Radiation Therapy Services Contact AIM for Delivery, Amerigroup for Planning
|
|
|
- Luke Greene
- 5 years ago
- Views:
Transcription
1 Radiation Therapy Services Contact AIM for, Amerigroup for Planning Prior authorization of outpatient radiation therapy services for Amerigroup* Community Care Medicare Advantage and Medicare Medicaid Plan members is required. Providers should continue to request prior authorization for the radiation therapy modalities and services listed below: Intensity Modulated Radiation Therapy (IMRT) 3D Conformal/ External Beam Radiation Therapy (EBRT) Proton Beam Therapy Stereotactic body radiation therapy (SBRT) and Stereotactic radiosurgery (SRS) Hypo fractionation for bone metastases and breast cancer when requesting EBRT and IMRT Special procedures and consultations associated with a treatment plan (CPT codes and 77470) Image-guided radiation therapy (IGRT)] The type of review needed will determine the prior authorization steps to be taken: 1. Planning Prior authorization is administered by contacting Amerigroup via Availity. 2. Planning & Prior authorization is administered by AIM Specialty Health (AIM) Prior authorization is administered by AIM Specialty Health (AIM). AIM reviews certain treatment plans against clinical appropriateness criteria to ensure the care aligns with established medical best practices and Medicare/Medicaid guidelines as appropriate. If you are ready to deliver any of the services listed above, please contact AIM. AIM reviews authorizations for delivery and planning services under the umbrella of radiation therapy modalities. To submit your request, go to the AIM ProviderPortal sm at From the dropdown menu, select Amerigroup MA. For additional assistance you may also call AIM toll free at , Monday through Friday, 8 a.m. to 8 p.m. Eastern Time. SSO-PEC
2 If you are ONLY requesting authorization for the planning codes, and not yet ready to request the delivery codes or radiation therapy is being performed as part of an inpatient admission, you may request approval by contacting Amerigroup through Availity. If you are ONLY requesting authorization for the planning codes, and not yet ready to request the delivery codes or radiation therapy is being performed as part of an inpatient admission, you may request approval by contacting Amerigroup via Aviality. Detailed prior authorization requirements for Medicare Advantage members are available to the contracted provider by accessing the Provider Self-Service Tool through the Availity web portal. From the Patient Registration drop down box on the top menu bar on Availity, select Authorizations & Referrals, then Authorizations. Select Amerigroup Medicare Advantage from the drop down box. You will be directed to the Medicare Advantage Precertification site which includes the precertification submissions and inquiries link MUPENMUB 12/14/2016 *In New Mexico, Amerigroup Community Care of New Mexico, Inc. In Texas, Amerigroup members in the Medicaid Rural Service Area are served by Amerigroup Insurance Company; all other Amerigroup members are served by Amerigroup Texas, Inc. In Washington, Amerigroup Washington, Inc. Amerivantage is a DSNP plan with a Medicare contract and a contract with the State Medicaid program. In New Mexico: Amerivantage is an HMO with a Medicare contract. Enrollment in Amerivantage depends on contract renewal. Page 2 of 2
3 <Radiation Oncology Prior Authorization Are you ready to deliver services. YES Contact AIM AIM reviews authorizations for delivery and planning services under the umbrella of certain modalities. NO Contact <Plan Name> If you are ONLY requesting authorization for the planning codes, and not yet ready to request the delivery codes or radiation therapy is being performed as part of an inpatient admission, you may request approval by contacting <Plan Name> through Availity. AIM will review for the indicated modality and appropriate related codes.
