By Becky Amann, Compliance Manager


As we have mentioned in previous client memos, Medicare Advantage Plans may require Fraud, Waste and Abuse training for their providers. If you are in need of this training, the Medicare Learning Network offers a Web-Based Training Course (WBT). This WBT is designed to provide education on fraud, waste, and abuse in the Medicare Parts C and D programs and general compliance concepts. It includes two parts and can be used to satisfy general compliance training requirements and fulfill the annual fraud, waste and abuse training requirement.  

To access the WBT, go to MLN Products on CMS’s website at:

At the bottom of the web page under Related Links, click on Web Based Training Courses. Under the list of courses, select: Medicare Parts C and D Fraud, Waste and Abuse Training and Medicare Parts C and D General Compliance Training. The course is approximately 60 minutes in length.

For Compliance questions, please contact Becky Amann at 716-348-3902 or


By Sarah Howarth, Billing Manager


Pay for Performance

2013 Pay for Performance checks were released during July.  Performance scorecards are available at The 2014 Pay for Performance program will focus on quality and be released by the end of the third quarter.

Medicaid Managed Care

Blue Cross has notified the Department of Health that they will no long offer Medicaid programs in Erie, Cattaraugus, Chautauqua, Orleans, Wyoming and Allegany counties.  Practicefirst is monitoring the status of this decision and will keep you informed as it progresses.  We are evaluating the potential impact to our clients. Please contact our office should you need assistance identifying your practice’s patients that have a Medicaid plan through Blue Cross.


Drugs and Vaccines

Univera has delayed the implementation of changes to their injectable drug reimbursement.  Effective November 15, 2014, reimbursement rates for injectable drugs administered to members in Child Health Plus, Family Health Plus, PlusMed, a Medicare Advantage or Heathy NY product will be set at rates comparable to Medicare fee-for-service rates.  Future updates will occur 45 days after the release of Medicare rates.

Please note vaccines for children covered by Child Health Plus or PlusMed should be obtained through the Vaccines for Children program.  Only the administration fee is covered.

Effective October 1, 2014, Univera will require claims to contain the appropriate national drug code (NDC) and the number of NDC units for all unlisted or miscellaneous drug codes. Failure to include the NDC and number of units will result in a rejected claim.

Customer Care

Effective July 1, 2014, the customer care telephone number for Univera Commercial and Medicare Advantage lines of business is 1-866-265-5983. 


Clinical Editing Policy:  Urinalysis with Evaluation & Management and Preventative Medicine.

This clinical editing policy identifies procedure codes for urinalysis without microscopy when billed with Evaluation and Management procedures including Preventative Medicine procedure codes. The justification for this policy considers urinalysis to be one of the most frequently used indicators of health and disease and is essential in the diagnosis and detection of renal and metabolic disorders. Like the measurement of blood pressure, it is considered an inherent component of an Evaluation & Management service performed in an outpatient setting. The limited resources required for the examination should be properly included, along with consideration of the obtained data in the selection of the appropriate level of E&M service intensity.


Provider File Updates

Over the course of the next few months, the Department of Health will be conducting provider information verification to ensure provider information on file is current.  If your office is contacted, please provide them with the necessary information.  Items to be verified include:

            -Provider phone number

            -Provider’s specialty

            -Line of business participation

For Billing questions, please contact Sarah Howarth at 716-348-3923 or<