AMCNO Hosts its Annual Third-Party Payer Seminar

The AMCNO held the annual “Solving the Third-Party Payer Puzzle” seminar May 4 at our offices. Several representatives from local private payer companies and Medicare discussed the latest news to update physicians and their staff about issues that could impact their practices.  

During her presentation on “The Healthcare Journey,” Diana Irvin, from Medical Mutual of Ohio, discussed a mobile app for members, ICD-10 information, National Drug Code requirements, and how employer groups may elect coverage maximum for specific lab services, which started in 2016.  She also highlighted how the Medicare Advantage provider network differs from commercial networks.

Bethany Meyer, from Anthem Blue Cross Blue Shield, covered several topics, such as the Medicare Advantage Precertification Tool, Interactive Care Reviewer (ICR), Orthonet, AIM, and Availity. Meyer also talked about the top reasons for medical record requests, the records that could be included in those requests, and tips for successful handling of them.

Vanessa Williams, from Ohio Medicare/CGS, discussed new and ongoing Medicare initiatives during her presentation as well as information about medical record review contractors, CGS operational reminders, assistive resources, and self-service technology options (including future enhancements, such as eChecks, single log-in capability, and Web chats).

In his presentation, Jeff Velick, from Buckeye Health Plan, informed attendees of how the company serves its 295,000 members in Ohio. He discussed claims, adjustments, and appeals; Buckeye’s informative website; the company’s care management programs and pharmacy service.

Gail Nadler, from Paramount, discussed the company’s different plan products in Northeast Ohio, 2014 HEDIS results, website resources, and claims submission information.

Sharon Rey, RN, from the UnitedHealthcare community plan MyCare Ohio, discussed care management, care teams, and helpful resources.

To view photos from the event, see the AMCNO Twitter feed @AMCNOTABLES or visit our Facebook page.   

The Pollen Line is now closed. See you in the spring!

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