4 AIM Radiation Oncology Prior Authorization Modality Based - 1. Primary Grouper 2. Grouper ID The provider must request the primary modality from AIM to request authorization for any of the related lower-tier codes 3. Included
5 AIM Radiation Oncology Prior Authorization Modality Based- IMRT Scenario 1 Provider calls AIM and requests authorization for code IMRT During the same call the provider requests authorization for an IMRT Planning code and some related treatment codes and AIM is able to process the request because the primary delivery code, 77385, has been requested and the provider is ready to deliver the service - 1. Primary Grouper 2.Grouper ID 3. Included
6 AIM Radiation Oncology Prior Authorization Modality Based- IMRT Scenario 2 Provider calls AIM and requests authorization for code 77301, an IMRT-related planning code The provider is NOT ready to deliver services at this time and does NOT request authorization for the primary modality delivery code (77385) - 1. Primary Grouper 2.Grouper ID AIM is NOT able to process the request. AIM informs the caller that it authorizes services based on delivery of a treatment modality (a grouping of codes/package of services) AIM indicates that this is NOT necessarily a denial of services and the provider is given two options: 3. Included Contact AIM when ready to deliver services and request approval for delivery and related codes at that time
7 The provider must request the primary modality from AIM (Tier 1, Green) to request authorization for any of the related lower-tier codes (Tier 2-Blue or Tier 3- Yellow) Otherwise, planning codes alone should go through the health plan. > Primary Modality Included Calculation Handling Q3001 Handling Esophagus Biliary Tract Penile Tumor Retina Breast Muscle/Soft Tissue Head/Neck Pelvic Bronchoscopy Uterine/Vaginal Calculation Uterine/Vaginal Breast Calculation Uterine/Vaginal Breast G MUPENMUB 12/14/2016
Questions and Answers
Questions and Answers Radiation Oncology Utilization Management Program Why did Florida Blue implement a radiation oncology utilization management program? The purpose of the program is to ensure radiation
Radiation Therapy Services
Radiation Therapy Services Chapter.1 Enrollment..................................................................... -2.2 Benefits, Limitations, and Authorization Requirements...........................
Frequently Asked Questions Radiology Prior Authorization Program for the UnitedHealthcare Community Plan, Arizona
Doc #: UHC1782m_20120305 Frequently Asked Questions Radiology Prior Authorization Program for the UnitedHealthcare Community Plan, Arizona 1. What is the UnitedHealthcare Radiology Prior Authorization
Anthem Blue Cross and Blue Shield in Maine Precertification/Prior Authorization Guidelines
Anthem Blue Cross and Blue Shield in Maine Precertification/Prior Authorization Guidelines The following guidelines apply to Anthem Blue Cross and Blue Shield ( Anthem ) products issued and delivered by
Intensity Modulated Radiation Therapy Policy
Policy Number 2017R0130D Intensity Modulated Radiation Therapy Policy Annual Approval Date 2/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You
2017 Hospital Outpatient Prospective Payment System Final Rule Summary
2017 Hospital Outpatient Prospective Payment System Final Rule Summary On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Hospital Outpatient Prospective Payment
Radiation Oncology Clinical Coverage Policy No.: 1K-6 Amended Date: October 1, 2015 Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 2 2.1 Provisions... 2 2.1.1 General... 2 2.1.2 Specific... 2 2.2 Special
Prior Authorization and Medical Necessity Determination Processes
Prior Authorization and Medical Necessity Determination Processes Prior authorizations (PAs) are required for inpatient admissions, various procedures, prescription medications and physical and occupational
Highlights of 2018 Medicare Proposed Rules. Wendy Smith Fuss, MPH Health Policy Solutions AAPM Consultant
Highlights of 2018 Medicare Proposed Rules Wendy Smith Fuss, MPH Health Policy Solutions AAPM Consultant Outline What we will cover? Payments to Physicians & Freestanding Cancer Centers under the MPFS
Radiology Management Reference Guide
April 2014 Radiology Management Reference Guide NIA TOLL-FREE TELEPHONE NUMBER: 1-866-214-1624 CALL CENTER HOURS: Monday-Friday, 7 a.m.-7 p.m. Saturdays, Sundays and Holidays, 9 a.m.-noon MPI 2469 4/14
Unit 14 Radiology Management
Unit 14 Radiology Management In this unit This unit covers the topics listed below: Topic See Page Introduction 14-2 Prior Authorization Overview 14-4 Retrospective Review, Appeal Process 14-7 Highmark
CMS 1450 (UB-04) institutional providers
Serving Hoosier Healthwise, Healthy Indiana Plan CMS 1450 (UB-04) institutional providers 2017 Annual Workshop Reminders and updates The provider manual was updated in July 2017. The provider manual is
CMS-1500 professional providers 2017 annual workshop
Serving Hoosier Healthwise, Healthy Indiana Plan CMS-1500 professional providers 2017 annual workshop Reminders and updates The (Anthem) Provider Manual was updated in July 2017. The provider manual is
UnitedHealthcare Medicare Prior Authorization Requirements Effective January 1, 2018
General Information This list contains prior authorization requirements for UnitedHealthcare Medicare Advantage (to include UnitedHealthcare Dual Complete and other plans listed in the Included Plans table
MEDICAL PHYSICS ECONOMICS UPDATE. CMS Proposed Rules for Medicare. Medicare Part B. Medicare Part A. Medicare Part C.
