Holiday office closure schedule - New Year's  (12/27/11)

Our offices will be closed on Monday, January 2 in observance of New Year’s Day.

Holiday office closure schedule - Christmas  (12/19/11)

Our offices will be closed on Friday, December 23 and Monday, December 26 in observance of Christmas.

Annual Wellness Visit Program reminders (9/1/2011)

If you have received a request for medical records for the Annual Wellness Visit Program, please submit them promptly to receive your payment. Payments for this program are sent quarterly.

Medicare requires several new encounter components in order for a visit to be eligible to be reported as a wellness visit with one of the following Healthcare Common Procedure Coding System (HCPCS) codes:

• G0438 Annual wellness visit, includes a personalized prevention plan of service (PPS), initial visit
• G0439 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit

Please remember to complete and document all required components for a Medicare annual wellness visit and submit these claims appropriately. Learn more about the eligible codes.

The Annual Wellness Visit Program encourages Asuris TruAdvantage members to schedule an annual wellness visit with their physician or other health care professional. Find out how to participate.

Member Explanation of Benefit (EOB) mailing schedule change (10/17/11)

Beginning October 17, 2011 we will begin mailing EOBs to our members every 14 days instead of daily. This will apply to all member EOBs except Asuris TruAdvantage and Healthy Options.

This change will not impact our timely processing of claims or the frequency of claims payments to our providers.

Generating an EOB summary statement twice a month instead of daily will result in a 29% decrease in claims documents mailed to our members and supports our corporate initiative to integrate sustainability measures into our processes.

Member wellness and care reminder program (10/5/11)

Our new member wellness and care reminder program is designed to communicate the importance of receiving annual wellness examinations, screenings and routine laboratory tests. The program applies to our Asuris TruAdvantage members.

Eligible members will receive automated interactive voice response (IVR) phone calls and letters with a reminder about the importance of receiving the health care services they need before the end of this year. Phone calls will be conducted in October. Letters will be mailed in November. We have contracted with Silverlink Communications, Inc. to perform these phone calls and mailings on our behalf.

We are focusing on members who have not received one or more of the wellness or care screenings listed below:

• Glaucoma testing
• Cholesterol screening
• Breast cancer screening
• Osteoporosis management
• Annual wellness examination
• Colorectal cancer screening
• Diabetes care, including:
• Eye examination
• Hb1Ac screening
• Cholesterol screening
• Healthy kidney function test

View member cards and search for 30 days of claims on the Provider Center  (9/6/2011)

Several enhancements were recently deployed on the Provider Center, including the following new features.

Member cards
Asuris member cards now appear on the Member Search results screen. These images can be viewed or printed. Member cards are available for members on our Individual, group and Medicare products, except for Healthy Options members.

Simply select the member card icon in the Member ID, Group ID, ID Card column to view the image.

Search for 30 days of claims
You can now search for 30 days of claims. Previously, it was two weeks.

Average wholesale price (AWP) primary source change: Effective September 28 (8/31/2011)

First DataBank (FDB), our primary source for obtaining average wholesale price (AWP) for medications, has recently announced that they will be discontinuing publication of the Blue Book Average Wholesale Price (BBAWP). Effective September 28, all National Drug Code (NDC) records containing AWP price values will be removed from BBAWP and AWP pricing will no longer be available from First DataBank.

We will begin using Medispan as our primary source for AWP beginning September 28. This change should not impact our pricing of medical drug claims.

Claims processing delay update (8/17/2011)

We are pleased to report that Asuris has made substantial progress in reduction of our claim payment delays since our last update. Asuris is now processing claims within our standard timeframes for our group, Individual, Medicare and other product lines.

HIPAA 5010 FAQ updated  (8/2011)

Paper claim submitters, please obtain an NPI (7/06/2011)

Paper-based claims transactions (CMS-1500, UB-04 and ADA J400-J404) will soon be required by Asuris to include a National Provider Identifier (NPI) along with your tax identification (ID) number. If you do not yet have an NPI apply now.

Electronic submitters, please discontinue use of your Asuris provider identifier on electronic claims transactions. Please submit only your NPI and tax ID number on electronic transactions. If you feel the Asuris provider identifier is necessary for proper reimbursement, please contact your provider consultant to discuss options.

