A New North Star on the Horizon

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1 [...NorthStar s new name identifies the plan s administrative role to potential members and reflects our direction of excellence.] Contents Claims with Dump Codes page 2 Fax Recall page 2 Habla Usted Espanol ~? page 3 Coming to Town page 3 Give Us Your Feedback page 4 A New North Star on the Horizon NCAS, LifeWise s third-party administrator, became NorthStar Administrators in May for easier identification in the marketplace. As an affiliate third-party administrator, NorthStar enables LifeWise to offer a full range of products to meet our member s specific needs, like self-funding options, and administering employee benefit plans for medical, dental, vision and prescription drugs. When a large group prefers a self-funded option, the LifeWise sales force turns to NorthStar Administrators. NorthStar s new name identifies the plan s administrative role to potential members and reflects our direction of excellence. Why NorthStar? Because explorers consistently look to the North Star to successfully lead them to their destination. The billing address has not changed and its relationship with LifeWise remains strong. NorthStar and employer groups are coordinating issuing new ID cards. Patients may continue to use their current NCAS cards until they receive new ones. It is important to remember that NorthStar provides its own benefit information, customer service and claim processes for Oregon members. However, LifeWise care managers will continue to process your requests for prior authorization. Members ID cards will include all the numbers you ll need to know. Here is the information on the back of a NorthStar members ID card: LifeWise To preauthorize hospitalizations and surgeries call: To verify benefits or eligibility call: or Pharmacy locator national line, 24 hours: Claims submission: NorthStar Administrators PO Box Seattle WA NOTE: The front of the ID card will bear the NorthStar logo in a primary position with LifeWise also listed in the upper right hand corner. The billingaddress and customer service phone numbers are on the back of the card. For questions or concerns, please contact the NorthStar Customer Service Center at We share a common goal. We want to provide access to quality health care for your patients and our members. Providing good health care plans is one way LifeWise supports access to care. AUGUST 2000 NETWORK NEWS

2 For Physicians and Practice Management Have You Met Fax Recall Yet? In July, we introduced a new way to quickly verify a patient s benefits or eligibility. Our Fax Recall system can assist you in meeting your patient s needs. What is Fax Recall? Fax Recall is an automated interactive system. Our new tool promotes timely verification of benefits, claim status and eligibility information for you. Why use Fax Recall? Easy access when you request information because the Fax Recall system verifies your request and faxes the response directly to you. Fax Recall reduces your time on the phone. The system is accessible 24 hours a day, seven days a week. The information is comprehensive. Reports include eligibility dates for your patient s entire family, their current deductible amounts, a full summary of benefits and the status of your most current claim submissions to LifeWise. Here s How It Works Enter your tax identification number, fax number and the patient s identification number from their ID card. The system will match the fax number to the tax identification number you input on your first call. The system will save your tax ID number so you don t have to enter it again. In the future, you will only be prompted for your fax number and the member s ID number. Fax Recall reports only claim information pertaining to your tax ID number. If you wish to initiate Fax Recall from a different office location or an outside office, please refer to the Fax Recall system on the flowchart mailed to you. We can store multiple fax numbers for one tax ID number. If your information is entered incorrectly or changes, please contact our LifeWise Customer Service representatives at CPT Code Change Our April Network News included information about CPT codes for evaluation and management services when billed with immunizations. We said we would require a modifier 25 on Evaluation and Management codes that also applied to immunization codes and LifeWise has re-evaluated this CPT coding change. Effective immediately, we will no longer require the use of a modifier 25 with these codes. Claims with Dump Codes CPT codes that end in 99 are non-specific and range from complex surgical procedures to supply codes. Do not submit claims with these codes electronically. If you do, we will need additional information before we can process those claims. Please file these claims on paper and describe the service or supply provided. If the claim is for a supply, bill with the cost invoice attached to the claim. Thank you. We appreciate your willingness to work with us to facilitate claims payment. Network News Editor: Linda Forrester , ext. 5795, e- mail linda.forrester@premera.com Fax: NETWORK NEWS 2