MEDICAL PHYSICS ECONOMICS UPDATE AAPM Annual Meeting July 2014 CMS Proposed Rules for 2015 Jim Goodwin Blake Dirksen Jerry White Medicare Medicare Part A Hospital Inpatient Medicare Part C Managed Care
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For Aetna New York Providers Performing Physical Medicine Services
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For Aetna New York Providers Performing Physical Medicine Services Question Answer General Who is National Imaging Associates,
Precertification requirements for FEP members for BRCA testing and outpatient services
2 3 4 5 INSIDE THIS EDITION Reminder: Delinquent payment indicator on NaviNet for APTC members Learn about a field that informs providers when APTC members are delinquent in paying their premiums Providers
CareCore National Frequently Asked Questions (FAQ)
CareCore National Frequently Asked Questions (FAQ) 1. What is changing? Based on the implementation date of your provider notification letter, a limited range of Musculoskeletal Pain, Sleep and Cardiology
General Who is National Imaging Associates, Inc. (NIA)?
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For Aetna/Coventry West Virginia Providers Performing Physical Medicine Services Question General Who is National Imaging Associates,
CareCore National Musculoskeletal Management Program Physical Medicine and Therapy Frequently Asked Questions
EVIDENCE-BASED HEALTHCARE SOLUTIONS CareCore National Physical Medicine and Therapy Prepared for December 2, 2014 Table of Contents Introduction to CareCore National... 3 Who is CareCore National?... 3
Claim Investigation Submission Guide
Claim Investigation Submission Guide August 2017 Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East, and QCC Insurance Company,
ICD-10. ProviderNews2015. coded prior authorizations. Did you know you also have NEW JERSEY
NEW JERSEY ProviderNews2015 Quarter 1 ICD-10 coded prior authorizations NJPEC-0571-15 03.15 1200830 The transition from ICD-9 to ICD-10 goes into effect on October 1, 2015. Amerigroup Community Care will
CT Transition of SAGA Clients to Medicaid Low Income Adults (Medicaid LIA) Workshop
CT Transition of SAGA Clients to Medicaid Low Income Adults (Medicaid LIA) Workshop Presented by The Department of Social Services & HP for Billing Providers 1 Training Topics Overview Recoupment of SAGA
Medicare Advantage Advance Notification/Prior Authorization Requirements Effective Oct. 1, 2015
Prior Authorization will be REQUIRED for In-Network Services for the following Plans: Included Plans Subject to the UnitedHealthcare Provider Administrative Guide and the UnitedHealthcare West Non-Capitated
UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Medicare Prior Authorization Requirements Effective October 1, 2017
General Information This list contains prior authorization requirements for UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare participating care providers for inpatient and
2015 Medicare Product Medicare Advantage. Dual Eligible Special Needs Plan (DSNP) Overview
2015 Medicare Product Medicare Advantage Dual Eligible Special Needs Plan (DSNP) Overview 1 Dual Eligible Special Needs Plan (DSNP) Overview What is a Special Needs Plan? Medicare Part C Medicare Advantage
Summary of Benefits. Allwell Medicare (HMO) Bexar County, TX H Benefits effective January 1, 2018 H0062_18_2962SB_Accepted
2018 Summary of Benefits Bexar County, TX H0062 -- 001 Benefits effective January 1, 2018 H0062_18_2962SB_Accepted 09102017 This booklet provides you with a summary of what we cover and your cost-sharing.