Network access and availability surveys (8/17/2011)

We recently mailed our annual access and availability survey letters to Asuris TruAdvantage and Healthy Options providers. We are conducting these surveys online. If you received a letter, please complete the survey as soon as possible, but no later than September 9.

Access the survey:

• Primary Care
• Behavioral Health Specialists

The letters included a personalized password for your clinic. If you have difficulty accessing the survey or need your password, please contact your provider consultant.

August 22-26 is National HIPAA 5010 Testing Week (8/2011)

The Annual Wellness Visit Program encourages Asuris TruAdvantage members to schedule an annual wellness visit with their provider. Find out how to participate. (7/28/2011)

Register for upcoming Radiology Quality Initiative (RQI) training (7/2011)

835 Remittance Advice enhancements (7/2011)

HealthDataInsights (HDI) to perform hospital audit services (6/2011)

Update your information in our Provider Directories (6/2011)

Electronic claims attachments now accepted. Learn more and register today (6/2011)

View our revised pre-authorization requirements notification effective August 1 (5/2011)

Claims processing delay update - (6/17/2011)

We are currently experiencing some claims payment delays relative to our first of the year system transition. We are working to correct the causes of this delay and reduce the claims inventory as quickly as possible.

All lines of business are impacted, including Individual, Group and Medicare.

We expect to be back to normal processing standard timeframes for most products by the end of July.  

If you are experiencing payment delays, please check the Provider Center prior to re-submitting claims; in most cases, claims have been received and are in process. 

If you are unable to view your claims on the Provider Center, and they are aged more than 30 days from submission, Provider Customer Service will assist you in verifying claim receipt. Note: Due to call volumes, Provider Customer Service cannot assist providers regarding claims aged less than 30 days from submission.

We would like to thank you for your patience during this period and we apologize for the inconveniences this has caused.

We will continue to provide updates as we work diligently to return to our normal claims processing inventory.

Medicare Pre-authorization List updated: Effective June 1, 2011

Partnering to Heal – Complete this free online patient safety training (5/24/11)

Partnering to Heal, a computer-based, interactive learning tool offered by the U.S. Department of Health and Human Services, highlights effective communication about infection control practices and what it means to help create a “culture of safety” in health care institutions.

The free, 30-minute training includes information on basic protocols for universal precautions and isolation precautions to protect patients, visitors and providers from the most common disease transmissions.

The training promotes these key behaviors:

• Teamwork
• Hand washing
• Communication
• Vaccination against the flu
• Appropriate use of antibiotics
• Proper insertion, use and removal of catheters and ventilators

Complete Partnering to Heal today.

June 15 is National 5010 Testing Day  (6/9/2011)

Claims payment delays (5/18/11)

Asuris is currently experiencing some claims payment delays relative to our first of the year claims system transition. We anticipate returning to normal processing levels in the coming weeks. If you are experiencing payment delays, please check the Provider Center prior to re-submitting claims; in most cases, claims have been received and are in process. Thank you for your patience as we work to improve our systems and service.

View common medical codes used by dental offices   (5/11/2011) 

System outage notice: (5/11/2011) 
A system outage has made information for some members on the Provider Center inaccessible. Electronic claims submission has also been impacted. We are working to resolve this issue as soon as possible and apologize for the inconvenience.

Save up to five minutes per inquiry by using the Provider Center to verify your patients’ eligibility and benefit information.   (4/26/11)

This free and secure online tool allows your office to:

• Verify coverage, benefit types and eligibility effective dates
  
• View patient-specific benefit information, including:
  
  • Office visit copayment and coinsurance amounts
    
  • Deductible, real-time out-of-pocket and coinsurance maximum amounts
    
  • The dollar amount or number of visits he or she has used to date and how much is remaining for benefits with limits (e.g., rehabilitation or spinal manipulations)
    
  • Complete benefit booklet in a PDF format
    
• Review the status of your submitted claims and view payment information
  
• Search for and view payment vouchers by provider name, voucher number or check number

Learn more and register for the Provider Center. View this guide for step-by-step instructions on how to view eligibility and benefit information.

