Volume 4, Issue 1 • 1st Quarter 2011 This material is considered part of the Provider Manual Medical Mutual of Ohio ® , Consumers Life Insurance Company ® and Carolina Care Plan ® PROFESSIONAL & INSTITUTIONAL PROVIDER NEWS In this issue: Updated Provider Manual Now Available ........................... 2 In-Network Services ......................................................... 2 Receive Publications Electronically ................................... 2 Medical Policy Updates ................................................... 2 One Provider Website ....................................................... 3 Registering NPI Number................................................... 3 HIPAA 5010 Electronic Format ........................................ 3 Provider Contracting Office Phone Numbers .................... 3 Accelerate Reimbursement........................................... back Paperless Notice of Payment Effective May 1, 2011, practices who receive the Health Insurance Portability and Accountability Act compliant 835 Remittance Advice transactions will no longer receive paper Remittance Advice statements with their reimbursement checks. This will have no effect on 835 transactions, nor will it impact the timeliness of payment. The Medical Mutual Family of Companies recognizes that many providers find value in the hard copy remittance statements and have therefore made these documents available on the Provider ePortal located at Provider.MedMutual.com. Once registered, login and select Claims, Claims Remit History to view your Electronic Remittance Advice statements. Claim Inquiry on eRA The Medical Mutual Family of Companies’ Electronic Remittance Advice (eRA) now features a Claim Inquiry Form directly on the online Notice of Payment (NOP). Submit the form electronically for any type of provider inquiry or request for adjustment related to the claim. Additionally, this new feature allows providers to attach supplementary documentation with their inquiry. EFT enrollment is not required to view your electronic NOP or to utilize the new electronic Claim Inquiry feature. Simply login to the Provider ePortal at Provider.MedMutual.com and select Claims, Claims Remit History to view your statements. NCQA Rates the Company Excellent Medical Mutual of Ohio ® is accredited at the highest level for our managed care products by the National Committee for Quality Assurance (NCQA). Medical Mutual ® has earned Excellent Accreditation Status for our Preferred Provider Organization (SuperMed Plus ® and OhioMed ™ ), Health Maintenance Organization (HMO Health Ohio ® and SuperMed HMO ® ), and Point-of-Service (SuperMed Select ® and SuperMed Preferred) products. In addition, Medical Mutual has earned the NCQA Wellness & Health Promotion Accreditation, which evaluates how well an organization manages all parts of its wellness and health promotion program for continuous improvement of the quality of services, materials and activities provided to eligible individuals.
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MUTUAL NEWS Volume 4, Issue 1 • 1st Quarter 2011
This material is considered part of the Provider Manual
Medical Mutual of Ohio®, Consumers Life Insurance Company® and Carolina Care Plan®
PRO
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In this issue:Updated Provider Manual Now Available ........................... 2In-Network Services ......................................................... 2 Receive Publications Electronically ................................... 2Medical Policy Updates ................................................... 2
One Provider Website ....................................................... 3Registering NPI Number ................................................... 3HIPAA 5010 Electronic Format ........................................ 3 Provider Contracting Office Phone Numbers .................... 3Accelerate Reimbursement ........................................... back
Paperless Notice of PaymentEffective May 1, 2011, practices who receive the Health Insurance Portability and Accountability Act compliant 835 Remittance Advice transactions will no longer receive paper Remittance Advice statements with their reimbursement checks. This will have no effect on 835 transactions, nor will it impact the timeliness of payment.
The Medical Mutual Family of Companies recognizes that many providers find value in the hard copy remittance statements and have therefore made these documents available on the Provider ePortal located at Provider.MedMutual.com. Once registered, login and select Claims, Claims Remit History to view your Electronic Remittance Advice statements.
Claim Inquiry on eRAThe Medical Mutual Family of Companies’ Electronic Remittance Advice (eRA) now features a Claim Inquiry Form directly on the online Notice of Payment (NOP). Submit the form electronically for any type of provider inquiry or request for adjustment related to the claim. Additionally, this new feature allows providers to attach supplementary documentation with their inquiry.
EFT enrollment is not required to view your electronic NOP or to utilize the new electronic Claim Inquiry feature. Simply login to the Provider ePortal at Provider.MedMutual.com and select Claims, Claims Remit History to view your statements.
NCQA Rates the Company ExcellentMedical Mutual of Ohio® is accredited at the highest level for our managed care products by the National Committee for Quality Assurance (NCQA).
Medical Mutual® has earned Excellent Accreditation Status for our Preferred Provider Organization (SuperMed Plus® and OhioMed™), Health Maintenance Organization (HMO Health Ohio® and SuperMed HMO®), and Point-of-Service (SuperMed Select® and SuperMed Preferred) products.
In addition, Medical Mutual has earned the NCQA Wellness & Health Promotion Accreditation, which evaluates how well an organization manages all parts of its wellness and health promotion program for continuous improvement of the quality of services, materials and activities provided to eligible individuals.
Receive Publications ElectronicallyReduce paper around your office and avoid postal delay. Register for the Provider ePortal and elect to receive this newsletter and other provider communications via e-mail. Additionally, online editions contain links to supplementary resources and search functionality.
Enroll in the Provider ePortal at Provider.MedMutual.com and opt “Yes” to receive newsletters and bulletins electronically. Providers currently enrolled in the Provider ePortal should have their Primary Access Administrator (PAA) login and update their preference under Subscription in the My Account section.