Frequently Asked Questions Radiology Management Program
Frequently Asked Questions Radiology Management Program Neighborhood Health Plan of Rhode Island (Neighborhood) has implemented a prior authorization program with MedSolutions. This will include clinical
Clinical Policies and Procedures for Major Joint and Lower Extremity Services Overview and FAQs for BCBSNC In-Network Providers.
Clinical Policies and Procedures for Major Joint and Lower Extremity Services Overview and FAQs for BCBSNC In-Network Providers October 17, 2016 Overview Blue Cross and Blue Shield of North Carolina (BCBSNC)
evicore healthcare Utilization management programs Frequently asked questions
evicore healthcare Utilization management programs Frequently asked questions Who is evicore? evicore is a specialty medical benefits management company that provides utilization management services for
Summary of Benefits. Join the WELLfluent Broward County. AvMed Medicare Choice HMO H1016, Plan 021 GET FIT. EAT RIGHT. CONNECT. GROW.
Join the WELLfluent GET FIT. EAT RIGHT. CONNECT. GROW. Summary of Benefits 2019 Broward County AvMed Medicare Choice HMO H1016, Plan 021 This is a summary of drug and health services covered by AvMed Medicare
Continuing the Growth
Varian Medical Systems Q3 FY2005 Overview Giving Fighters a New Edge 2004 and Beyond Continuing the Growth Forward-Looking Statements Except for historical information, the information that follows contains
Summary of Benefits. Allwell Medicare (HMO) Cameron and Hidalgo counties, TX H
2018 Summary of Benefits Allwell Medicare (HMO) Cameron and Hidalgo counties, TX H0062 -- 003 Benefits effective January 1, 2018 H0062_18_2965SB_Accepted 09102017 This booklet provides you with a summary
Interventional Pain Management (IPM) Frequently Asked Questions
Interventional Pain Management (IPM) Frequently Asked Questions Question GENERAL Why did HMSA implement a process to review pain management? Answer To improve quality and manage the utilization of nonemergent
Impact of Work RVU Changes. Impact of PE RVU Changes. Total $93,149 0% 0% 0% 0% $1,745 0% 1% 0% 1%
On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare Physician Fee Schedule (MPFS) final rule. The final rule updates the payment policies, payment rates, and quality
Specialty Drug Medical Benefit Management
Specialty Drug Medical Benefit Management Agenda Introduction Specialty Medical Benefit Management (SMBM) Strategy Prior Authorization Process Other Important Information Provider Tools Provider Relations
Summary of Benefits. Join the WELLfluent Broward County AvMed Medicare Choice HMO H1016, Plan 021 GET FIT. EAT RIGHT. CONNECT. GROW.
Join the WELLfluent GET FIT. EAT RIGHT. CONNECT. GROW. Summary of Benefits 2018 Broward County AvMed Medicare Choice HMO H1016, Plan 021 This is a summary of drug and health services covered by AvMed Medicare
UnitedHealthcare Medicare Prior Authorization Requirements Effective April 1, 2018
General Information This list contains prior authorization requirements for UnitedHealthcare Medicare Advantage (to include UnitedHealthcare Dual Complete and other plans listed in the Included Plans table
HOW TO SUBMIT OWCP-04 BILLS TO ACS
HOW TO SUBMIT OWCP-04 BILLS TO ACS OFFICE OF WORKERS COMPENSATION PROGRAMS DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION The following services should be billed on the OWCP-04 Form: General
Soundpath Health. Our service area includes the following counties in Washington State:
Soundpath Health Peak (HMO), H9302-011, Sound (HMO), H9302-007, Charter +Rx (HMO), H9302-003 This is a summary of drug and health covered by Soundpath Health from January 1, 2018 - December 31, 2018. To
PAYMENTS MADE BY NOVITAS SOLUTIONS, INC., TO HOSPITALS FOR CERTAIN ADVANCED RADIATION THERAPY SERVICES DID NOT FULLY COMPLY WITH MEDICARE REQUIREMENTS
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL PAYMENTS MADE BY NOVITAS SOLUTIONS, INC., TO HOSPITALS FOR CERTAIN ADVANCED RADIATION THERAPY SERVICES DID NOT FULLY COMPLY WITH MEDICARE
Provider Training Program. Date
Mountain State Blue Cross Blue Shield Provider Training Program Presenter Date Provider Training Program Agenda Welcome and Opening Remarks About NIA The Provider Partnership The Program Components The
Summary of Benefits. for Anthem MediBlue Select (HMO) Available in Hartford county, CT
Summary of Benefits for Available in Hartford county, CT Anthem Blue Cross and Blue Shield is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.
