EXCHANGE NETWORK. First Choice Health Network (FCHN) is excited to be a part of Assurant s initial offering on the Montana Exchange.

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1 Fall FCH Big Sky Region Provider Newsletter EXCHANGE NETWORK First Choice Health Network (FCHN) is excited to be a part of Assurant s initial offering on the Montana Exchange. You may remember that with a diminishing number of exceptions involving direct access through First Choice Health/Health InfoNet, Assurant generally accesses our Montana providers in our service as the Aetna network in Montana. ID cards for both these Exchange and off-exchange Assurant plan members are identifiable from reference to Aetna/Aetna Signature Administrators, as well as from inclusion of our Health InfoNet logo (Health InfoNet, Inc. is a wholly owned subsidiary of First Choice Health). **Please note that Exchange members will generally be indistinguishable from non-exchange members when referring to member ID cards. If you have concerns about scheduling appointments/services, you may want to contact Assurant s provider services reps and/or pre-auth department to determine patient eligibility for benefits based on the paid to date of their coverage. CONTENTS Exchange Network... 1 State of the Network... 2 EFT / Virtual Payment Systems... 2 Provider Web Experience Update... 2 FCHA s 835 / EFT Vendor: PaySpan CA Electronic Claim Acknowledgement... 3 Just a Reminder... 4 Other Client Updates... 5 Contact Us... 5 Provider Appeals... 5

2 Big Corporate Sky Region News News State of the Network Provider Web Experience Update Big Sky Region One of our 2014 initiatives was to improve the provider tools on the FCH website, so we are pleased to announce we have made numerous changes over the past several months. Listed below are some of the enhancements made to the PPO and First Choice Health Administrators (FCHA) provider tools. First Choice Health continues to expand across its Big Sky and Pacific Northwest Regions, including over 14,000 participating providers in the Big Sky Region and over 78,000 total across the two regions combined. Our networks also serve 770,000 total plan members, about 100,000 of whom reside within the Big Sky states. PPO Priced Claims Status Tool: The ability to search for claims using a calendar function or manual date entry rather than the previous dropdown option The ability to print multiple claims at once by adding claims to a print queue EFT / Virtual Payment Systems Please be sure to review the FCH quarterly List of Payors to identify the FCH payors who are offering EFT (Electronic Funds Transfer). Contact those payors directly to ensure you are getting reimbursed in the most efficient manner. We would like to remind our contracted providers that you are not obligated to accept payments from bank card or virtual payment systems and you should always expect payment based on the terms of your FCH contract including clean claim processing standards. Providers should be able to receive payment by check without a processing fee. As a reminder, FCH is not an insurance company and we do not pay claims we are a Preferred Provider Organization (PPO). If you choose to opt out of the bank card option, you will need to contact the payor(s) directly by calling the number on the EOB and/or the number on the back of the patient s ID card. FCHA Claim Status Tool: The search results shown now match the RA and users can recreate the RA and print a copy for their records Claims results will show the user both processed and in-process claims The overall functionality of the Benefits & Eligibility and Claims Status search Next in line for improvement is the Provider Resources page. This is the page users are directed to when they select FCH from OneHealthPort. We plan to improve the navigation of the tools so users can get where they need to go with fewer clicks and fewer questions. Look for more improvements in the coming months! (888)

3 Big Corporate Sky Region News News FCHA s 835 / EFT Vendor: PaySpan Would you like to receive your FCHA claim payments faster? Register now with our partner, PaySpan, to receive electronic claim payments via ACH and be provided with your options for electronic remittance advice. Listed below are instructions for how to sign up with PaySpan and/or register specifically with FCHA. If you do not have an existing PaySpan account CA Electronic Claim Acknowledgement COMING SOON! First Choice Health Network, Inc. is pleased to inform you that we are currently working on an X12 277CA Electronic Claim Acknowledgement. The 277CA is utilized by healthcare payors to report on the status of claims previously submitted by providers via 837. FCH providers typically initiate electronic transactions through various clearinghouses. As a PPO network, we can report limited status on claims, based upon our pricing activities. FCH performs various validations on claims and we reject a moderate volume of claims back to our providers. These are referred to as Provider Sendbacks. Currently, FCH sends the hardcopy FCH Pricing Worksheet back to you, as a provider, via US Postal Service. FCH understands that this adds additional days to your collection time and we are working on an X CA to facilitate reducing the time frame for claim resolution. No registration code is required to register for FCHA You can visit to register You will be prompted to enter your NPI, TIN, and billing zip code If you have an existing PaySpan account... The registration code and PIN are required to create a PaySpan account specifically with FCHA To obtain an FCHA-specific registration code, visit If you already have a registration code, visit to register Please note that as we are not the payor in most situations, we are unable to provide electronic status on the adjudication performed by our payor partners. Once we are able to offer this transaction, we will provide further notice. We will work with the various clearinghouses to ensure they are able to take in the claim status details. You should then work with your clearinghouses, to ensure that the business rules you set up with them can support the detailed information. Look forward to a future provider bulletin when the transaction is available. If you need assistance, please contact PaySpan Provider Services at (877) , Option 1. (888)