3 For Physicians and Practice Management News You Can Use Habla Usted Espanol ~ or any other language? Do you speak a language other than English? If you do, please notify our Provider Relations staff of the languages we may include with your listing in our directory. You can reach a representative at or fax information to Payment Clarification Only physicians and health-care providers with LifeWise preferred status are paid at the preferred level of benefits. This is true regardless of the status of any referring physician or facility. We regularly advise our members about this process but appreciate your assistance in explaining this whenever possible. You or your patients may confirm current physician and practitioner participation by calling LifeWise Customer Service at for group policies or for individual policies. Preferred status applies at the listed addresses only, and status is subject to change. Groups listed may not include all physicians and providers within a practice or group. All physicians and providers need to be aware that if they refer to someone who is not contracted as a LifeWise preferred physician or provider, members will have to pay more out of their own pocket. We are currently working to provide this information on our new LifeWise Web site. We ll notify you as soon as construction of the site is complete. We re Coming to a Town Near You Our Care Management and Network Development teams are on the road again. We continue to learn how to make working with LifeWise easier for you when we hold Office Staff Workshops in your communities. We appreciate this chance to hear and respond to your concerns and to share more about our mission to provide our members peace of mind about their health care. We send written invitations in advance of planning a luncheon in different areas; so, keep your eye on the mail. We may be coming to your area soon. Thanks again to those who have participated this year. Credentialing Reminder Thank you for being part of our network of physicians and medical practitioners. Establishing a coordinated network to meet our members needs begins with our credentialing program. As many of you know, our directories only include physicians and practitioners with fully approved credentials. LifeWise follows Premera s highly rated credentialing program. The process typically takes 60 to 90 days after we receive a complete application. We assign an effective date to your physician or provider after credentialing is complete. We reassess and update these credentials every two years. Please call our Network Development department for further information on pursuing a preferred provider contract. You may reach representatives at or Keeping You Posted In the June issue of the LifeWise s HouseCall, members learned about: Diabetic eye exams Breast cancer risk factors Diet and protein in diet tips Have a healthy baby Independent review announcement Obtaining care away from home Facts about inhalants Self care -- antibiotics Hooked on Rx drugs NETWORK NEWS 3

4 PO Box 7709 Bend, OR PRESORTED STANDARD U.S. POSTAGE PAID SEATTLE, WA PERMIT NO Give Us Your Feedback We are considering making several improvements in our Explanation of Benefits (EOB) form, and we d like your input. Would including CPT codes in our EOBs be helpful to you? Yes No Additional comments: Please fax your response to us at Thank you for your valuable feedback. F A (7-2000)

5 Tell Us What You Think for a Chance to Win Dinner on Us We recently revamped Network News and are working to make it more applicable to your concerns and interests. Your input would help us greatly. Please take a few minutes to give us your opinions. One lucky person will win a gift certificate (see bottom). 1. Are you: q A physician q Other provider q Office staff member 2. How much of Network News do you read? q Some q All q Scan 3. What areas interest you the most? Check all that apply. q Care management q Administrative/procedural changes q Regulatory/legislative q Pharmacy q Billing and claims q Medical policy q New initiatives q Clinical quality q Organizational news q Medicare/Medicaid q How we support physicians as they provide care q Contracting updates q Plan-specific informationwhich plans 4. Do you find Network News easy to read? q Yes q Somewhat q No How can we improve it? 5. On a scale of 1 to 5 (5 being the best), rate the usefulness of Network News. 6. What s the best way to communicate with you? q Mail q q Fax q Web site q Phone 7. Do you have ? q Yes q No Access to the Web? q Yes q No 8. Comments and suggestions to improve our communication with you based on the above questions or other communication concerns? Thank you for your feedback! To be entered into a drawing for a $75 gift certificate to a local restaurant of your choice,please fill out the information below and answer the survey questions. Only completed surveys qualify. Name Address City, state, zip Fax address Fax this form to Linda Forrester at by August 21 to qualify for the drawing.