November 2017 I N S I D E T H I S I S S U E : epower. Credentialing of New Providers:

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1 November 2017 P r o H e a l t h P r o v i d e r R e l a t i o n s U p d a t e I N S I D E T H I S I S S U E : 1 epower 1 New Provider Credentialing New & Termed Payors 2 Updates on PA Requests 2 MRIs of the Spine 2 PAs Medicaid Eligible 8/1/ New Providers, effective 11/1/ Termed Providers 5-6 CareSource Medicare Terming 7 Better Doctor, Inc. Validation 8 VHG - Healthcare & Business Consulting epower ProHealth s epower (Provider Portal) is now available on our website at: provider-relations Providers may login and use epower to check claim status, eligibility and more. Credentialing of New Providers: *PLEASE NOTE* Credentialing through ProHealth for ALL new providers can take anywhere from days from notification to completion. The Credentialing fee has increased to $200 for ALL new providers wishing to join the Community/ProHealth network, effective 11/1/2016. ProHealth Credentialing/Enrollment Supervisor: Jenna White jwhite2@ecommunity.com Phone#: (317) New Payors for CHNw Employed/CPN providers, effective 1/1/2018: AllWell (MHS Medicare) - ALL CHNw Employed/CPN providers Community Health Direct - ALL Tier 1 providers (Basic PPO Plan) Humana Military - ALL CHNw Employed/CPN providers Payors Terming for CHNw Employed/CPN providers, effective 12/31/2017: CareSource Medicare MDWise Marketplace Anthem Pathway (Marketplace plan) Anthem PathwayX (Marketplace plan) 1

2 Update on Prior Authorization Requests: Due to regulatory and legal issues, ProHealth will no longer allow providers to withdraw prior authorization requests that list incorrect tests or procedures. Any request submitted with incorrect information will result in a denial of the request, and the provider and member will be notified by mail. A new prior authorization request must then be submitted with the correct test or procedure for review. MRIs of the Spine: In order to clarify the criteria used for reviews of MRIs of the spine in adults, the following must be submitted within the clinical information: 1) Rule out syringomyelia, transverse myelitis or demyelinating condition 2) Suspected post-operative spinal complication or known trauma 3) Acute onset of back pain where no red flag symptoms are present will require documentation of a minimum of 6 weeks of conservative management, that includes two of these three treatments: A. NSAIDs or acetaminophen/analgesics and/or oral steroids for > 3 weeks (Unless contraindicated or not tolerated) B. Physical therapy and/or a home exercise program for 6 weeks C. Activity modification for 6 weeks 4) Red flag symptoms associated with back pain A. Unexplained weight loss B. Unexplained fever C. Immunosuppression D. History of cancer E. Bowel or bladder incontinence F. Severe nighttime pain G. Saddle anesthesia H. Prolonged use of corticosteroids, osteoporosis I. Age > 70 Physician Assistants Now Eligible for Medicaid: *PLEASE NOTE* Effective 8/1/2017, Physician Assistants (PAs) are now eligible to be enrolled in Indiana Medicaid. If you are an independent provider who has signed a contract with Community ProHealth to be enrolled in CHNw MDwise (HIP & HHW) and wish to have your PAs enrolled in these plans, please contact your ProHealth Provider Relations Analyst so they can start the process. Dawn Widgery, Provider Relations Analyst Carol Boyd, Provider Relations Analyst Phone#: (317) Phone#: (317) Dwidgery@ecommunity.com Cboyd@ecommunity.com 2

