1 June 2016 ProHealth Provider Relations Update I NSIDE T HIS I SSUE : 1 ePower 1 Claim Editing Software 1 MDwise CHNw - eff 7/1/2016 2-3 New Providers, effective 7/1/2016 4-5 Termed Providers 6-7 Veterans Choice Program 8 PH Provider Satisfaction Survey Results - 2016 9 Provider Relations Staff Directory Claim Editing Software Effective 7/1/2016 : Pro Health has installed new claim editing software effective July 1, 2016. The claim editing software automates processing of the same industry-standard claim edits which have been in use by ProHealth for several years. There is no change in ProHealth reimbursement policies, but the policies will be enforced consistently and automatically by the claim editing software. If your practice encounters any issues related to claim editing, please send your usual provider claim appeal letter, along with supporting documentation, to: ProHealth, Attention Provider Claim Appeal, 6626 E 75th Street, Indianapolis, IN 46250. MDwise Community Health Network - effective 7/1/2016: Community Health Network will become a Delivery System in the MDwise HHW (Medicaid) and HIP programs, effective July 1 st , 2016. ALL Employed providers will be loaded with these plans, and paents assigned to CPN PCPs within MDwise will be a part of the MDwise Community Health Net- work delivery system and will be required to see providers within Community Health Network for their medical care. The ProHealth Medical Management department will be do- ing Prior Authorizations and Case Management for this popu- lation. Claims Administration will continue to be performed by MDwise. Provider Representative – Salena Woodson Phone#: (317)621-7593 [email protected]ProHealth Medical Management & PA contact info. - Phone#: (317)621-7575 or 1-800-344-8672 Fax#: (317)983-7757 or 1-844-309-4009 **Please see additional information attached to email**
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1
June 2016
P r o H e a l t h P r o v i d e r R e l a t i o n s
Pro Health has installed new claim editing software effective
July 1, 2016. The claim editing software automates
processing of the same industry-standard claim edits which
have been in use by ProHealth for several years. There is no
change in ProHealth reimbursement policies, but the policies
will be enforced consistently and automatically by the claim
editing software.
If your practice encounters any issues related to claim editing,
please send your usual provider claim appeal letter, along with
supporting documentation, to: ProHealth, Attention Provider
Claim Appeal, 6626 E 75th Street, Indianapolis, IN 46250.
MDwise Community Health Network - effective 7/1/2016:
Community Health Network will become a Delivery System
in the MDwise HHW (Medicaid) and HIP programs, effective
July 1st, 2016. ALL Employed providers will be loaded with
these plans, and patients assigned to CPN PCPs within MDwise will be a part of the MDwise Community Health Net-work delivery system and will be required to see providers within Community Health Network for their medical care.
The ProHealth Medical Management department will be do-
ing Prior Authorizations and Case Management for this popu-
lation. Claims Administration will continue to be performed