New resource helps hospitals improve safety culture   (4/26/11)
Hospitals working to improve the safety culture of their organization have a new Web-based resource that provides practical information on the patient safety dimensions used in AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS).

The resource is organized by the dimensions assessed in the HSOPS, such as:

• Teamwork within units
• Overall perceptions of safety
• Feedback and communication about errors
• List of general resources from leading public and private groups involved in patient safety
• Links to useful tools and examples that organizations can use to help improve their safety culture

View this resource.

New resource helps hospitals improve safety culture   (4/26/11)
Hospitals working to improve the safety culture of their organization have a new Web-based resource that provides practical information on the patient safety dimensions used in AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS).

The resource is organized by the dimensions assessed in the HSOPS, such as:

• Teamwork within units
• Overall perceptions of safety
• Feedback and communication about errors
• List of general resources from leading public and private groups involved in patient safety
• Links to useful tools and examples that organizations can use to help improve their safety culture

View this resource.

Updated Group and Individual pre-authorization list available April 29 (4/1/2011)

Register for free Web conference on April 29 to learn about Patient Safety Culture  (4/26/11)
The Agency for Health Care Research and Quality (AHRQ) is conducting a free 60-minute Web conference on their Medical Office Survey on Patient Safety Culture on Friday, April 29 from 10 to 11 a.m. (PT).

The session will cover:

• Survey development
• Preliminary comparative results
• Lessons learned from implementation

Facilitators will discuss how patient safety culture perceptions differ between physicians and other medical office staff and how medical office characteristics affect survey results. Also, learn how and when you can submit data to a national comparative database on the survey. 

Register today.

New resource helps hospitals improve safety culture 

Hospitals working to improve the safety culture of their organization have a new Web-based resource that provides practical information on the patient safety dimensions used in AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS).

The resource is organized by the dimensions assessed in the HSOPS, such as:

• Teamwork within units
• Overall perceptions of safety
• Feedback and communication about errors
• List of general resources from leading public and private groups involved in patient safety
• Links to useful tools and examples that organizations can use to help improve their safety culture

View this resource.

Register for TRICARE’s annual provider seminars now (3/31/2011) 

Notice of Medicare Non-Coverage (NOMNC) forms have been updated. Download the latest forms now. (3/8/2011) 

Updated pre-authorization request form available (3/1/11)
Our updated Pre-authorization Request form (PDF) is used for durable medical equipment (DME), inpatient and outpatient surgeries, and outpatient medical services. The updated format and fields will help ensure we receive the necessary information to efficiently and quickly process your request.

Behavioral Health fax number and authorization form change (3/2/11)
Behavioral Health has a new fax number and updated Outpatient Treatment Plan (authorization request) form. All outpatient authorization requests should now be sent to 1 (888) 496-1540.

Share your email address with TriWest (3/1/11)

New screening requirements for Medicare providers: (3/1/11)
Learn how these requirements will impact your office

Updated pre-authorization request form available (3/1/11)
Our updated Pre-authorization Request form (PDF) is used for durable medical equipment (DME), inpatient and outpatient surgeries, and outpatient medical services. The updated format and fields will help ensure we receive the necessary information to efficiently and quickly process your request.

New features recently deployed on the Provider Center (3/1/11)
The following new features have recently been deployed on the Provider Center:

• Claims search response time is now faster for most members. The navigation, sorting and searching functions have also been improved.
• Claims pended reason codes are now displayed in plain English for most members. In addition to displaying the current claims status codes (completed, pending and in process), pended claims now indicate what is needed to complete the claim process.
• Pre-existing waiting period credits and the member’s original effective date are now displayed. The new feature displays what the waiting period is, if it applies, and also the waiting period credits, if the member has any. The original effective date of the member’s policy is also displayed.

Continued batch delivery delays (2/11/11 through 4/8/11)
We continue to experience unexpected batch delivery delays for American National Standards Institute (ANSI) 835 Electronic Remittance Advices. Delays can be up to three days from our normal delivery dates

Additionally, ANSI 270/271 Eligibility Request and Response transactions have also been impacted and we continue to declare outages.

Both issues have been escalated and are being worked at the highest possible urgency. We apologize for any inconvenience this may cause and will continue to provide updates on the status of these transactions.