Tagged with Provider Contracting and Enrollment

Virginia Launches Program to Connect All EDs Statewide

Virginia has launched a pioneer program to connect all hospital emergency departments (EDs) across one state. The first of its kind in the United States, the Virginia Emergency Department Care Coordination (EDCC) Program will facilitate real-time communication and collaboration among health care providers, health plans, clinical and care management personnel for patients receiving services in Emergency Departments.

Anthem Adopts MCG Care Guidelines

Anthem’s behavioral health medical policies and clinical guidelines currently in place for reviewing of behavioral health services, will be replaced by the MCG Care Guidelines 22nd edition Behavioral Health guidelines.

Pennsylvania – FY 2019 Budget Legislation Approved

The governor of Pennsylvania has given final approval for the state’s $32.7 billion 2018-19 spending bill. The finalized bill, House Bill 2121, includes a number of healthcare related provisions, such as increased funding for community-based family centers and home-visiting providers, additional investments to assist individuals with intellectual disabilities and autism, and increased access waivers for in-home supports and services.

MBI Changes for New Medicare Cards

CMS has posted information regarding the instances in which a Medicare Beneficiary Identifier (MBI) could be subject to change.

CMS Reintroduces QMB Information in Provider RAs and MSNs

CMS has issued a reminder to Medicare providers regarding proper billing for certain beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program and also announced the reinstatement of QMB information in provider Remittance Advices (RAs) and Medicare Summary Notices (MSNs).

Quality Data Model (QDM) Update Released

CMS has published the most recent updates to its Quality Data Model (QDM) standard. According to the agency, the latest version has been updated to align with the emerging standard, Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) and add increased explicit capabilities.