Archive for the ‘Blog’ Category

Important News! State Health Benefit Plan Employees Can Now Apply for PeachCare for Kids

7 November 2011 | Author: ttisdale

Important News! State Health Benefit Plan Employees Can Now Apply for PeachCare for Kids

Beginning October 1, 2011, State Health Benefit Plan enrollees can apply for PeachCare for Kids® for their child (ren). This new option provides high- quality, low-cost healthcare to children covered under the State Health Benefit Plan. Enrollees who take advantage of this change will significantly reduce their out-of- pocket cost through a reduction in premiums and co-payments for their child/children’s healthcare coverage. To apply for the program online visit: www.peachcare.org or call: 1-877-427-3224.

Please take a moment to read more information about this new health insurance option.

SHBP Members PeachCare for Kids Letter

Peach State Benefits Brochure

Peach State Enhanced Benefits

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Big Brothers Big Sisters of Metro Atlanta Partners with Peach State Health Plan for 2011 Big & Little Picnic

22 September 2011 | Author: ttisdale

ATLANTA, September 21, 2011 – Big Brothers Big Sisters of Metro Atlanta (BBBSMA), the area’s leading youth mentoring organization, partners with Peach State Health Plan for 2011 Big & Little Picnic. The event, open to all Bigs, Littles, their families and friends, will be held on September 24 from noon to 3 pm at Candler Park in Atlanta.

The Big & Little Picnic has been a staple on the BBBSMA calendar for many years and is designed to give Bigs and Littles the opportunity to meet other program participants, as well as spend time with other family members and friends of the organization. Those attending the picnic will enjoy games, prize drawings, face painting, arts and crafts, a complimentary catered lunch and may receive a free health screening from event sponsor Peach State Health Plan.

“We are proud to be the sponsor of the 2011 Big & Little Picnic,” says Patrick M. Healy, President and Chief Executive Officer of Peach State Health Plan. “Peach State is committed to investing in the communities we serve and this partnership allows us to offer health screenings and health tips to these kids in a fun and friendly setting.”

“This event is the one time all year where we can all come together – Bigs, Littles, parents, siblings, friends and staff – to celebrate the power of mentoring,” says BBBSMA President & CEO Janice McKenzie-Crayton. “Now that Peach State Health Plan is part of the Big & Little Picnic, it should be one of the biggest and best ever.”

About Big Brothers Big Sisters of Metro Atlanta (BBBSMA)

Founded in 1960, Big Brothers Big Sisters of Metro Atlanta (BBBSMA) is a 501(c)(3) nonprofit organization and an affiliate of Big Brothers Big Sisters of America. The Mission of BBBS is to provide children facing adversity with strong and enduring, professionally supported, one-to-one relationships that change their lives for the better, forever. In 2010, BBBSMA served more than 3,200 children ages 6-18, in a 12-county service area, making it one of the largest affiliated agencies in the United States. For more information about Big Brothers Big Sisters of Metro Atlanta or to sign up as a volunteer adult mentor, please visit www.bbbsatl.org or call (404) 601-7000.

About Peach State Health Plan

Peach State Health Plan (Peach State) is a Care Management Organization that serves the Medicaid and PeachCare for Kids population in partnership with Georgia Families. Peach State is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services. Information regarding Peach State is available via the Internet at www.pshp.com.

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Peach State Health Plan Donates $100,000 to Columbus Regional for Pediatric Medical Care

16 March 2011 | Author: admin

 

FOR IMMEDIATE RELEASE

 

Media Contact

Robert Clarke

404-446-1670

rclarke@duffey.com

 

–Funds will bolster access to pediatric care in Muscogee County region–

 

Columbus, GA (March 9, 2011) – To address the shortage of pediatric physicians in Muscogee County and surrounding areas, Peach State Health Plan (Peach State) will announce a $100,000 donation to Columbus Regional Healthcare System and The Medical Center at a March 9 event. The funds will be used to help establish a medical practice that will increase access to primary and pediatric care, primarily for those enrolled in the Medicaid program in the Columbus area.

“The limited access caused by the lack of pediatric physicians in the area can escalate chronic medical conditions into acute, emergency situations that result in unnecessary, costly strains on emergency departments,” says Dr. Dean Greeson, VP, Medical Affairs and Chief Medical Director at Peach State. “Peach State is uniquely positioned to step up and play a proactive role in providing Muscogee-area children greater access to health care services.”

The new practice – projected to open in spring of 2011 – will be on Columbus Regional’s main campus, which is centrally located and on city bus routes. The site is positioned near various specialists and ancillary care sites, including OB/GYN and diagnostic imaging.

“Considering the central location of the Columbus Regional campus, the practice is projected to accommodate approximately 23,000 annual patient visits by the third year of operation,” says Mike Hill, CEO of Evergreen Medical Group, a physician-hospital organization jointly owned by Columbus Regional and community physician partners. “Peach State’s donation will have a positive and lasting effect on Muscogee County and make a real difference to our region’s children and caregivers.”

Columbus Regional will recruit one physician and two mid-level pediatric-care providers. Plans are to recruit either a family practice physician with interest in newborns or a pediatrician. By not limiting the scope of the physician recruitment, the practice will be better positioned to meet the needs of the Muscogee County pediatric population as quickly as possible.

“Establishing a new medical practice open to patients who rely on Medicaid is among the most viable and expedient solutions to address pediatric care in the Muscogee County region,” says Patrick Healy, CEO of Peach State. “Peach State is committed to investing in the communities we serve, and this donation is a testament to our give-back philosophy.”