4 Big Sky Region News Just a Reminder! Changes to Provider Demographic Information Please notify FCH when you make changes to your demographic information such as: Tax name changes including Doing Business As (DBA) names Practitioner name changes or practice location name changes including clinics, hospitals, and facilities Changes in practice locations that you are affiliated with Physical billing address as required by 5010 (this must be a physical street address) Practice address (the physical address where the practice(s) are located Clinic NPI (this is an organizational NPI and should match the CMS website) Practitioner NPI (this is the individual rendering practitioner NPI and should match the CMS website) Notice of new clinics (additional clinics that the practitioner is associated with and/or new practice locations for an existing clinic) Notice of new practitioners (additional practitioners that are associated with a medical group, clinic or hospital); Please note that they must be credentialed or joining an entity that has a delegated credentialing relationship Notice of practitioners no longer with clinic This information can be submitted to FCH two ways: Use the FCHN Provider Update form available online. You can submit the form via to PPOFileMaintenance@fchn.com or via fax to (406) made to Attention: Provider Information Management. The average time for demographic changes to be entered into the FCH system is ten (10) business days from date of receipt. Use ProviderSource to indicate what demographic changes you wish to make. You must indicate that you want FCH to be notified that you are making the changes; otherwise, we will not know that the changes are there to be picked up. Getting these changes to FCH in a timely manner will ensure your claims will be priced and forwarded on for processing in the most efficient manner. In addition, FCH patients will be able to see your most recent demographic information such as where to call to make an appointment and where your practice is located on our website. (888)

5 Big Sky Region News Provider Appeals In order to ensure your appeals are handled in a timely and accurate manner, FCH would like to remind you of our streamlined appeals process. Other Client Updates New Payors/Groups First Choice Health announced its acquisition of the EBMS Select Network in November We expect all groups currently accessing the Select network to convert over to FCH for primary network access on their various health plan anniversaries. In the meantime, if you participate in both the Select and FCH (HIN) networks, your Select terms will continue to apply to Select groups until their conversion. If you are a FCH provider who is not participating in Select, you are now actively preferred/participating for Select groups and members through your FCH participation. Effective January 1, 2015, FCH also will begin serving the Mail Handlers plan in Montana through Aetna. Contact Us If you have questions, please don t hesitate to contact any of our team members. Name / Position Rob Hunter - President John Larson - Director, Network Management Craig Gould - Director, Network Management Melody Heide - Lead, Provider Relations & Account Management Jim McInerney - Director, Operations & Client Services Jennifer McGlone - Provider Information Management / Credentialing Compliance & Oversight Lead Melody Browning - PPO Provider & Client Services Specialist Lore Smith - Credentialing Specialist Phone: (866) Fax: (406) rhunter@fchn.com jlarson@fchn.com cgould@fchn.com mheide@fchn.com jmcinern@fchn.com jmcglone@fchn.com mbrownin@fchn.com lsmith@fchn.com FCH prices claims to the FCH allowed amount according to the terms of your contract and then forwards them to the payor for processing. FCH does not process or adjudicate claims and does not review or make any determination on claims, appeals, and/or payments regarding appeals. Here are some common types of appeals that FCH can not handle or make a determination on: Denial of benefits Denial due to medical review, cosmetic, experimental and investigational review Denial based on coding, modifier, and/or bundling Submission of records as a result of a denied claim Denial due to lack of authorization (prior or otherwise) Reconsideration of a medical denial If you are submitting one of these types of appeals, please send the appeal directly to the payor for reconsideration. The payor information is located on the patient s ID card and/or the EOP/RA you received, along with a processing summary. Sending your appeal directly to the payor will ensure the appeal is handled in the most expeditious manner. If FCH receives an appeal that should go directly to the payor, we will return the appeal to your office rather than forward it to the payor. If you need assistance, we will gladly help you determine the correct payor. What should I do if my reimbursement rate is incorrect? If the EOP/RA indicates that you were not reimbursed at the correct allowed amount or if you are not certain what the allowable amount should be and the claim was sent to FCH for pricing (EDI# or PO Box 2289, Seattle, WA 98101), you may reference the re-pricing worksheet at To access the pricing worksheet, follow the instructions below: Click the Resources for Providers link in the top right corner of our homepage Select Priced Claims Status to view and print the pricing worksheet if needed You can also access Priced Claims Status via the following link: If the claim was not priced by FCH and if you have any questions regarding the appeal process or incorrectly priced claims, please contact Melody Heide at (888) ext or via at mheide@fchn.com and copy Jim McInerney at jmcinern@fchn.com (888)