Healthcare Common Prodecure Coding System
G6016 COMPENSATOR-BASED BEAM MODULATION TREATMENT DELIVERY OF INVERSE PLANNED TREATMENT USING 3 OR MORE HIGH RESOLUTION (MILLED OR CAST) COMPENSATOR, CONVERGENT BEAM MODULATED FIELDS, PER TREATMENT SESSION
GENERAL Why did Magellan Complete Care implement an MSK Program focused on IPM procedures?
Magellan Healthcare 1 Musculoskeletal Care Management (MSK) Program Interventional Pain Management (IPM) Frequently Asked Questions (FAQ s) For Magellan Complete Care of Florida Providers Question GENERAL
Training Documentation
Training Documentation Substance Abuse Rehab Facilities 2017 Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital
Vermont Collaborative Care, LLC. Release date: May 15, 2013 Updates to original March 2013 Overview highlighted in yellow
Vermont Collaborative Care, LLC Release date: May 15, 2013 Updates to original March 2013 view highlighted in yellow Vermont Collaborative Care, LLC (VCC) will begin operations on July 1, 2013. VCC was
Network Health Claims Editing Portal
Network Health Claims Editing Portal CPT codes, descriptions and other CPT material only are copyright 2010 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative
What s New for 2017? Retiree Dental and Retiree Life Insurance Coverage (Closed Plans) Benefit Resources and Contacts 14-16
This 2017 Retiree Open Enrollment Guide is not an employment contract or an offer to enter into an employment contract, nor does it constitute an agreement by the corporation to continue to maintain the
CHAPTER 4: PROVIDER RESPONSIBILITIES AND GUIDELINES
CHAPTER 4: PROVIDER RESPONSIBILITIES AND GUIDELINES UNIT 5: OUTPATIENT RADIOLOGY AND LABORATORY IN THIS UNIT TOPIC SEE PAGE Radiology Management Program Overview 2 Privileging for Radiology Services 3
Summary of Benefits. Join the WELLfluent Miami-Dade County. AvMed Medicare Choice HMO H1016, Plan 001 GET FIT. EAT RIGHT. CONNECT. GROW.
Join the WELLfluent GET FIT. EAT RIGHT. CONNECT. GROW. Summary of Benefits 2018 Miami-Dade County AvMed Medicare Choice HMO H1016, Plan 001 This is a summary of drug and health services covered by AvMed
MEDICAL ASSISTANCE BULLETIN
ISSUE DATE August 31, 2015 SUBJECT EFFECTIVE DATE September 1, 2015 MEDICAL ASSISTANCE BULLETIN NUMBER BY 01-15-30, 14-15-25, 31-15-30 Prior Authorization Requirements and Fee Schedule Updates for Hyperbaric
Working with Anthem Subject Specific Webinar Series
Working with Anthem Subject Specific Webinar Series BlueCard Program Introduction Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your Phone
Highlights of the Group Medicare Prescription Drug Plan. Administrative Services from Group Administrative Concepts
Highlights of the Group Retiree Medical Plan for Schools Insurance Group Retirees The Hartford offers Group Retiree Insurance Plans for Medicare-eligible retirees over 65 years of age. The plan helps pay
2018 Medicare Program Overview
2018 Medicare Program Overview State College of Florida Florida College System Risk Management Consortium #78800 Retirees Eligible for Medicare Florida Blue is an Independent Licensee of the Blue Cross
CarePartners of Connecticut HMO Plans Buyer s Guide. Includes a chart comparing all HMO plan options
CarePartners of Connecticut HMO Plans 2019 Buyer s Guide Includes a chart comparing all HMO plan options Service Area: to join a CarePartners of Connecticut plan, you must live in our service area: Hartford,
2017 NMRHCA Benefits Presentation
2017 NMRHCA Benefits Presentation Presbyterian Senior Care (HMO-POS) Plan I and Plan II _[code]_[mmddyyyy] Who we are Started in 1908 as a Tuberculosis Sanatorium Presbyterian Today Locally owned, nonprofit
Medex 3 Plan 2013 Summary of Benefits with 3-Tier Prescription Drug Coverage: $5/$10/$25
Medex 3 Plan 2013 Summary of Benefits with 3-Tier Prescription Drug Coverage: $5/$10/$25 This Medex plan provides benefits for the: Medicare Part A Deductible and Co-insurances Medicare Part B Deductible