3 Contracting and Credentialing Corner Providers Joining ProHealth We would like to welcome the following providers to the ProHealth Network effective November 1, Hospital affiliations will be listed with each provider. Prime SCP Chapman LCSW, Peppi A. - Behavioral Health Drew LMFT, Jennifer - Behavioral Health Elsinger MD, Swapna - Otolaryngology Otolaryngology Associates, LLC - CHE/CHN, CHV, CHS Haynes LCSW, Elwanda - Behavioral Health Hussey MD, Richard W. - Pediatric Neurology Josephson Wallack Munshower Neurology, P.C. - CHE/CHN, CHV, CHS Leising LCSW, Kathryn S. - Behavioral Health Lin MD, David - Orthopedic Surgery CPN, Orthopedic Specialty Care - Anderson (Employed) - CHA Majors LCSW, Danielle L. - Behavioral Health Maloy MD, Kelsey M. - Anesthesiology Community Anesthesia Associates, P.C. - CHE/CHN, CHV Moore CGC, Jennifer - Genetic Counseling Maternal-Fetal Medicine Comprehensive Care (Employed) Morrow MD, PhD, Jay T. - Vascular & Interventional Radiology Summit Radiology, PC - CHRH, CHSH Motashaw DO, Veera - Hospice & Palliative Medicine Palliative Care Services (Employed) - CHE/CHN, CHV Okwechime MD, Josephine - Dermatology Suburban Dermatology - CHRH Pabon MD, Sheila - Opthalmology Corneal Consultants of Indiana - CHE/CHN, CHV Peragallo LCSW, Lianna - Behavioral Health Power MD, Megan E. - Anesthesiology Southeast Anesthesiologists, PC - CHS, CSC-S Robbins LMHC, Andrew - Behavioral Health Roussey LCSW, Kyle T. - Behavioral Health Community Howard Behavioral Health (Employed) Vincent MD, Robert - Gastroenterology Indianapolis Gastroenterology & Hepatology - CHS Watts LCSW, Angela - Behavioral Health 3

4 Prime SCP Advanced Practice Practitioners Contracting and Credentialing Corner Providers Joining ProHealth We would like to welcome the following providers to the ProHealth Network effective November 1, Hospital affiliations will be listed with each provider. Byrum NP, Kimberly - Nurse Practitioner Community Physician Network, Orthopedic Specialty Care (Employed) Caress PA, Serena - Physician Assistant Radiology of Indiana Davis NP, Caitlin E. - Nurse Practitioner St. Francis Medical Group / IIMC Fish NP, Michelle S. - Nurse Practitioner Gastroenterology Care (Employed) - CHE/CHN, CHV Fuss NP, Joyce A. - Nurse Practitioner St. Francis Medical Group / IIMC Greenwalt MP, Mary L. - Nurse Practitioner Grubb NP, Emily - Nurse Practitioner JWM Neurology Hamilton PA, Nicole - Physician Assistant Indianapolis Gastroenterology & Hepatology Hubbard NP, Laurel A. - Nurse Practitioner Marquez NP, Linda - Nurse Practitioner Morris NP, Angela D. - Nurse Practitioner Family Medicine, Pediatric and Ob/Gyn Care, CLMP (Employed) Randall NP, Andrea - Nurse Practitioner JWM Neurology Rominger NP, Helen C. - Nurse Practitioner Damien Cares Scherschel PA, Matthew - Physician Assistant Prime PCP Bergfeld MD, Sara B. - Pediatrics Community Pediatric Hospitalists (Employed) - CHE/CHN, CHV Morad MD, Mohamed H. - Internal Medicine St. Francis Medical Group / IIMC - CHS Prime PCP Advanced Practice Practitioners Oakley NP, Lisa - Nurse Practitioner Community Physician Network, Family Medicine Care (Employed) Stephenson NP, Kathryne W. - Nurse Practitioner Northpoint Pediatrics 4

5 Termed Providers The following providers will no longer be participating with ProHealth: Brinson PA, Kyle - Physician Assistant, termed 10/1/2017. Choi DO, Peter Y. - Family Medicine, termed 10/1/2017. Community Physician Network, Family Medicine Care (Employed) Daugherty LCSW, Deborah L. - Licensed Clinical Social Worker, termed 10/17/2017. Anderson Psychiatric Clinic, LLC Fuller-Nave NP, Mary K. - Nurse Practitioner, termed 10/1/2017. Lawson NP, Terri L. - Nurse Practitioner, termed 10/1/2017. Community Physician Network, MedCheck (Employed) Nichols DO, James T. - Family Medicine, termed 10/1/2017. Community Physician Network, Family Medicine Care (Employed) Torres MD, Michelle - Internal Medicine, termed 10/1/2017. Community Physician Network, Internal Medicine Care (Employed) Ullah MD, Asad - Neurology, termed 10/31/2017. Albert C Lee, M.D. P.C. Attention Community-Employed Practices: CareSource Medicare Advantage Indiana Exit Announced: Effective January 1, 2018, CareSource Medicare Advantage product will no longer be sold in Indiana and Kentucky areas. The CareSource Medicare plan has mailed letters to their members as well as providers impacted by this change. Community Health Network employed practices, please remember: Medicare open enrollment starts October 15, 2017 and runs through December 7, During open enrollment, CareSource Medicare patients will have the opportunity to choose another plan for the January 2018 coverage year. These members will maintain their CareSource Medicare coverage until 12/31/17. Please direct all member questions to CareSource Medicare at Community Health Network is contracted with various Medicare Advantage plans. For a list of those plans or questions of what plans do we accept, please call ProHealth Provider Relations at

