Peach State Health Plan Blog

Dear Peach State Provider:

As you may know, Peach State Health Plan (Peach State) uses code editing software to assist in improving the accuracy of its claims processing, payment, and reporting.  Effective June 6, 2011, Peach State along with our strategic business partner HealthCare Insight (HCI) will implement a new business process that will focus on the persistent problem of waste, fraud and abuse in healthcare claims payment. 

HCI will provide additional software tools and skilled clinical and coding analysts to assess and evaluate claims.  This is in addition to all other claims payment processes that Peach State currently employs.  This upgrade will help ensure that Peach State continues to process claims in accordance with generally accepted industry coding standards and guidelines as published and defined in the Current Procedural Terminology (CPT) and by the Centers for Medicare and Medicaid Services (CMS); unless specifically addressed in the fee-for-service provider manual published by the Department of Community Health (DCH) or regulations. 

As this new process is implemented, you may observe that the more sophisticated programs now in place will help ensure that only accurately and properly coded and billed services will be reimbursed.  Some of the changes that you will see will include the identification of unbundled and fragmented services and consequent payment denials; For example:

• Global surgical packages that include uncomplicated follow-up visits will be tracked and related post-operative visits will be denied
• Billings for assistant surgeons and secondary surgical procedures will be identified and payments reduced or denied in accordance with coding and reimbursement guidelines

Peach State takes the responsibility of accurate and appropriate claims payment very seriously.  These changes to our claims processing activities will enable us to pay claims more effectively while limiting waste, fraud and abuse.

This letter serves as your official 90-day notification of Peach State’s intent to implement this new procedure. 

Should you have any questions about this notification please call Peach State’s Provider Services Department at 1-800-704-1463.

 Sincerely,

Patrick Healy

President and Chief Executive  

Peach State Partners with HealthCare Insight – Letter (PDF)

This entry is filed under Blog, News.

As of January 1, 2011, The Planning for Healthy Babies (P4HB) Program went into effect. For additional information regarding the program, select the links below to review the P4HB resource tools. This information is also available in the Provider Resources section.

To speak to a representative, call Provider Solutions, at 1-866-874-0633, Mon – Fri, 7am-7pm.

Planning for Healthy Babies (P4HB) Program

• Planning for Healthy Babies _ Quick Reference Guide (PDF)
• Planning for Healthy Babies_Provider Manual Update (PDF)
• Family Planning – Preferred Drug List (PDL)

This entry is filed under News.

Peach State’s new Interactive Voice Response system will give providers and members additional automation and self service functionality. New features of the system include:   

1. Full speech recognition 
2. Member eligibility verification
3. Member PCP name and telephone number 
4. Member co-pay information  
5. Claims status lookup

For more information about our new enhancements to the IVR, ask to speak with a Representative today!

This entry is filed under News.

Dear Peach State Providers,

We are pleased to share an educational opportunity with you regarding PaySpan Health (Payformance). Payformance is happy to announce the continuation of the Webinar Wednesday program. Listed below are scheduled webinar dates for February 2011. Due to limited space, early registration is encouraged.

  During the webinar, the following topics will be covered:

o        Viewing News & Alerts

o        Working with New Payments

o        Using the New Posting & Denial Reports

o        How to Use Account & Payer Management

o        Search for Remits using Document Archive Search

o        User Administration

o        Mailbox Management

o        Questions & Answers

Sign up for a FREE PaySpan Health Training Webinar today! Please click one of the links below to register for the meeting of your choice. Space is limited!

Please click one of the links below to register for the meeting of your choice.

Space is limited! 

***PLEASE NOTE ALL WEBINAR TIMES ARE EASTERN TIME***

*** PaySpan Health Website Training *** 

Wednesday, February 16, 2011 – 2:00PM EASTERN STANDARD TIME

https://www2.gotomeeting.com/register/541179770

During the webinar, the following topics will be covered:

• Viewing News & Alerts
• Working with New Payments
• Using the New Posting & Denial Reports
• How to Use Account & Payer Management
• Search for Remits using Document Archive Search
• User Administration
• Mailbox Management
• Questions & Answers

*** PaySpan Health Mailbox Training ***

Wednesday, February 9, 2011 – 10:00AM EASTERN STANDARD TIME 
https://www2.gotomeeting.com/register/766959187

During the webinar, the following topics will be covered:

• Define the PaySpan Health Mailbox
• Discuss Access Points
• Demonstrate Setup of Mailbox
• Routing Files to Data Exchange Partner
• Questions & Answers

You may be eligible to register additional payers to your PaySpan® Health account. Reply to this email if you are interested in receiving more payments and remittances electronically.

Click here or copy and paste this link into your browser window to view a list of all PaySpan Health Payers:

http://www.payformance.com/for-providers/participating-health-plans/

To speak with one of our Provider Services Specialists, please call 1-877-331-7154. The Provider Services Team is available Monday through Friday, from 7am to 9pm Eastern Time.

Thank you for using PaySpan® Health.

Provider Services

PaySpan® Health

1-877-331-7154

providersupport@payspanhealth.com

www.payspanhealth.com

PaySpan® Health -

“The Electronic Settlement Network. The right choice for real savings and provider satisfaction.”

This entry is filed under News.

Dear Peach State Provider:

Please click the link below to review the Family Planning PDL.  For questions or concerns, contact your Provider Relations specialist or call 1-866-874-0633, Monday – Friday, 7am – 7pm.

Family Planning Preferred Drug List

Thank you~

This entry is filed under News.