In-Network ServicesThe SuperMed® network has participating national and local reference and specialty labs that allow your patients to have broad access to diagnostic and testing services. In-network laboratories and other healthcare facilities minimize the Covered Person’s out-of-pocket expense and facilitate the delivery of cost-effective healthcare.
To locate an in-network lab select Find a Provider/Practitioner on the sidebar of Provider.MedMutual.com and search for a Medical Facility.
Updated Provider Manual Now AvailableWith resources for effectively working with the Medical Mutual Family of Companies, the Provider Manual contains topics related to claims submission, care management programs, forms, adjustments and inquiries, payment and remittances schedules, plan guidelines, appeals, and other essential information.
Easy to navigate, the online Provider Manual includes links, bookmarks, search functionality, and additional features that assist in quickly locating required information. Visit the Tools & Resources, Provider Manual section of Provider.MedMutual.com to access the Company’s updated Provider Manual.
The following Corporate Medical Policies (CMPs) were developed or revised October 1 to December 31, 2010. For easy identification, “New” or “Revised” notations are included with policies added or updated within the last 30 days on Provider.MedMutual.com.
For a complete list of CMPs, please visit the website’s Tools & Resources, Care Management, Corporate Medical Policies section.
For services requiring prior approval or considered investigational, please consult the website’s Tools & Resources, Care Management, Prior Approval & Investigational Services section.
Registering NPI NumberWith the Health Insurance Portability and Accountability Act (HIPAA) 5010 format transition, payer-specific ID numbers will no longer be accepted as of January 1, 2012. To avoid claims processing delays, register your National Provider Identifier (NPI) with the Company to submit on both electronic and paper claims.
NPI numbers can be submitted by completing a Provider Information Form located in the Tools & Resources, Forms, Provider Information Form section of Provider.MedMutual.com.
Professional providers should furnish their billing NPI numbers in Box 33a (LOOP 2010AA, NM109
Segment in the 837 4010 or 5010 electronic claims transaction). Should the rendering or service provider’s NPI differ from the NPI in Box 33a, the NPI should be entered in 24j (rendering Provider LOOP 2310B, NM109 in the 837 4010 or 5010 electronic transaction or the service provider LOOP 2310D, NM109 in 4010 or 2310C in 5010).
Institutional providers should furnish their service facility NPI in Item 56 on UB-04 (LOOP 2310E, NM109 in the 837 4010 or 5010 electronic claims transaction) and the billing provider (LOOP 2010AA, NM109).
Contact your provider contracting representative with any questions regarding registering your NPI number.
One Provider WebsiteThe Medical Mutual Family of Companies have consolidated the Providers section of our three websites (MedMutual.com, CarolinaCarePlan.com and ConsumersLife.com) into a single domain, Provider.MedMutual.com.
For easier access to Company resources, provider tools and information are now available at one location regardless of state or carrier. When accessing the Providers section from CarolinaCarePlan.com or ConsumersLife.com, users are automatically redirected to this comprehensive site. Visit Provider.MedMutual.com to access all our electronic services.
HIPAA 5010 Electronic FormatHere are some key points to prepare for the January 1, 2012, Health Insurance Portability and Accountability Act (HIPAA) 5010 transition for 837 transactions:
Determine if there are any changes to your National Provider Identifier (NPI) enumeration due to the 5010 Instructions noted below and register if needed (see Registering NPI Number article above for additional information).
•Provider Identification Number (PIN) is not HIPAA compliant and should no longer be submitted.
•NPI is required for electronic submissions. Only vendor to vendor submissions do not require NPI.
•Billing providers must use same subpart schema in billing across all trading partners.
Submit a Provider Information Form if you have any address changes to support 5010 instructions for Billing and Service Provider addresses; specifically for PO Box or Lock Boxes that are only permitted in Payto Address and the requirement for 9-digit ZIP codes per the 5010 Instructions below.
•PO Box is only permitted in the Payto Loop. Submissions of PO Box in Billing Address will not be accepted.
•Billing provider address requires a full zip code, including the 4-digit zip suffix.
For more information visit http://www.x12.org or http://www.hipaasimplified.com and contact your vendor for 5010 readiness.
This material is considered part of the Provider ManualMutual News, Volume 4, Issue 1, 1st Quarter 2011
Published by the Provider Communications Department • 2060 E. Ninth Street, Cleveland, OH 44115-1355Medical Mutual of Ohio, Consumers Life Insurance Company and Carolina Care Plan
2060 East Ninth Street • Cleveland OH 44115-1355X7902 R3/11 • pcat – 1613
Accelerate ReimbursementThe Medical Mutual Family of Companies offers Electronic Funds Transfer, a secure, fast, efficient process for directly depositing payments into your bank account. A viable and preferable alternative to paper claims with benefits including: Elimination of time-consuming, cumbersome administrative tasks for you and
your staff.
Faster access to funds and reduction of paper around your office.
Funds transferred electronically eliminating mail delays, lost checks and fraud.
Immediate access to an online history of deposits and an itemized claim statement.
Easy reconciliation of payments with bank statements.
Adjustments continue to follow the standard invoicing process as identified in the Claims Submission section of the Provider Manual under Recovery of Claim Overpayments.
Register for EFT through the Provider ePortal at Provider.MedMutual.com.
