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PSYCHCARE TRIAGE AND REFERRAL PROCESSES 23 Aug 2013 | 11:11 am
Our clinical philosophy is to provide the most appropriate member/practitioner match and the least restrictive treatment intervention for each member's needs across the life cycle. Our c...
ICD 10 - Frequently asked question 18 Aug 2013 | 11:04 am
1. Q: What is ICD-10? A: ICD-10 is the International Classification of Diseases, version 10. (ICD is the international standard for diagnostic classifications.) The current version, ICD-9, was adopt...
HIPAA 5010 Frequently Asked Questions and Answers 12 Aug 2013 | 10:57 am
Its may be little late but still useful. 1. Q: What is 5010? A: HIPAA mandates certain transaction types for electronically submitted claims. The current format is ANSI (American National Stand...
TEN STEPS FOR ACCURATE ICD-9 CODING 7 Aug 2013 | 10:50 am
To code accurately, it is necessary to have a working knowledge of medical terminology and to understand the characteristics, terminology and conventions of ICD-9-CM. Transforming desc...
Hospice CPT Coding FAQ 2 Aug 2013 | 10:52 am
How do I bill for hospice services? The following is an excerpt from the “Part B Answer Book” CD-ROM. Hospice Care: Overview If one of your patients has a terminal illness, with about six ...
Member Enrolled in hospice ? Does Medicare HMO covers the service? 29 Jul 2013 | 10:48 am
What is Hospice? Hospice is a program of care and support for people who are terminally ill. It is available as a benefit under Medicare Hospital Insurance (Part A). The focus of hospice is on care...
What is MEDICATION THERAPY MANAGEMENT (MTM) 23 Jul 2013 | 10:59 am
Purpose: ** To optimize therapeutic outcomes for individual patients. ** Optimize drug therapies. ** Improve medication use. ** Reduce risk of adverse events and drug interactions. ** Increase patien...
CMS STAR RATINGS 17 Jul 2013 | 10:57 am
The Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system. This ...
claim submission guideline form SHP 11 Jul 2013 | 09:38 pm
Claims Submission Claims are to be submitted to Simply Healthcare Plans with appropriate documentation by mail or filed electronically for CMS-1500 and UB-04 claims. For those members that may be ass...
Submission of Formal Grievances and Appeals: to simply health care insurance 2 Jul 2013 | 09:17 pm
Providers are encouraged to first communicate any concerns or dissatisfaction about an SHP process or decision verbally through the Provider Relations telephone lines at 1-800-887-6888 ext. 6005 Monda...
