Magnolia Health Plan » Provider News

JACKSONVILLE, FL., February 20, 2012 – Payformance Corporation, a leading provider of healthcare payment and reimbursement automation, announces today its corporate name change to PaySpan®, Inc. The new name is designed to further establish the Company’s unique market identity and expanding product offerings that serve healthcare payers, providers, consumers and the Financial Services industry.

Important Notice from Opticare

mfoster — Wed, 29 Feb 2012 16:03:56 +0000

Attention: Magnolia Health Plan Providers

Effective April 2012, the following requirements for the dispensing of aspheric lenses will be enforced:

Aspheric lenses (V2410, V2430, and V2499) will only be considered medically necessary for prescriptions greater than ±4.00 diopters.

Medical necessity documentation (i.e., eyeglasses prescription, medical record with documented refraction) and a copy of the laboratory lens invoice must be submitted with the claim to be considered for reimbursement.

Paper claims: Supporting documentation may be submitted with the CMS-1500 for claims submitted by paper.

Electronic or Web claims: Supporting documentation may be submitted by fax for claims submitted electronically or through OptiCare’s Eye Health Manager. The Fax Cover Sheet for Claim Attachments is available on the Provider Forms page of www.opticare.com and must be included with the supporting documentation.

Claims submitted without the required documentation will be denied.

Denials for CPT Codes 75572 – 75574

mfoster — Wed, 22 Feb 2012 19:40:01 +0000

CPT codes 75572-75574 have been opened for reimbursement effectivie 1/1/2010. Claims billed with these codes which denied for Edit 0439 – PROCEDURE NOT A BENEFIT FOR DATE OF SERVICE will be reprocessed for dates of service 1/1/2010 – 8/11/2011. The mass adjustments will begin the week of 02/13/2012. If you have any questions, please contact your provider representative or the Division of Medicaid.

Vaccines for Children Update

mfoster — Wed, 15 Feb 2012 21:39:27 +0000

The Division of Medicaid (DOM) claims processing procedures were recently modified to be in compliance with the 2009 Code Update AMA change in regards to the billing rules for immunization codes 90471 and 90473. The AMA ruling indicated only one or the other code can be billed on a single date of service. The recent NCCI mutually exclusive ruling also mandates certain codes cannot be billed together by the same physician on the same beneficiary on the same date of service.

DOM claims processing system will evaluate all claims by the same physician on the same beneficiary on the same date of service. If a claim is found which indicates one of the codes has been paid, the current claim will be denied.

DOM claims processing procedures were also modified to become in compliance with the 2011 Code Update AMA change in regards to the billing rules for immunization codes 90460 and 90461 on the same date. Both codes can now be billed on a single date of service.

Prior Authorization for Plastic Surgeons

mfoster — Wed, 15 Feb 2012 21:25:06 +0000

Office visits/consults (including follow-up after procedures) with plastic surgeons do not require prior authorization for par providers. Surgery would still require prior authorization as with all other outpatient surgical procedures.

PaySpan Health Training Webinars

mfoster — Mon, 13 Feb 2012 19:04:02 +0000

Wednesday, February 15th, 2012 – 2 p.m. (EST) – https://www2.gotomeeting.com/register/311130498

Wednesday, March 14th, 2012 – 2 p.m. (EST) – https://www2.gotomeeting.com/register/535888730

Hospice Prior Authorization Medical Necessity Changes

mfoster — Thu, 04 Aug 2011 18:36:40 +0000

Effective August 15, 2011, the required documentation to support medical necessity for hospice admissions will change. Our current guidelines only require the physician certification signed by the attending physician and the hospice medical director to be submitted for prior authorization. Effective August 15, 2011, Magnolia Health Plan will require in addition to the physician certification, a patient election form, a history and physical by the attending physician with the terminal diagnosis listed. All hospice prior authorizations will be evaluated for medical necessity using the medical necessity criteria developed by the Louisiana Mississippi Hospice and Palliative Care Organization.