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TRIAGE: Interpreting, explaining important news for your practice
e-Reports, Feb. 7, 2011
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INSPECT: Software glitch results in a backlog with drug monitoring system
In response to members calls, the ISMA learned problems are occurring with Indiana Scheduled Prescription Electronic Collections and Tracking (INSPECT), the state’s drug monitoring system.

INSPECT Director Joshua Klatte advised that a required software upgrade created a backlog, causing at least 13 percent of records submitted by pharmacies since Dec. 10 to be rejected.

INSPECT staff is working with the vendor on a solution and is notifying all users of INSPECT about the backlog.

To follow the situation, read updates on the INSPECT website.

Medicare: NGS advises wellness visit claims to be reprocessed
National Government Services (NGS), Indiana’s Medicare carrier, advised that diagnosis code V70.0 (routine general medical examination at a health care facility) has been inappropriately issuing denials in the system. The amounts have been transferred to patient responsibility in error.

NGS is reprocessing the claims. You need not take any action at this time.

However, Jeri Biedenkopf, R.N., ISMA’s Medicare practice advisor, said, “It would be advisable for practices that have billed this code to track their denials to be certain they do eventually get paid for these claims.”

To read the official message from the Centers for Medicare & Medicaid Services (CMS) on this issue, see here.

Medicaid: The ISMA gets update on filing St. Francis Hoosier Healthwise claims
The ISMA initiated a conference call Jan. 26 to detail how your Central Indiana practice can determine if patients are in the St. Francis network and be assured of timely payment of those claims.

Since Jan. 1, St. Francis Anthem members are only identified as Anthem members on web interchange, and practices have advised the ISMA they cannot differentiate between a St. Francis Anthem member and all other Anthem members.

A system fix for this issue will not be complete until March 31. Therefore, an interim solution is needed.

In the conference call, Anthem representatives first assured the ISMA they would process St. Francis primary medical provider (PMP) claims even if the claims were sent in error to Anthem. Also, the 90-day filing limit will not apply in these cases, and practices should contact Anthem provider services if claims are returned for this reason.

As an interim solution to identify St. Francis Anthem members, please take the following recommended steps:

  1. Verify patient eligibility
  2. If patient is an Anthem insured, check the St. Francis PMP listing:
    • a. If doctor is not a St. Francis PMP, submit the claim to Anthem.
    • b. If doctor is a St. Francis PMP, submit the claim to St. Francis (except for behavioral health claims and those for family planning, which go to Anthem).

Again, if a St. Francis claim goes in error to Anthem, it will be processed according to the St. Francis guidelines.

Also, remember that all claims going to Anthem must have a “YRH” prefix before the Recipient Identification (RID) number; the prefix is not necessary for St. Francis claims, only the RID number.

Special services exceptions
On web interchange, VSP is named as the vision vendor for Anthem members; however, St. Francis Anthem members are not required to use VSP. Those members can use any active Indiana Health Coverage Program (IHCP) provider; no authorization is needed.

Also, Anthem is responsible for family planning and behavioral health claims. Submit all those claims to Anthem and NOT to St. Francis Health Network.

More about St. Francis Anthem
St. Francis Health Network handles prior authorization for St. Francis Anthem members. The state-approved prior authorization form includes the St. Francis Health Network prior authorization phone and fax numbers.

St. Francis Health Network pays claims and responds to questions about those claims – from both members and providers.

To assist you, find the listing of St. Francis PMPs here.

Also, read a pertinent St. Francis Health Network communication here.

Copyright: Information written and displayed on www.ismanet.org is the property of ISMA and may not be reproduced without expressed written permission of the Indiana State Medical Association.

For a more detailed sitemap click here.