If you granted a billing service access to our secure Provider website to manage your administrative functions in 2014, you'll receive an annual verification in 2015. We send a verification request one year from the date the billing service received access on your behalf.
Find Past Topics Quickly Using New
Provider Alert Subject Index
Find previously published items quickly
Use the new Provider Alert Subject Index to locate previously covered topics. Our subject index is available from the Archives page and the main portion of the News page. The index includes links to the identified issues.
We've also changed our News page to make it easier to find topics of interest.
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CLAIMS
File 2014 Services
We encourage you to file claims for 2014 services no later than March 1, 2015. For inpatient hospital claims that will span from 2014 to 2015, please submit an interim claim.
Multiple interim claims may be billed throughout the hospital stay followed by the final claim with the appropriate discharge status. Inpatient interim claims contain a unique Type of Bill (TOB) and may require a patient status code:
|
Type of Bill
| Inpatient Description | Patient Status
|
| 112 | 1st Claim | 30 - Still Patient |
| 113 | Cont. Claim | 30 - Still Patient |
|
114
|
Last Claim
|
|
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Change in Claim Review Timelines
In most cases, a claim can be reviewed for adjustment if requested within one year from the date the claim was processed. Please note the two exceptions, as one has recently changed:
- Change: Claims that deny to provider liability when a prior authorization was not requested may be appealed up to 180 days from the date of the claim's denial.
- Claims that deny because they are received after the timely filing requirement may be appealed up to 60 days from the date of the claim's denial.
To request a claims appeal or adjustment, select the appropriate claims form.
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MEDICAL POLICY
Updated and New Medical Policy Information Posted
To see more information about the following medical policy updates and additions, check the Medical Policy Update dated January 2015:
Medical Services
Pharmacy Services
Always check the most current information using our Medical Policies/Coverage Criteria.
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PHARMACY
Drug List Changes for First Quarter 2015 Available
To see a list of recent and upcoming changes to the 2015 CoOportunity Health Drug List, use these resources:
Always check the most current information using the Drug List.
Hepatitis Drug Prior Authorization Form Includes a Member Page To help our members take a more active role in their health, we've recently updated our Forms page to include a Hepatitis Medication Regimen Initial Request Form. Please complete this form to request a prior authorization when prescribing Harvoni�, Sovaldi�, or Olysio�.
This form outlines items you should discuss with our member to help them understand their responsibility for the drug therapy's success, and the approximate cost of these drugs - around $1000 per day. Please ask our members to sign the second page of the form at the conclusion of your discussion.