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD 2019
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD 2019 * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital
Excellus BlueCross BlueShield Provider Relations Fall Seminar
Excellus BlueCross BlueShield Provider Relations Fall Seminar Agenda Product Updates Safety Net Clear Coverage Authorization Tool Website Updates EDI Updates Clinical Editing BlueCard Medicare Updates
ProviderNews PLEASE SHARE WITH YOUR APPROPRIATE CLINIC PERSONNEL December 2015
PLEASE SHARE WITH YOUR APPROPRIATE CLINIC PERSONNEL December 2015 Important: To ensure that your questions are answered by the appropriate person, we have created new email addresses. Please use one of
Summary of Benefits. for Anthem MediBlue Select (HMO) Available in Hartford county, CT
Summary of Benefits for Available in Hartford county, CT Anthem Blue Cross and Blue Shield is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.
2017 Group Retiree Medicare Plans
2017 Group Retiree Medicare Plans Standard Health Maintenance Organization (HMO) Plans Empire BlueCross BlueShield is an HMO and PDP plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield
New Claims Status Listing Tool Table of contents How to access the Claims Status Listing Tool:
2016 Quarter 2 New Claims Status Listing Tool On June 18, 2016, a new Claims Status Listing Tool will be offered on the Amerigroup Community Care Payer Spaces on Availity. This application enables you
Life is Full of Important Choices
* Life is Full of Important Choices Let us help you make the right choice for your 2017 Medicare insurance. Your Guide to Medicare Supplement Insurance from Blue Cross and Blue Shield of Texas, a Division
2018 Summary of Benefits
2018 Summary of Benefits Gateway Health Medicare Assured Diamond (HMO SNP) Gateway Health Medicare Assured Ruby (HMO SNP) Gateway Health Medicare Assured Select (HMO MA-PD) Gateway Health Medicare Assured
Summary of Benefits. Join the WELLfluent Miami-Dade County AvMed Medicare Circle HMO H1016, Plan 023 GET FIT. EAT RIGHT. CONNECT. GROW.
Join the WELLfluent GET FIT. EAT RIGHT. CONNECT. GROW. Summary of Benefits 2019 Miami-Dade County AvMed Medicare Circle HMO H1016, Plan 023 This is a summary of drug and health services covered by AvMed
Summary of Benefits. Aetna Medicare Rx Costco Plus Plan (PDP) S5810. California. January 1, 2010 to December 31, 2010
January 1, 2010 to December 31, 2010 Summary of Benefits Aetna Medicare Rx S5810 California S5810_D_PE_SB_90712 (08/2009) Visit us www.aetnamedicare.com 1 Summary of Benefits: Aetna Medicare Rx Section
Memorial Hermann Advantage (HMO)
Memorial Hermann Advantage (HMO) INTRODUCTION TO SUMMARY OF BENEFITS January 1, 2015 December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service
Summary of Benefits. My RxBLUE (PDP). Medicare prescription drug plan from the Cross and Shield 10MX0010 R1/11 S5937_091010AMFU
2011 Summary of Benefits 2011 My RxBLUE (PDP). Medicare prescription drug plan from the Cross and Shield 10MX0010 R1/11 S5937_091010AMFU Summary of Benefits for RxBLUE (PDP) January 1, 2011 December 31,
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD - 2018 * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the
HNE Medicare Value (HMO)
2016 Medicare Advantage Summary of Benefits January 1, 2016 - December 31, 2016 H8578_2016_453 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have
2018 CareOregon Advantage Star (HMO) Summary of Benefits
2018 Summary of Benefits For Oregon counties: Clackamas, Columbia, Multnomah and Washington H5859_1099_CO_3018v3 CMS ACCEPTED CAREOREGON ADVANTAGE STAR (HMO) (A Medicare Advantage Health Maintenance Organization
Annual Notice of Changes for 2018
Amerivantage Dual Coordination (HMO SNP) Offered by Amerigroup Annual Notice of Changes for 2018 Next year, there will be some changes to the plan s costs and benefits. This booklet tells about the changes.
