MN Statute 62J.536 all providers in MN
are to be submitting claims electronically as of 12/15/09
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88%
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Minimum of 90%
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