Since ASH can be confusing, especially the threshold starting over in the middle of the year versus benefits being per calendar year, I wanted to reiterate a response I had issued to help clarify this policy.
The ASH threshold actually DOES reset in July. I am quoting from ASH’s site, taken moments ago: “The Clinical Treatment Form Waiver is available for the first episode of care provided to a member who is a new or established patient (over 12 years of age) during the twelve month period of July 1st through June 30th. If there are additional services that may be necessary beyond the Clinical Treatment Form Waiver you will need to submit a Clinical Treatment Form (CTF) to ASH. Once a Clinical Treatment Form (CTF) has been submitted during the calendar year the Clinical Treatment Form Waiver is no longer available.”
Just a reminder to all of you California ASH providers that the most wonderful time of the year is upon us….threshold time! You should have recently received a letter about your tier status, hopefully you went up or at least didn’t go down….To recap what this means, most of you are at a 5 visit threshold. If your tier status increased, you may be at 8 now or even better 12 or the elusive unlimited (never need authorization). It can take a very long time to move up in tier status and you all start out with 5.
I find it so frustrating that verifying your provider is listed on the appropriate website has become a full-time job! In this day and age, not being listed as a provider on-line with various insurance companies you are contracted with can take you right out of the running for potential new patients. Who is verifying that you are listed, you ask? No one! As I’ve mentioned before, with payors such as ASH being a gatekeeper for companies like Aetna, Cigna, etc. you assume that they are updating them appropriately and that they are updating their websites accordingly. Not the case.
It always amazes me when patients don’t have med pay. What are they thinking? More importantly, why don’t insurance agents who sold them their auto policy offer them ALL coverage benefits? Isn’t it in their best interest to try and SELL people all that they can? In this case med pay is so critical to a persons well-being in the event of an accident. So many providers don’t take liens and if you don’t have health insurance for the provider you need to see (assuming it’s not an HMO, that adds a whole other level of complication), you are potentially OUT OF LUCK. In case someone reading this doesn’t know what med-pay is, I’ll explain.
I have heard way too many times lately that Acupuncturists need to belong to Acucare to be a Cigna provider? What in the world is Cigna talking about? Your contract with ASH is what gains you access to Cigna NOT Acucare. When I was first told this (by Cigna provider relations, by a couple of different people because I called back hoping to get the REAL story) I sat there perplexed. I then immediately called ASH provider relations and had a discussion with them asking if they knew what Cigna was telling people and reconfirmed that they still handled Cigna, right? Yes.
Tiffany and I are so pleasantly surprised at how easy it has been to get this website up and running. Word Press is awesome! And easy…
We have put up two new pages tonight. MPNs is a list of where to go to join a Medical Provider Network in California so one can bill worker’s compensation. In addition, we promised in our book that we would provide location codes for the CMS 1500 form and those can now be found on the 24B page. In addition, we did a little clean up tonight. We still need to go back and clean up the outcomes assessment and populate the forms pages.
In California, when we underwent “work comp reform” in 2004. Many of us saw life as we knew it change forever. Practices folded as the power changed hands to the insurance companies and subsequent review agencies that began denying everything and reduced business’ heavily weighted in work comp to nothing. I am happy to report that the pendulum has begun to swing back towards the middle. While all care requires prior authorization (always in writing), we are seeing increased referrals and authorizations while acupuncture, once again, is recognized as an effective component in work comp rehabilitation. I’m so glad to see this. I’ve seen work comp at its highest, its lowest and wasn’t sure if it would ever return in the world of acupuncture. I am refreshed to see that this is finally happening as so many patients truly benefit from this awesome form of medicine.
We’ve gotten the CPT codes page up and running…so another page down. We also changed the header graphic to a snippet of the front cover of our book, and we set up Google Analytics. If you are not familiar with Analytics and you run a website of your own, you need to check them out. It is a very useful way of checking the stats of your website and will tell you a lot about who has visited your website. Really useful and entirely free. Check them out at: https://www.google.com/analytics/settings/home.
As if American Specialty Health (ASH) didn’t have it’s hands in enough, now it is the gatekeeper for Cigna too. Unfortunately though, it didn’t get the system figured out before taking the reigns. Since it is only partly involved in claims processing (but we have to go through THEM or else), we have many claims unresolved months later because they’ve “forwarded the claim to the home plan for processing.” Their job is done (who cares that we’ve received nothing yet?) So another decent insurance company has gone to the dark side. Poor patients. They never understand. They continue to come in thinking they’ve got Cadillac insurance only to find themselves needing to fill out paperwork all the time now and pay additional fees for non-covered services. Since all ASH’s per-diem includes is the needling portion of the treatment along with heat packs, our patient’s are charged a flat additional amount for all the non-covered services done with the treatment such as: massage, gua sha, cupping, castor oil packs, etc. With billion dollar profits, I would expect a bit more for Practitioners from an insurance company involved in (seemingly) everything. With that being said, as long as ASH is around and so involved, we must ‘play the game’ to survive.
Last week we put up our “About Us” page and a beginning page for “Outcome Assessments.” This last page is, and will be for a while, a page in progress as we try to get direct links to each of the assessments and potentially add our thoughts about each. We just posted our “HIPAA” page and expect its usefulness to grow as well. Right now we are trying to get the skeleton up and we’ll put flesh on the bones as we go along. Please let us know what you think, and if you have any helpful materials, please send them our way. We will give full credit, of course. I ended up sneaking another page up, “Fee Schedules.” Hope it is helpful…