CENTENARY COLLEGE OF LOUISIANA SCHEDULE OF BENEFITS
CENTENARY COLLEGE OF LOUISIANA SCHEDULE OF BENEFITS PLAN NAME CENTENARY COLLEGE OF LOUISIANA HDHP-HMO GROUP NUMBER 78L11ERC PLAN'S ORIGINAL BENEFIT PLAN DATE PLAN'S AMENDED BENEFIT PLAN DATE January 1,
Annual Notice of Changes for 2018
Amerivantage Classic (HMO) Offered by Amerigroup Annual Notice of Changes for 2018 Next year, there will be some changes to the plan s costs and benefits. This booklet tells about the changes. 1-866-805-4589,
BUNDLED PAYMENTS IN RADIATION ONCOLOGY
BUNDLED PAYMENTS IN RADIATION ONCOLOGY CASE STUDIES IN INNOVATIVE SPECIALIST VALUE-BASED PAYMENT INITIATIVES: SPECIALTY PAYMENT REFORMS THAT REDUCE THE COSTS OF PROCEDURES Constantine Mantz MD Chief Medical
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct HMO Plus (HMO)
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct HMO Plus (HMO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties P age 1 SECTION I - INTRODUCTION TO SUMMARY
Annual Notice of Changes for 2018
Amerivantage Select (HMO) Offered by Amerigroup Annual Notice of Changes for 2018 Next year, there will be some changes to the plan s costs and benefits. This booklet tells about the changes. 1-866-805-4589,
Cenpatico South Carolina Frequently Asked Questions (FAQ)
Cenpatico South Carolina Frequently Asked Questions (FAQ) GENERAL Who is Cenpatico? Cenpatico, a division of Centene Corporation, is one of the nation s most experienced behavioral health companies providing
Evidence of Coverage:
January 1 December 31, 2018 Evidence of Coverage: Your Medicare Health Benefits and Services as a Member of Aetna Medicare SM Plan (PPO). This booklet gives you the details about your Medicare health care
Beneficiary co-insurance for OPPS services is projected to decrease from 19.9 percent in CY 2015 to 19.3 percent in CY 2016.
CMS Finalizes Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes, Including Changes to the Two-Midnight Rule and Quality Reporting for 2016 The Centers for Medicare & Medicaid
PLAN F or HIGH DEDUCTIBLE PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD
SERVICES DS-GRMSP10(46) Page 1 MEDICARE PAYS AFTER YOU PAY $2240 PLAN PAYS HOSPITALIZATION * Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1340
CHRISTUS Health Plan Generations (HMO) Summary of Benefits. Finally, access to the doctor and hospital you know and trust. christushealthplan.
