Consultation codes no longer reimbursed by Centers for Medicare & Medicaid Services (CMS) ( 5/04/2010)
CMS no longer reimburses for most consultation codes. Effective January 1, the only consultation codes still eligible for reimbursement are HCPCS G0425 – G0427 initial inpatient telehealth consultation and G0425 – G0408 follow-up inpatient telehealth consultation. The savings realized by CMS due to this determination will be redistributed among existing evaluation and management (E&M) services. CMS also adjusted its reimbursement for the surgical global period to reflect the higher value of office visits during the global period.

Regence adheres to CMS determinations; therefore, we have made the same adjustments to our reimbursement methodology for Regence MedAdvantage and other Medicare members. We will continue to pay a percentage of CMS allowances as currently established. No other Regence lines of business are affected by this change.

Asuris TruAdvantage™ claims pended (7/9/2010)
Asuris TruAdvantage claims for services paid under the Medicare Physician Fee Schedule (MPFS) for dates of service on or after June 1 are currently being held. These claims have been pended while we update our system to apply the newly approved rates. 

If you have submitted claims, they are in our system, but you will not be able to view them in the Provider Center at this time. We will process all claims as quickly as possible. Please do not resubmit claims for Asuris TruAdvantage members. Duplicate claims will inflate the inventory and cause additional delays in processing.

Asuris TruAdvantage™ claims pended 6/1/2010
Beginning on June 1, we will hold Asuris TruAdvantage™ claims for services paid under the Medicare Physician Fee Schedule (MPFS) with dates of service on or after this date.

We are awaiting a decision from Congress on changes to the MPFS. The Centers for Medicare & Medicaid Services (CMS) has announced it will hold claims paid under MPFS with dates of service on or after June 1 for a period of 10 days, pending Congressional action. Once we receive the updated MPFS, we will process claims as quickly as possible.

If you submit claims for dates of service on or after June 1, claims status may not be available in the Provider Center.

All claims for dates of service on or before May 31, 2010, will be processed and paid under normal procedures.

Addressing consequences and etiology of patient falls – free teleconference 4/19/2010
Join the Institute for Healthcare Improvement (IHI) and The Journal of the American Medical Association (JAMA^®) on Wednesday, April 21, at 11:00 AM Pacific Time for the free Author in the Room^® teleconference. Mary Tinetti, MD will present her findings of the most effective interventions in fall prevention from her January JAMA article, The Patient Who Falls.

Learn more about the Author in the Room teleconference series, and enroll today.

Specific fax numbers for Pharmacy Prior Authorizations and Medicare Part D 3/8/2010

We have a designated fax line for incoming Pharmacy Prior Authorizations. We also have a specific Medicare Part D fax line for enhanced receipt and tracking. Please use these numbers to help efficiently process authorizations.

This information is available in the Contact Us section.

Walgreens free blood glucose testing event 2/3/2010
The clinic is available to anyone age 18 or older. All 24-hour Walgreen stores will hold the event on February 5. Anyone not living near a 24-hour Walgreens may call 1 (800) 925-4733 or visit Walgreens for a variety of locations nearest to them. Read more details about the event (PDF).

Tracer claims no longer accepted 1/5/2010
As a reminder, we are no longer accepting tracer claims. These are claims that are resubmitted due to nonpayment. They are also known as rebills, second submissions or duplicate billings.

Please use Asuris Online Services for Providers for basic claim status (if the claim has been received, is in process or has been completed). This process also applies to tracer claims.

If you are unable to find the information you’re looking for online, please contact Customer Service.

Consultation codes no longer reimbursed by Centers for Medicare & Medicaid Services (CMS) 12/29/2009
CMS no longer reimburses for most consultation codes. Effective January 1, the only consultation codes still eligible for reimbursement are follow-up inpatient telehealth consultation, HCPCS G0406 - G0408. The savings realized by CMS due to this determination will be redistributed among existing evaluation and management (E&M) services. CMS also adjusted its reimbursement for the surgical global period to reflect the higher value of office visits during the global period.

Asuris adheres to CMS determinations; therefore, we have made the same adjustments to our reimbursement methodology for Asuris TruAdvantage and other Medicare members. We will continue to pay a percentage of CMS allowances as currently established. No other Asuris lines of business are affected by this change.

February's The Connection Online newsletter: available now

Group and Individual pre-authorization lists: effective February 1, 2010

Register for TRICARE’s annual provider seminars now

Provider Consultant assignments have changed

Change to TriWest’s timely claims filing process

2010 Prior Authorization and Formulary Changes

Washington State Department of Social and Health Services' new payment processing system: Learn more about ProviderOne.

Federal Mental Health Parity and Addiction Equity Act: new utilization management guidelines.