Modernized National Plan and Provider Enumeration System

  • July 28, 2017

CMS has modernized the National Plan and Provider Enumeration System (NPPES 3.0) that now has unified login for type 1 and type 2 providers which increases security, provides new surrogacy functionality, has a more responsive User Interface (UI) and a streamlined NPI application process. All NPPES users who obtain and manage NPI account information should be aware of these new and improved...

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New Prior Authorization Request Forms

  • July 28, 2017

Effective July 1, 2017, there will be two new Prior Authorization Request Forms posted in the Prior Authorization Section of the Medicaid website. The following forms will be posted and are required after October 1, 2017. The general Request for Prior Authorization Form should only be used when there is not a specific form for the service(s) being requested. The new forms are Request for Prior...

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Redetermination Requests Which Contain Multiple ICNs

  • July 28, 2017

When submitting a Redetermination request that contains multiple Internal Control Numbers (ICNs), include the following to ensure proper review and prompt response. Attach a spreadsheet. If submitting multiple spreadsheets, include page numbers. It/they must contain specific beneficiary appeal documentation. Separate each beneficiary documentation with a spacer page. Include documentation...

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Association of Molecular Pathology Test Directory

  • July 28, 2017

AMP's Test Directory is Open for Business. Add your Laboratory and Tests today. New and improved, the AMP Test Directory features up-to-date test options, robust help files, and improved search functions. Listing your lab in the directory is a benefit of an AMP Membership.

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New Clinical Guidelines – Prior Authorization (PA) of Genetic Cancer Susceptibility Panels Using Next Generation Sequencing

  • July 28, 2017

Effective August 1, 2017, new clinical guidelines will be used in conjunction with the Department of Social Services’ (DSS) definition of medical necessity to render determinations on prior authorization (PA) requests for Genetic Cancer Susceptibility Panels Using Next Generation Sequencing. The new policies will be made available on the HUSKY Health Web site at: www.ct.gov/husky. Providers must...

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Requirement for Fingerprint-Based Criminal Background ChecksBackground

  • July 28, 2017

On July 30, 2017, NCTracks will implement a federal requirement for providers designated as "high categorical risk" or any person with a 5 percent or more direct or indirect ownership interest in the organization to be fingerprinted. The requirement is retroactively effective for providers enrolled or re-credentialed on or after August 1, 2015. For more information on the specific federal...

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Changes to the Payment Error Rate Measurement and Medicaid Eligibility Quality Control Programs

  • July 28, 2017

On June 29, 2017 CMS posted a final rule that will publish on July 5, 2017 to implement changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs to reflect changes to the way states adjudicate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) required by law, as well as to implement other changes to the PERM and MEQC...

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Enhanced prior authorization form for Genetic testing now available

  • July 28, 2017

As communicated in the June edition of health lines, effective July 10, 2017, UCare launched enhanced prior authorization forms for genetic testing services. The form enhancements will ensure that all of UCare’s prior authorization forms have a similar look and feel, provide clear instructions for what is needed to efficiently process requests and reduce the amount of administrative time for the...

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