CHRISTUS Health Plan Generations Summary of Benefits Finally, access to the doctor and hospital you know and trust. christushealthplan.org Summary of Benefits CHRISTUS Health Plan Generations H1189 This
FloridaBlue BlueOptions PPO 3
FloridaBlue BlueOptions PPO 3 PPO 3 MEDICAL PLAN ENROLLMENT CODE FBO3 Estimated Metal Level Silver Carrier Network BlueOptions 05901 In-Network Out-of-Network Calendar-Year Deductible (Deductible applies
MU Stage 1 - EP Public Health Reporting Exclusion
MU Stage 1 - EP Public Health Reporting Exclusion Final Rule Extract (Final Rule pg. 767+) 495.6 Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs. (2) Exclusion for non-applicable
Procedure Access Program
Procedure Access Program ww Patient and provider focused ww Benefit verification service w w Pre-authorization service and appeal support ww Excluded benefit support ww Financial Assistance Program AMS
Dual Special Needs Plans, Behavioral Benefit
Dual Special Needs Plans, Behavioral Benefit Offered by UnitedHealthcare Dual Complete Launch Date January 1, 2019 Contents What are Dual Special Needs Plans (DSNPs)? UnitedHealthcare Dual Complete Behavioral
Interim Report NINE MONTHS ENDED JANUARY 31, /04
9 Interim Report NINE MONTHS ENDED JANUARY 31, 24 23/4 ELEKTA AB (PUBL) CORP. REG. NO. 55617-415 INTERIM REPORT NINE MONTHS ENDED JANUARY 31, 24 Interim Report Nine months ended January 31, 24 Operating
Arlington County Government 2015 Medicare Retiree Health Care Program Your Retiree Health Benefits
c/o AmWINS Group Benefits 50 Whitecap Drive North Kingstown, RI 02852 Arlington County Government 2015 Medicare Retiree Health Care Program Your Retiree Health Benefits Your 2015 Arlington County Retiree
Important Messages from Aerospace Employee Benefits 2. Anthem Medicare Preferred PPO with Senior Rx Plus Plan Medical Coverage 5 9
This 2019 Retiree Open Enrollment Guide is not an employment contract or an offer to enter into an employment contract, nor does it constitute an agreement by the corporation to continue to maintain the
Summary of Benefits. for Anthem Senior Advantage Basic (HMO)
Summary of Benefits for Anthem Senior Advantage Basic (HMO) Available in Ashland, Clermont, Cuyahoga, Darke, Fairfield, Franklin, Fulton, Geauga, Lake, Licking, Lorain, Madison, Medina, Ottawa, and Warren
(PDP) 2014 Summary of benefits for our Medicare prescription drug plans (Enhanced and Standard)
(PDP) 2014 Summary of benefits for our prescription drug plans (Enhanced and Standard) Contract S5540, Plans 004 and 002 January 1, 2014 December 31, 2014 U5073c, 8/13 Y0079_6249 CMS Accepted 09112013
How Medicare Works. Helping you make the most of Medicare. MedicareBlue SM Rx (PDP) S5743_ mmddyy_xxx
How Medicare Works Helping you make the most of Medicare 2018 MedicareBlue SM Rx (PDP) S5743_ mmddyy_xxx About Medicare Whether you re new to Medicare or want a refresher, this guide can help you understand
Summary of Benefits. Allwell Medicare Premier (HMO) Duval, Pinellas, Polk, Hernando, Pasco and Volusia Counties, Florida H
2018 Summary of Benefits Duval, Pinellas, Polk, Hernando, Pasco and Volusia Counties, Florida H9276-002 Benefits effective January 1, 2018 H9276_18_2859SB_B_Accepted 10032017 This booklet provides you
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For AmeriHealth Caritas District of Columbia (DC) Providers
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For AmeriHealth Caritas District of Columbia (DC) Providers Question GENERAL Why is AmeriHealth Caritas DC implementing an outpatient
Any missing information may cause a delay in processing your request.
Member Reimbursement Claim Form *3000* This form may be used for Allwell Medicare products. Important: Complete a separate Member Reimbursement Claim Form for each member asking for reimbursement for covered
NCQA Corrections, Clarifications and Policy Changes to the 2017 UM-CR Standards and Guidelines
This document includes the corrections, clarifications and policy changes to the 2017 UM-CR standards and guidelines. NCQA has identified the appropriate page number in the printed publication and the
Frequently Asked Questions Cardiology Prior Authorization Program Applies to UnitedHealthcare Community Plan Members.
Frequently Asked Cardiology Prior Authorization Program Applies to UnitedHealthcare Community Plan Members. Overview Prior authorization is required for select cardiology procedures provided to certain
Medical Policy Guidelines and Procedures
Medical Policy Guidelines and Procedures An independent licensee of the Blue Cross and Blue Shield Association. U7430a, 2/11 2012, Blue Cross and Blue Shield of North Carolina is an independent licensee