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. . . . . . . . . . . . . . . . . . Kelly Geise Lisa E. Featherman
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Class A Members Scott Hartzell, MD Douglas A. Spotts, MD Fred Teichman, MD P. Ronald Zug, MD Class B Members Michael O'Keefe James Willshier, Vice President of Operations J. Lawrence Ginsburg, MD Linda Boose, Planning Director James Stopper, Controller Other
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FOR YOUR INFORMATION
Geisinger Health Plan (GHP) sent a flyer to all provider offices explaining National Imaging Associates (NIA) internet capabilities through GHP. Offices now may order and precertify tests via the internet at www.RadMD.com/signup. If you have any questions regarding this new web based capability, please contact your GHP Representative.
Lately, our office has been receiving phone calls from patients and office staff, regarding the difference between participation with an insurance company and acceptinga patient’s insurance card. The difference between the two scenarios is if a physician office or a facility accepts a patient’s insurance card (meaning physically), this does not automatically mean that the provider is participating, or in network, with that specific insurance company. If a card is unfamiliar to you, please make the patient aware that it is possible you might not be an in network provider for that insurance company, but you are still willing to see the patient. If you are not an in-network provider, the patient may have higher cost sharing related to the visit.
On December 31, 2005 CSHP terminated its contract with Private Healthcare Systems (PHCS). Many employers use PHCS as a wrap around network, or a larger network to wrap around their smaller “core” network. If we are participating with one or more of the network logos on the card, and PHCS is one of them, we are in network providers for that insurance plan. For example, Susquehanna Health System self funds their health insurance for their employees. They use CoreSource as their TPA, CPPN as their “core” network and PHCS as their wrap network. In this situation, you are participating if you are a participating provider with CPPN.
Medical Development International (MDI) is the insurance company that currently covers the Lewisburg Federal Inmates. In 2001, CSHP contracted with MDI to cover these inmates. This contract is up for bid every five years, and 2006 is a renewal year. With that in mind, CSHP has once again partnered with MDI to place a bid. NaphCare is another company bidding on the same contract, which CSHP has partnered with as well. The final contract was to be awarded in March 2006, but the Federal Bureau of Prisons has additional questions for the companies, and this has prolonged the award of the contract. We will keep the offices posted when the final award takes place.
With the termination of PHCS in December, it left CSHP without participation in a National Insurance Company or PPO Network. Currently, CSHP is looking at a contract with CIGNA, which formerly accessed us through PHCS. This is a nationally fully and self-insured company that has its own national network of providers. The second contract CSHP is looking at is with MultiPlan. This is a national PPO Network similar to PHCS. We will keep you updated with any new developments.
The CSHP and Evangelical Community Hospital’s Managed Care Departments answer the Evangelical Physician Referral Line. This line gives information to the public regarding any physician who has privileges at Evangelical. With the world of HMOs, the name “Physician Referral Line” has become confusing to the general public. We have received many phone calls asking to be “referred” to a physician. Because of these situations, we have decided to change the name to “Evangelical Physician Finder.” You may still obtain the same information, just with a different name. Also with this line, we receive many phone calls asking who is accepting new patients, who is accepting Medical Assistance (MA) and who is accepting new MA patients. Erin Rice will be contacting your office to ask these questions, and this information will be updated every six months. If there is any confusion or questions regarding this change, please contact our office.
Over the course of some time, the CSHP office has noticed a trend in the phone calls that we receive from the provider offices. Because these phone calls seem to be similar in nature, we have put together an informational packet regarding the insurance companies and PPO Networks that CSHP has signed contracts with on your behalf. These packets include basic information about the insurance companies, copies of logos, client lists and the CSHP Employer List. Erin Rice will be bringing them around to the office managers, which can be shared with the office staff. Erin is also available to meet with the office staff to discuss any insurance questions or problems. These packets are a work in progress, so if you see anything in these packets that is not useful, or if something is not included, please contact our office.
Just a reminder that CSHP’s new Physician Fee Schedule has gone into effect on April 1, 2006. The old fee schedule was based on 2001 Medicare Reimbursement. It will now be based on 2006 Medicare. The basis will change every year to reflect the most current Medicare Fee Schedule. The percentage of the Fee Schedule will stay the same. Please contact our office with any questions or concerns.
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