About Peach State Health Plan

Peach State Health Plan (Peach State) is a Care Management Organization that serves the Medicaid and PeachCare for Kids population in partnership with Georgia Families. Peach State is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services. Information regarding Peach State is available via the Internet at www.pshp.com.

 

About Columbus Regional Healthcare System

Columbus Regional is a not-for-profit organization providing health, medical and educational services to west Georgia and east Alabama. Facilities and services include The Medical Center, Doctors Hospital, Hughston Hospital in Columbus and the John B. Amos Cancer Center. Columbus Regional has the region’s only advanced maternity services and neonatal intensive care unit, a dedicated pediatric service and pediatric critical care unit, a dedicated trauma center and highly regarded emergency services for children and adults. Information is available at www.yourhealthourmission.com.  

 

About Evergreen Medical Group

Evergreen Medical Group is a physician-hospital organization jointly owned by Columbus Regional and community physician partners. Evergreen contracts with payors on behalf of community physicians and Columbus Regional facilities and services. Information is available at www.evergreenmedicalgroup.com.

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Peach State partners with HealthCare Insight (HCI)

7 March 2011 | Author: Lori Pruitt

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)

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Provider Communication Tip Sheet

16 December 2010 | Author: Lori Pruitt

Dear Provider:

Please select the link below to review the Provider Communication Tip Sheet. This resource tool has been developed to provide  updates regarding Peach State’s programs and services. For questions or concerns, call the Provider Solutions Department, 1-866-874-0633, Monday – Friday, 7 am-7 pm.

Provider Communication Tip Sheet

Thank you~

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Provider Watch – December 2010

13 December 2010 | Author: Lori Pruitt

Dear Provider:

Attached is the latest information regarding enhancements to Peach State’s website. Please select the link below to read this issue. For questions, contact Peach State’s Provider Department at 866-874-0633, Monday-Friday, 7am-7pm.

Provider Watch – December 2010

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2010-2011 Influenza Vaccination Billing Guide

2 December 2010 | Author: Lori Pruitt

Dear Provider:

The 2010-2011 Flu Season is underway and the CDC (Centers for Disease Control and Prevention) recommends that everyone, 6 months or older receive an “annual influenza vaccination”.

As you already know, the flu (influenza) is an infection of the nose, throat, and lungs caused by the influenza viruses. The flu vaccine is the best way to protect against the flu. Please encourage your Peach State patients to obtain a flu shot regardless of their age; including your pregnant members, since pregnancy can increase the severity of the flu. According to the CDC, this year’s seasonal flu vaccine includes protection from the 2009 H1N1 virus, and two other influenza viruses (an H3N2 virus an influenza B virus).  

To ensure accurate and timely claims processing, please adhere to the benefits and billing requirements provided in this notification.  

 Providers should report these services using one of the following CPT codes.

90655- Influenza virus vaccine, children 6-35 months (preservative free); intramuscular

90656- Influenza virus vaccine, individuals 3 years and above (preservative free); intramuscular

90657- Influenza virus vaccine, children 6-35 months; intramuscular

90658- Influenza virus vaccine, individuals 3 years and above; intramuscular

90660- Influenza virus vaccine, (FluMist); intranasally

Diagnosis Code: V04.81

Note: Providers who receive their vaccine through Vaccines for Children (VFC) will be reimbursed for the administration fee only.

We are pleased to offer expanded coverage to all eligible adult Peach State members (ages 18 and over) to receive the flu shot at either their physician’s office or select participating pharmacies. Members must be at least 18 years old to receive their flu shot at the pharmacy and must present a valid prescription for the flu shot to the pharmacist. Members who are under 18 years of age must receive their flu shot from their doctor’s office. To locate a local participating pharmacy, please refer to the attached participating pharmacy list.

Peach State wants our members to stay healthy during this flu season! Please encourage all members to get their Flu Shot Today! If you have questions or need more information, please contact Peach State Provider Services at 1-866-874-0633.

Sincerely,

Peach State Health Plan

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Columbus, GA – Town Hall Meeting Cancellation

1 December 2010 | Author: Lori Pruitt

 

Dear Peach State Provider:

Recently you received an invitation from Peach State Health Plan (Peach State) to attend our town hall meeting in Columbus at the Columbus Convention and Trade Center on Tuesday, December 7, 2010.  The goals of the meeting were to give providers and other interested stakeholders an operations update on calendar year 2010 activities, discuss new initiatives planned for 2011, and establish a forum for dialogue with our senior leadership team.

Following our invitation outreach efforts, we have found that most of our providers have indicated that they are satisfied with the current means for receiving updates and engaging in dialogue with Peach State.  For this reason, we have decided to postpone this town hall meeting and work towards putting together another event in early first quarter of 2011. Please accept our apology if this comes as an inconvenience. Thank you for your understanding and for the excellent care you provide to our members. 

Should you have questions or need assistance, please contact us at 1-866-874-0633.  

Sincerely,

Kevin Sears

Vice President of Provider Affairs

Peach State Health Plan

 

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Provider Watch – October 2010

9 November 2010 | Author: Lori Pruitt

Dear Peach State Provider:

The attached communication has been developed to share information regarding  our policies, procedures, benefits, and  updates. Please select the link below to review. For concerns or copy requests, contact the Provider Relations Department, 866-874-0633, Monday – Friday, 7am – 7pm.

Provider Watch – October 2010 (PDF)

Thank you

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Provider Report – Fall 2010

9 November 2010 | Author: Lori Pruitt

Please select the link below to review the fall Provider Report newsletter. For questions or concerns, please contact the Provider Relations Department, 866-874-0633, Monday-Friday, 7am-7pm.

Provider Report _ Fall 2010

Thank you~

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Provider Report – Fall 2010