If you are a Regence provider or subscriber, you have received notice of the mandatory pre-authorization change scheduled to happen in October. To the left is a link to a letter written by our attorney, John Conniff, to the Office of the Insurance Commissioner (OIC) regarding the proposed change. Washington State law does not allow insurance companies to require pre-authorization for chiropractic services. Although the letter is written for the Washington State Chiropractic Association (WSCA), we are watching for the outcome. It is not against state law to require pre-authorization for massage, so we will watch closely to see if this change will remain in effect with Regence for any health care professionals listed in the letter.
Last minute update: the following info just came in from Regence as this email was being prepared. "Our launch of the recently announced physical medicine program has been delayed. The physical medicine program, when launched, will focus on pre-authorizations for spinal procedures, physical, occupational and speech therapy, as well as chiropractic, acupuncture and massage services. We'll provide you with more information about our upcoming program, its planned effective date and dates for education opportunities to learn more about the program in an upcoming issue of this [The Connection Online] newsletter."
Reviews and refund requests:
Many massage practitioners are being asked to send in documentation for reviews of services. Two carriers in particular are requesting such reviews: Group Health Options and Aetna. In June, we sent members a form letter to be used as an appeal for these reviews when benefits are denied and refunds are being requested. This is to be used and attached to an online complaint to the OIC as well. Here is where this gets a bit tricky. If these requests are from GHC it does fall under the jurisdiction of the OIC, and the appeal and complaint are of our highest priority. The OIC only acts after numerous complaints. We have also forwarded a letter from John Conniff to the OIC reviewing this practice and his belief that the carriers are requiring practitioners to determine medical necessity and asking us to step out of our scope. We will keep you posted on this if more develops. Again, please forward complaints online to the OIC so that we can get them to evaluate this practice carriers are now doing much more often.
Now, if your review is from a Health Plan such as a federal, city, state or union trust plan, or a plan that is self-funded, this does not fall under the jurisdiction of the OIC. This is a private trust health plan and is not an insurance plan at all. Therefore, none of the prior mentioned rules apply. We are at the mercy of doing appeal after appeal and hoping we can 1) get the administrators to find this to not be a cost effective method for them to continue to pursue and 2) start winning these appeals. I believe we need to get the client involved, as the contract is with them and benefits are continually and permanently being denied. It also goes back to ONLY working within the guidelines of a prescription, whether or not a prescription is required by the plan. This is your proof of medical necessity, and without it, we will not have much to appeal with.
Opting out of Corvel:
It has been brought to our attention by a non-member that it is necessary to opt out of Corvel through Healthways. If you are a contracted provider with Healthways, Corvel allows auto claims to be discounted at the insurance carrier rate. The following is a sample letter you may use. Use your own information and letterhead and either fax or mail to Heathways to have Corvel removed from your contract.
To Whom It May Concern,
I acknowledge that I am credentialed through an organization called Healthways, which allows carriers to receive a discounted fee for my services as a licensed massage practitioner. Healthways was presented to me as a health insurance organization only and not as an auto insurance company providing personal injury protection. I find it very irregular that an insurance PIP claim is being processed with the discounts I would give to a health care company. At this time I wish to sever the Corvel aspect of my Healthways contract. I do not wish to participate in a contract with auto insurance PIP payers at this time.
I hope this satisfies all concerned. I may be contacted at______________.
Change in filing fees from the state:
If you are charging a fee for requested records, please update the increase in the charges as follows.
The 1993 amended act states that copy charges may be adjusted every 2 years for inflation, according to the consumer price index as determined by the Washington State Secretary of Health pursuant to RCW 70.02.010 (12). Guess what? Very recently, changes have been made to the definition of reasonable copy charges.
Effective July 1, 2013, reasonable fees for duplicating health care records are as follows:
- A maximum $24.00 flat fee for clerical searching and handling (it was $23.00 from July 2011-July 2013)
- A maximum $1.09 per page for the first 30 pages of records (it was $1.04 from July 2011-July 2013); and
- A maximum .82¢ per page after the 30th page (it was $.79 from July 2011-July 2013)
This new rate for copying medical records will remain in effect for two years through the mid-part of 2015. Thereafter, the copy charges will once again be adjusted by the Washington State Department of Health.