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March 1, 2014
Claim Reimbursement Options
How to Access Claim Processing Details
Because our claim remittances are not mailed, use one of the following options to access details about how your claims processed:
Receive Claim Payments Directly to Your Bank Account
Enrolling for electronic funds transfer (EFT) is safe and secure. If your company has received a claim payment and you are an authorized requester, learn more about enrollment and the required information on our EFT Enrollment page.
Modifier Updates
The following modifier changes become effective May 1, 2014. Look for the update to our online Claims Manual in May.
|
Modifier |
Description |
Fee Adjustment Factor | |
53 |
Discontinued Procedure |
25% | |
80 |
Assistant Surgeon |
16% | |
82 |
Minimum Assistant Surgeon |
16% |
Medical Policy Updates
View recent and upcoming revisions on our Medical Policy Updates. The following updates were posted on March 1, 2014; effective dates noted below.
When searching for a medical policy, select Clear search filters if you need to remove a previously entered keyword. Deleting the keyword may not remove it from your search.
Claims Filing Assistance
Avoid claim delays and denials by using information from the patient's CoOportunity Health identification card.
- Each family member, regardless of age, receives an identification card and ID number. To file a claim, use patient information when entering:
- Insured's ID Number
- Insured's Name
- Insured's Address
- Patient Relationship to Insured - Self
- The back of each patient's card provides claims filing details.
Note: CoOportunity Health contracts with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services on our behalf; do not file claims for CoOportunity Health members with Midlands Choice.
Secure Provider Website Tools
To register for access to our secure Provider website, visit our registration page. With access, you can:
- Locate a patient ID number using his or her name and birth date.
- Request a time- and date-stamped PDF of a member's benefits.
- Check claim status.
- Sign up to receive an email notification when a remittance is posted.
Training
Participate in provider training sessions via a posted video link for Phase 1, or by registering for upcoming Phase 2 and Phase 3 webinars. Webinars are currently scheduled through March.
- Phase 1 Introduction to CoOportunity Health and Marketplace Changes
- Phase 2 Plan Overview, Benefits, Claims Information, Medical Management
- Phase 3 CoOportunity Health's Secure Provider Website
ICSI Guidelines - New & Revised
Institute for Clinical Systems Improvement (ICSI) healthcare guidelines represent the most appropriate medical practice for a range of common preventive services, chronic diseases, and acute conditions. ICSI guidelines/protocols/order sets are based on the best available evidence.
Healthcare protocols/order sets that have been recently developed or updated by ICSI include:
Please review the updates to determine if it is appropiate to implement some or all of them within the clinical practice of your medical group.
For complete copies of all ICSI Guidelines, Protocols and Order Sets, visit the ICSI website, or call ICSI at 1.952.814.7060 to obtain a hard copy.
Posted News
Locate these topics from past Provider Alerts using our online News page:
- Benefits: Preventive Services; Three-for-Free Benefit; Iowa Marketplace Choice Plan; D.C.'s Office Visit Copayment; Annual Physicals
- Medical Policy: Musculoskeletal Treatment Update, Preventive Services
- Pharmacy: Pharmacy Step Therapy Drugs; EnhancedRx Drug List: How to Use the Key; Specialty Pharmacy Information
- Administration: Commonly Used Forms: How to Access; Financially Solid, Secure and Protected
- Claims: Unique ID Numbers; Use Back of ID Cards
Please share this information with staff members. | 
