CARE IMPROVEMENT - Attention:Home Health Services Providers - Effective January 15, 2015, in keeping with Medicare guidelines and contractual obligations, home health authorizations will change from a 3 day turn-around-time to a 14 day turn- around-time. All home health services require authorization during the first week of services. Requests must include number of visits and services requested (skilled nsg, PT/OT, SW), ICD-9 codes, CPT codes, start of care date and MD order and/or 485 POC. For all RECERTIFICATIONS we will require the 485 plan of care, the previous certification SIGNED 485 POC, documentation of face to face, specific services requested, nursing and therapy progress notes. Information should be received within 72 hours of expiration of previous episode. Plan will notify provider of determination within 14 days of receipt of all clinical information. ALL HOME INFUSION services require PRIOR AUTHORIZATION BEFORE initiating care.

UNITED HEALTHCARE - Monthly Coverage Summary Updates: Ambulance Services Laser Procedures Allergy Testing & Allergy Immunotherapy Blepharoplasty Brachytherapy Procedures Cardiovascular Diagnostic Procedures Chelation Therapy Dialysis Services Evaluation & Management Services Infusion Pump Therapy Joint & Joint Procedure Pain Management & Pain Rehabilitation Radiologic Therapeutic Procedures

AETNA - Have you completed your required Medicare attestation? The Centers for Medicare & Medicaid Services (CMS) requires any contracted Aetna Medicare provider to complete certain Compliance Program requirements. We require that your organization attest by December 31 that you have met these requirements.

UNDERPAYMENTS - As we start 2015, take care to review payments to make sure you’re receiving correct payments.

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