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Fax Telephone 855-454-5584 502-719-8600 9900 Corporate Campus Dr. Ste. 1000 Louisville, Ky. 40223 FAX To: Providers Fax: From: CoventryCares of Kentucky Date: April 11, 2014 Re: Important Reminders & Updates Pages: pages including cover CC: New edit implementation ASC Billing Provider Survey Urgent For Review Please Comment Please Reply Please Recycle Notes: We appreciate your participation in the CoventryCares of Kentucky provider network and hope you find the enclosed information helpful. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is STRICTLY PROHIBITED. If you have received this message by error, please notify us immediately and destroy the related message. To: From: Date: RE: CoventryCares of Kentucky Providers CoventryCares of Kentucky April 11, 2014 Notice of Claims Edit Implementation and Ambulatory Surgical Center (ASC) Claims Form 1. Claims Edit Implementation On April 29, 2014, CoventryCares of Kentucky will implement additional claims edits. These edits are part of the health plan’s initiative to ensure the quality of care provided to our members. The edits being implemented will look for services and procedures billed by providers who are not by conventional wisdom held to have the training or hold the requisite experience to provide the service or perform the procedure. The denial code on remittance advices will be, “Not A Covered Service For Provider Specialty.” Edits being implemented include: Allowed Provider Type(s) Service or Procedure Otolaryngology Neurology Cardiology Cardiovascular Surgery Vestibular Function Tests, With Recording Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive Cardiovascular procedures Family and General Practice OB-Gyn Reproductive Endocrinology Neonatal-Perinatal Medicine Radiology Critical Care Hospital Medicine Neurology Otolaryngology Pulmonary Sleep Disorders Asthma and Allergy Cardiology Critical Care Hospital Medicine Pulmonology Ultrasound, pregnant uterus Sleep testing Pulmonary laboratory services Allowed Provider Type(s) Service or Procedure General Surgery Nephrology Radiology Urology Vascular Surgery Ultrasound, retroperitoneal Ultrasound, transplanted kidney Otolaryngology Evoked otoacoustic emissions Cardiology Cardiovascular Surgery General Surgery Interventional Cardiology Podiatry Radiology Vascular Surgery Orthopaedics Physical Medicine Physical Therapy Occupational Therapy Family and General Practice Podiatry Neurology Multispecialty Cardiology Cardiovascular Surgery Emergency Medicine Family and General Practice Internal Medicine Pulmonary Medicine Extremity Arterial Studies Extremity Venous Studies Physical Medicine and Rehabilitation Services Interpretation and Report for EKG Cardiac stress test interpretation and/or supervision Interpretation of cardiac rhythm ECG Interpretation of External mobile cardiovascular telemetry 2. Ambulatory Surgical Center Billing As you likely remember, the Department for Medicaid Services (DMS) implemented required billing of a provider’s NPI and taxonomy in Fall 2013 for encounters (provider claim data plus adjudication details). DMS uses encounter data for a number of purposes including determination of enhanced primary care payments under the Affordable Care Act, and incentive payments for Electronic Health Record providers. To date, CoventryCares of Kentucky has allowed Ambulatory Surgical Centers (ASC) to bill using either a UB 04 or a CMS 1500 claims form. However, after review of encounter rejections and consultation with DMS, ASCs will only be allowed to be claims on a CMS 1500 claims form going forward. Since this is a change, we are notifying ASC providers that effective July 1, 2014, CoventryCares of Kentucky will no longer accept ASC claims submitted on a UB 04 claims form. Claims will be either denied or rejected. 3. Provider Survey We are always interested in receiving feedback from our providers. Your provider representative or any CoventryCares of Kentucky representative is willing to receive your feedback at any time. However, at least once a year, we want to give our providers a formal method for feedback by conducting a provider survey. This year’s provider survey period is open from April 11, 2014 through May 15, 2014. Please access the following website to participate in the survey: https://www.surveymonkey.com/s/W3BB99B. We have also posted the link for the survey at www.coventrycaresky.com on the Provider Page. You can click on the Provider Satisfaction Survey link on that page. Thank you in advance for you participation. Who Is My Provider Relations Representative? 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