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7 BETTER DOCTOR, INC. VALIDATION - Employed Providers : Many Community employed practices have received phone calls or faxes from a company by the name of Better Doctor, Inc. This organization is a third party vendor that seeks contracts with many of the Medicare Advantage (MA) plans to verify provider data on a quarterly basis. CMS has required all MA companies to verify data on a quarterly basis. Community Health Network has contracts in place with several of the MA companies. ProHealth transmits provider demographic data to these organizations on a bi-weekly basis. Please do not verify provider data either via fax or phone with Better Doctor, Inc. at the practice level. The provider data is shared by ProHealth to the MA companies bi-weekly on your behalf. We have reached out to the MA plans and Better Doctor, Inc. to assist in streamlining their process and ask that they do not contact our offices for this project. It has been communicated to Better Doctor, Inc. that we do not verify provider data at the practice level. If you have further questions or concerns, please contact Lori White, Medicare Program Manager, ProHealth Lwhite4@ecommunity.com or

8 Visionary Health Group veicorp.com/consulting Are you an independent practice that needs consulting/financial help?... Integrated physician consulting services A division of VEI since 1987, Visionary Health Group (VHG), formerly known as Indianapolis Medical Management (IMM), has provided physician practice management and consulting services for more than 20 years. VHG prides itself in providing comprehensive, tailor-made services that meet and exceed the needs of its physician clients. VHG s consulting and evaluation services have been designed to objectively evaluate every aspect of a medical practice and to provide realistic solutions to the challenges faced by physicians today. VHG offers a diverse team of skilled individuals to assist you with your various practice needs. *Complimentary business assessment available upon request* Consulting and practice operations Business healthcare consulting Revenue cycle management Documentation and coding experts Financial consulting and reporting Payer credentialing and enrollment Practice/business start-up Full suite of human resource services OSHA/HIPAA compliance Project management Process improvement Development of policy and procedures Please Contact: Tara Rieman Director, Provider Operations Ph#: (317) trieman@ecommunity.com Pat Schmitter, CPC, CPC-I Senior Healthcare Consultant Ph#: (317) pschmitter@ecommunity.com Joni A. Reed, MBA, BSBA, ASB, CMA Jamie L. McAllister, MA Business Consultant - Physician Services Business Consultant Ph#: (317) Ph#: (317) jareed@ecommunity.com schroth@ecommunity.com Anita Huse, RN, CAPPM Pam Cawood, CPPM Business Consultant - Physician Services Business Consultant - Physician Services Ph#: (317) Ph#: (317) ahuse@ecommunity.com pcawood@ecommunity.com 8

9 Provider Relations Department 6626 E. 75th St, #500 Indianapolis, IN Phone: Department Staff Manager Provider Relations: Jenny Bouck, Business Information Coordinator Hollie Putzback, Provider Relations Analysts: Carol Boyd, Dawn Widgery, Amanda Bobo, Governmental Programs Manager (Medicare): Lori White, Governmental Programs Manager (Medicaid): Salena Woodson, Supervisor Provider Credentialing: Jenna White, Credentialing Coordinators: Kim Tibbets, Julia Chumbley, Julie Starr, Aletha Burnett, April Woodruff, Adrianne Stocks, Provider Credentialing Assistants: Amy Walls, Denise Smith, Dianne Castillo, Sharon Harlan, Lori Jones, Melissa Scharfenberg, 9