| Deficit Reduction Act legislation impact to Medicare physician fee schedule
Effective July 1, federal Deficit Reduction Act (DRA) legislation will enact a 10.1% reduction in the Medicare physician fee schedule.
We recognize this reduction may cause considerable hardship for physicians and other health care professionals and potentially impact access for Medicare beneficiaries. Therefore, Regence has decided not to implement the reduction. In addition, we will not implement the reduction for the remainder of 2008, regardless of whether or not the legislation is repealed. This applies only to our Regence MedAdvantage plans; we are obligated to implement the reduction for claims that crossover to Regence when we are a secondary payer to Medicare and for Medicare supplement plans. If subsequent legislation passes approving an increase in the physician fee schedule in 2008, we will implement the increase as required by our contracts.
Please do not submit requests for reprocessing of claims for Medicare Supplement plans or Medicare claims crossed over to Regence for secondary processing. These claims will be paid in accordance with federal requirements as of July 1, 2008.
National Provider Identifier (NPI) dual-use period extended
Regence is extending the dual-use period until further notice because many entities are still in varied stages of compliance. You may submit your NPI and tax identification (ID) numbers; or submit your NPI, tax ID and Regence provider identifier. We will notify you at a later date when the Regence identifier will no longer be accepted.
New payment vouchers for InnovaSM, EngageSM and BlueCard®members?
By now you should be receiving the new vouchers for our Innova, Engage, and BlueCard business. We hope that you find the improvements in the vouchers helpful. If you are experiencing any issues or difficulties with these new vouchers, or if you have any questions, please contact your Provider Consultant.
January BlueCard® Claims May be Delayed
We recently announced that beginning December 31, 2007, we are now processing BlueCard claims on our new system. You may experience delays in BlueCard claims submitted in late December through January 16th. During this time, a technical problem caused some transmitted files to be deleted before Regence could process the data. This prevented some of our data transmissions from posting correctly.
In early February, we began processing and mailing payments on a daily basis. At this time, the majority of these files and payments have been received and processed. Beginning March 13, 2008, we will return to our regular weekly payment schedule.
If you have questions or would like more information, contact your provider relations representative or BlueCard Customer Service at 1 (800) 676-2583 or in Salt Lake City at (801) 333-2370.
Contacting TriWest? Let Us Help You
Suggestions from TriWest Healthcare Alliance to improve your experience when calling TriWest:
Call 1-888-TRIWEST (888-874-9378) during off-peak hours (after 1:00 pm in your time zone) for a quicker response time.
- Use the Interactive Voice Response (IVR) system to receive information 24-7 without the necessity of speaking to a customer service representative.
- An IVR guide is available in the Provider Connection of www.triwest.com in the Resource Library.
- Specific sections for TRICARE reimbursement rates, referrals and authorizations, claims and reimbursement, TRICARE programs and benefits, the National Provider Identifier (NPI), Electronic Data Interchange (EDI), the Resource Library are also found in the Provider Connection
- Go to Provider Connection to find E-Seminar links allowing seminars at a time most convenient to you.
- Register for the secured Web site to perform functions without calling TriWest. Registered providers have access to a secure portal on www.triwest.com where they can:
- Verify patient eligibility
- Determine status of referrals/authorizations
- Submit claims online, view claims and check claim status
- Download Explanations of Benefits
- See what checks have been issued
ReinventHealthCare.com
Regence is committed to working with members, physicians and employers to create a health care system that works more effectively for everyone. With this goal in mind, we recently launched a web site where anyone interested in health care can share ideas and listen to what others have to say. The site is www.ReinventHealthCare.com.
As a physician, your perspective is essential to an open, honest and productive public conversation. We encourage you to visit the site and join in. Find out more and share your thoughts at ReinventHealthCare.com.
Medicare crossover update
Coordination of Benefits Agreement (COBA) identification number not necessary for secondary crossover claims.
Recently the Centers for Medicare & Medicaid Services (CMS) changed the way in which claim-based crossover information is sent to secondary insurers. (Claim-based crossover occurs when the rendering provider bills Medicare primary, and on that claim, supplies secondary insurance information.) As of 10/1/07, CMS advised providers to obtain a Coordination of Benefits Agreement (COBA) identification number to add to these claims.
Regence already shares its eligibility files with Medicare, and, as a result, receives secondary crossover claims directly from Medicare. It is therefore not necessary for a provider to include a COBA ID on these claims.
If your secondary claims have not been successfully received by Regence, please contact Customer Service at
1 (800) 624-6519
as we may need to add your patient’s Medicare coverage information to our eligibility files.
Important update regarding BlueCard® claims processing
We recently announced that BlueCard® claims would be processed on our new system beginning December 17, 2007. The date has been moved. We will now begin processing BlueCard claims on our new system on December 31, 2007.
The new clinical edit rules will continue to be effective for all claims, including BlueCard claims, on December 17, 2007.
After the conversion to the new system, claims for your BlueCard patients will be reported on our new vouchers. Sample vouchers are included in the Payment section (PDF) of our Administrative Manual.
Questions
If you have questions or would like more information, please contact your provider consultant at (801) 333-2600 or 1 (800) 621-2155.
NASCO® claims migrated to new claims system on 1/1/08
The National Account Service Company (NASCO®) claims will be migrated to our new system on January 1, 2008. You will receive a Regence Life and Health voucher for any NASCO claims received prior to December 31, 2007 and any adjustments or recoveries to these claims. You will receive our new voucher (the same voucher used for your InnovaSM, EngageSM and BlueCard® patients) for NASCO claims received on or after January 1, 2008. Sample vouchers are included in the Payment section (PDF) of our Administrative Manual.
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