BILLING UPDATES JUNE 2016

By Becky Amann

UNIVERA /EXCELLUS

ELECTRONIC PAYMENTS AND REMITTANCES THROUGH INSTAMED

Univera and Excellus have partnered with InstaMed to provide electronic funds transfers (EFT’s), beginning May 1, 2016. This service is offered free of charge to practitioners and is available for all lines of business.

Transition to InstaMed from PaySpan will not be automatic. Providers must register with InstaMed by September 30, 2016 or your Univera and Excellus remittances will convert to paper. Practitioners began to receive letters from InstaMed in mid-May regarding this process.

Practicefirst is in the process of transitioning EFT’s and remittances to InstaMed for the majority of our clients whom we have enrolled in Payspan previously. If you are unsure if we previously handled that enrollment, please contact our Jr. Credentialing Coordinator, Elisa Mize at (716) 566-4511.

UNIVERA

CLEAR COVERAGE PREAUTH REQUIREMENTS

Effective September 1, 2016, all pre-authorizations for T.E.N.S units must be requested through Univera and Excellus’s Clear Coverage. This applies to all lines of business that require preauthorization and impacts the following specialties: Pain Management, Internal Medicine, Family Practice, Neurology Physicians, Neurosurgeons and Orthopedic Surgeons.

If you have any questions related to Clear Coverage, please contact their Customer Care Medical Intake Unit at 1-800-363-4658.

MEDICAID

ePACES TO ADD NEW FEATURE EFFECTIVE JUNE 1, 2016

As we mentioned in our May Client Memo, in an effort to make user data more secure and to improve system performance, eMedNY will be installing a new feature that will impact ePACES users when signing on to the ePACES application. This new feature, commonly called CAPTCHA, is a program that can distinguish whether the user attempting to sign on is a human or a computer.

EFFECTIVE June 1, 2016: When users attempt to sign on to ePACES from the eMedNY website, the user will be asked to verify that he/she is a person and not a computer by selecting specific images. Once the user has successfully verified the correct images, he/she will be allowed to sign into the ePACES account. If the incorrect images are selected, the user will be asked to verify another set of images before being allowed access to ePACES.

This new feature is widely utilized by other secure websites. Many people are familiar with it and have probably had to use it to gain access to those secure websites. The NYS Department of Health is adding this feature to help secure your data, and to prevent unauthorized computer-automated access to ePACES that could adversely impact ePACES performance.

IMPORTANT NOTE: All users will need to have installed Internet Explorer (IE) version 10 or greater or any alternative browsers including Google Chrome, Mozilla Firefox, or Apple Safari. IE versions 9 and below will NOT be supported. Please be sure to coordinate with your IT department to upgrade your internet browser, if necessary, before the effective date shown above.

Questions about ePACES can be directed to the eMedNY Call Center at 800-343-9000.

HEALTH REPUBLIC – LIQUIDATION PROCEEDING AND CLAIMS PROCESS

Providers began to receive notices from the New York State Dept. of Financial Services (DFS) in early May, regarding the liquidation of Health Republic (HR). The superintendent of DFS, Maria Vullo, has been appointed as the liquidator of HR and has been directed to take possession and control of HR’s property and assets.

Practicefirst has previously submitted all claims to HR and not required to resubmit them based on the liquidation process. We have a record of all claims submitted to HR.

Per HR’s website regarding claims payment: Based on information available to date, any funds available will be applied first to administrative expenses incurred from the liquidation process and then to a portion of the claims submitted by providers and members. Under the NYS Insurance Law, administrative expenses and policy claims must be paid in full before any other claimants may receive distributions.

Information regarding the liquidation of HR can be found under the provider section of their website at: http://www.healthrepublicny.org/

For Billing questions, please contact Becky Amann at 716-348-3902 or beckya@pracfir