Newsletter Highlights

• Medical Record Documentation
• Lead Screening Criteria
• Immunizations Chart
• Peer-to-Peer Denial Notices 

The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization.  This program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

Buckeye oversees the NIA program and is responsible for claims adjudication.  NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities. 

Prior authorization is required for the following outpatient radiology procedures:

• CT /CTA/CCTA 
• MRI/MRA                                                                                              
• PET Scan

KEY PROVISIONS:

• Emergency room, observation and inpatient imaging procedures do not require authorization.  
• It is the responsibility of the ordering physician to obtain authorization.
• Providers rendering the above services should verify that the necessary authorization has been obtained.  Failure to do so may result in non-payment of your claim. 

Go to the NIA website for more information.

Please join PaySpan for a training session on how to use PaySpan Health. During this session, we will cover the following topics:

How to Use the New Posting and Denial Reports
How to Add Receiving Accounts, Registration Codes & Users
How to Set Up a Mailbox
How to Search for remittance data

Please click on the links below to reserve your seat for a PaySpan Health Training Webinar.

Reserve your seat today – seating is limited!

Wednesday, July 7, 2010 – 2 p.m. to 3:30 p.m. EDT

https://www2.gotomeeting.com/register/117204163

Wednesday, July 14, 2010 – 10 a.m. to 11:30 a.m. EDT

https://www2.gotomeeting.com/register/568183723

Wednesday, July 21, 2010 – 3 p.m. to 4:30 p.m. EDT

https://www2.gotomeeting.com/register/269668482

For more information about PaySpan Healht, visit payspanhealth.com

Buckeye Community Health Plan is pleased to partner with Payformance by PaySpan Health to provide an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is provided at no cost to providers and allows online enrollment. Visit our Payformance page for more information.

“Achieving an accreditation status of Commendable (the NCQA’s second highest Health Plan accreditation status) from NCQA is a sign that a health plan is serious about quality,” said Margaret E. O’Kane, NCQA’s President. “It is awarded to plans whose service and clinical quality meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement.”

NCQA HP Accreditation is a nationally recognized evaluation that purchasers, regulators and consumers can use to assess health plans. It evaluates how well a health plan manages all parts of its delivery system—physicians, hospitals, other providers and administrative services—in order to continuously improve the quality of care and services provided to its members.

“This is a wonderful accomplishment,” said Steve White, Buckeye’s President/CEO. “We are proud of the effort we put forth not only during the accreditation process, but for the effort we put forth every day to exceed service and quality standards on behalf of the members we serve throughout Ohio.”

NCQA accreditation standards are purposely set high to encourage health plans to continuously enhance their quality. No comparable evaluation exists for fee-for-service health care. The standards are intended to help organizations achieve the highest level of performance possible, reduce patient risk for untoward outcomes and create an environment of continuous improvement.

“We work closely with our contracted providers to ensure the highest quality of care for our members,” added White. “This accreditation demonstrates that our service and clinical quality meet NCQA’s rigorous requirements for consumer protection and quality improvement. At a time when many healthcare consumers are looking for quality solutions for their families and when legislators are seeking proven ways to help their constituents connect with outstanding healthcare solutions, this accreditation will help point those in need to Buckeye. And, they will know that the Buckeye Community Health Plan is a leader in meeting needs with caring service with the highest standard of quality.” 

Newsletter Highlights

• Stay in charge of asthma
• Adult dental benefits
• Do you need a PAP test?

Newsletter Highlights

• Stay in charge of asthma
• Adult dental benefits
• Do you need a PAP test?

Newsletter Highlights

• HEDIS Season
• Protected Health Information
• Medicare Centralized Unit
• Claims Processing Tips

Starting May 3, 2010 all prior authorization and care management needs that providers handle for Buckeye’s Medicare Advantage members will be processed at Buckeye’s Independence, Ohio office.

Jill Becenti, RN, BSN, CCM will provide care management services. Katherine Zielaski, RN, will be the lead nurse for prior authorization requests.

The prior authorization fax number is: (877) 861-6722.

The revised provider Medicare Quick Reference Guide can be found in the forms and reference section on this website.

For more information, providers should contact Buckeye’s Medical Management Department at (866) 246-4359.

Follow Buckeye on Twitter as Buckeye_Health

Newsletter Highlights

• Cut Down Your Cholesterol
• Prescription Drug Changes
• Controlling Diabetes