Updates from CareOregon |
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RA change gives most complete claim information By Rebecca Fortuine Take a look at the paper version of your remittance advices (RAs) from CareOregon. You should now see a new column, titled “Expl Code.” This addition allows CareOregon to put the Claims Adjustment Reason and Remittance Advice Remark explanation codes together on the same claim itemization. The paper version already lists written messages entered by the claim adjuster. By adding this new column, the paper RA is more complete than the electronic RA (the 835 data stream) and now gives you most complete information on how claims were considered for payment. The change is brought to you by CareOregon’s provider satisfaction process improvement team, Barrier Breakers. These are the same folks who put the links to HIPAA code definitions on the CareOregon web site under “Provider Resources.” (You also can link directly to Claim Adjustment Reason Codes or to Remittance Advice Remarks Codes here.)
“We wanted to give providers as much information as possible related to their claims,” says Barrier Breakers coach Teresa Boatright. “But in the past the systems were not configured to allow two HIPAA codes. We were able to add the second column on the version printed by AdminiSource, which handles our RA processing.” Paper RAs, with the new information, will continue to be mailed once a week on Tuesday. Do you want the more complete information, but would like to have it as fast as electronic 835 data? “We are piloting a new project because of the 835’s limitations,” says Rebecca Fortuine, co-coach. “Right now AdminiSource prints our paper RAs from PDFs, then mails them to you. We are working with AdminiSource to allow providers to access the PDFs directly via a secure web site. “This is a greener process that can eliminate the need for printing, mailing and any internal copying. The RAs will be available online each Tuesday, and will be are searchable like any other PDF.” After testing this process and finding it satisfactory, providers can then opt out of receiving the print copies, which will save the cost of mailing and reduce environmental impact, Rebecca says. The Barrier Breakers welcome providers who would like to participate in this pilot program. If you are interested in participating, contact your Network Representative Associate (you can find their contact information here). If you want more information e-mail the Barrier Breakers directly Stay tuned. Barrier Breakers will bring you more positive changes. |
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Updates from Network Relations |
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Meet your Contract Manager: Kass Jones
“What do I want to do with the rest of my life?” That’s a common question for many people at midpoint in their careers. That’s what Kass Jones asked herself a couple of years ago. “As I’ve gotten older and the kids have moved out, I wanted to feel like I was giving to the community,” she says. “We’d paid off the house, we were OK financially. Now let me give something back.” That’s why in April Kass celebrated the completion of her second year as CareOregon’s contract manager. And it’s a commonality among many of the providers with whom she works. Even though Medicaid reimbursement is low, providers are still willing to provide care to those in need. “They also feel like they are giving to the community,” Kass says. “It's really a different conversation than you have for commercial plans, and I really appreciate it.” Health care is in Kass’ DNA. She’s the daughter of Ted Dillman, first chief of surgery at what is now Southwest Washington Medical Center in Vancouver. “My first income was from cleaning doctor’s office and picking berries,” She says. “Then when I was a teenager, I worked as a candy striper at St. Joseph’s Hospital.” That was followed by work at Hi School Pharmacy in Vancouver as a cashier. Then, before you had to have a pharmacist or pharmacy technician license to deliver medication, Kass also delivered prescriptions to nursing homes. She attended first Evergreen College, then the University of Washington as a pre-med major, attended Portland State University and Portland Community College for a time before graduating from Concordia University with a degree in business and communications, with a medical emphasis. Her career has always been in health care. She’s managed a physical therapy clinic, worked in the workers compensation department for Providence Health System, then moved into Providence’s provider relations and contracting departments. Kass’ last job before CareOregon was in the contracting department at Great Western Life, where she worked for six years in the contracting department. In early 2007, with two stepsons, a son and a daughter grown and moved away from the house in rural Clark County, when Kass was asking herself those mid-career questions, her sister Ann told her about the company where her next-door neighbor worked. Axel Bergman, who shares an interest in gardening with Ann, is audit and compliance officer for CareOregon. It’s a good fit, Kass says. CareOregon does reach a population with special needs, so that helps fulfill those desires to service the community. And the position gives Kass the opportunity to stay connected with the front-line health care providers that have been her own world all of her life. "I feel I can build trust with providers,” she says. “And they can depend on me to be straightforward with them.” Annual HEDIS reviews beginThe annual review medical record to gather data for the Healthcare Effectiveness Data and Information Set (HEDIS) started in March. If your clinic is selected as part of our HEDIS review for 2009, we will ask for your help to ensure that the data collection is accurate and completed with as little disruption as possible to your staff and clinic. If your clinic is chosen to participate, here is what you can expect:
If you have any questions, please call Joyce Caramella, RN, at 503-416-8026, or send her an e-mail. Also please don’t hesitate to contact the Network Relations Associate assigned to your clinic. You may access the assignment list on our web site or call our main telephone line at 503-416-4100 or 1-800-224-4480. DHS updates prioritized listThe following OHP Provider Announcement for Oregon Department of Human Services, Division of Medical Assistance Programs is now available: "Prioritized List revised to add/delete diagnosis, CPT and HCPCS codes." Pharmacy updatesThe pharmacy department would like to remind you that the CareOregon Advantage formulary may change during the plan year. We post these changes on the web site in a table titled “CareOregon Advantage Formulary Update,” which you can reach from www.careoregon.org/provider/pharmacy. This table is updated monthly.  This quarter in CareLinkOur member newsletter for Spring 2009 includes stories about a clean beaches poster contest for kids and the active family sport of letterboxing. We also give advice on and links to information on breastfeeding and infants’ dental care, as well as tips on driver’s safety training for seniors, understanding the peanut recall and how to dispose of unused medicines properly. Our web site includes the latest issue of CareLink and an archive of back issues, in English, Russian, Spanish and Vietnamese. |
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