October 1, 2014  
Curious about upcoming changes? Plan to attend one of two webinars:

Learn more about other training options available.


Drug List ChangesDrugListChanges  

October 2015 Drug List Updates Now PostedOctDrugListUpdates

The following drugs require a prior authorization beginning November 1:

  • metformin ER
  • doxycycline hyclate
Watch for News About Drug List Changes Coming January 1JanDrugListChanges
Beginning January 1, we will change from the EnhancedRx Drug List to the CoOportunity Health Drug List. At that time, we'll be adding prior authorization requirements to a number of drugs. We'll also be moving some high-cost drugs to a different benefit level (the member will still have coverage, but may have a higher cost share).
Doctors who have prescribed a drug that is changing will receive a letter in late October. In addition, November's Provider Alert will provide a link to a list of January 1 drug changes and the 2015 drug list so you can see changes in advance.
Covered Blood Glucose Testing ProductsGlucoseTestingProducts
Not all blood glucose testing products are covered by our plan. To help patients identify covered products, we post a Diabetes Supplies List Fact Sheet at coOportunityhealth.com/DrugList.
  • Accu-Chek Active strip
  • Accu-Chek Aviva Plus meter & Aviva strip
  • Accu-Chek Nano SmartView meter & strip
  • Accu-Chek Compact meter & strip
  • TRUEresult meter
  • TRUE2go meter
  • TRUEtest strips
If you need to request an approval for one of your patients for a noncovered item, complete the Prior Authorization/Exception Form. You'll find more information about coverage criteria for diabetic supplies within the following medical policies:
Medical Policy UpdatesMedicalPolicyUpdates
Two medical policies were recently updated or added to our website. Visit the medical policy update page for more information about an update.
How Cost Shares Apply to Office ServicesOfficeServicesCostShares
In many cases, CoOportunity Health members owe a copayment for an office visit. When applicable, a member's ID card lists a primary and a specialty office visit copay amount. The primary copay applies to office visits from family and general practice, internal medicine, pediatrics, obstetrics/gynecology, and doctors of chiropractic.
Other office services provided during the visit - such as surgery, labs, or x-rays - apply to the deductible, and then pay at a percentage until the out-of-pocket maximum is met.
In some situations, members owe a deductible and coinsurance for the office visit instead of a copay.
  • Out-of-Network - Office visits from an out-of-network provider are subject to deductible and coinsurance. Out-of-network care has a higher, separate deductible, coinsurance, and out-of-pocket maximum.
  • Catastrophic & Bronze Plans - Office visits are subject to deductible. Because the deductible and out-of-pocket maximum are the same, office visits pay at 100 percent once the out-of-pocket is met.
  • HSA Plans - Office visits are subject to deductible and coinsurance until the out-of-pocket maximum is met.
  • All of our plans cover in-network services submitted as routine preventive care at 100 percent (no copay or deductible).
  • Some plans waive the office visit copay or the deductible for the first three in-network office visits processed in a calendar year. Select the Features tab to read more about Three-for-Free.
  • To know your patients' cost share amounts, log on to our secure website at coOportunityhealth.com/Provider. Select the Eligibility Inquiry tool and enter the member identification number or name and birthdate. This tool is available 24 hours a day, 7 days a week.
Changes in 2015: Some of our plans' cost share amount could change next year to meet actuarial values. This means that some of your patients' cost shares will be different in 2015 even if they keep the same coverage.
Submit Claims and Receive Payments More EfficientlyClaimPaymentsFaster
Receive claim payments more efficiently by doing business electronically.
  • Claims: For clearinghouse information and Payer IDs, visit coOportunityhealth.com/eServices. Please confirm this information with your vendor or clearinghouse prior to submission. Even if your clearinghouse is not listed, your vendor can redirect claims through a HealthPartners approved clearinghouse.
  • Payment: To receive access to claims payments sooner, sign up for electronic funds transfer.
Tools for New Providers and Staff Membersfornewprovidersandstaffmembers
Access these tools to learn more about us at coOportunityhealth.com/Provider.

For access to our secure Provider website tools, contact your organization's site delegate or register today.