Provider News 
May 2019 - In this issue:
 RSVP      
RSVP Today For Our June 14 Provider Meeting

AllWays Health Partners Provider Relations is hosting our next meeting on Friday, June 14th at our headquarters in Assembly Row, Somerville. Join us to hear the latest news and updates. Lunch will be served.

Topics will include:
  • Product updates and information
  • Authorization updates/reminders
  • Important websites and resources
Date: Friday, June 14, 2019

Time: Doors open at 11:30 AM, Presentation 12:00-1:00 PM

Location: Partners HealthCare campus
  399 Revolution Drive
  Assembly Room B
  Somerville, MA 02145

Parking: Visitor parking is available in the on-site parking garage. Parking is FREE without validation for the first 3 hours. 

RSVP: Click Here
 blog      
Provider Blog 

Through our  Provider Blog, AllWays Health Partners shares a fresh and candid perspective on important health care topics and industry news. Get a behind the scenes look at AllWays Health Partners, or read about topics that matter to you. Check out the Provider Blog today and don't forget to register to get the latest blogs delivered straight to your inbox. 
 
lab      
Important: Your Laboratory Claims Will Reject If The Referring Provider Field is Incomplete

Federal regulations require that the referring provider be included on all laboratory service claim submissions. Please refer to the HIPAA X12 standards for additional information on this requirement.
 
For facility and professional laboratory claims submitted on or after June 1, 2019 that do not include the referring provider, the claim will reject as noted below. To ensure your lab claims are processed appropriately, please identify the referring provider on all laboratory claims.
 
Claims submitted without a referring provider will reject with the following message:
 
STC*A7:21:DN
 
A7      Acknowledgement/Rejected for Invalid Information - The claim/encounter 
has invalid  information as specified in the Status details and has been rejected.
 
21       Missing or invalid information.
 
DN     Referring Provider
 
Please share this information with the appropriate billing staff within your organization.
 
  formulary     
Formulary Updates

AllWays Health Partners regularly reviews and updates our formulary. Check out the  latest updates effective 7/1/19.

For the latest information on our pharmacy programs, visit our  online formulary today! 

mpr      
Medical Policy

The following medical policy updates are effective May 1, 2019: 
  • Arthrodesis, Sacroiliac Joint Pain - Annual review without substantial changes in medically necessary indicators. Updated references. 
The following medical policy updates are effective June 1, 2019:
  • Reconstructive & Cosmetic Procedures - Off-cycle review. Added MassHealth language to adopt MassHealth guidelines for Varicose Veins treatment. Updated references section. 
Click Here to view all medical policies.

code      
Code and Benefit Updates

April 2019 Codes 
The following codes/services are not covered as they are considered experimental/investigational:
Code
Description
Effective
93740
Temperature gradient studies
7/1/19
S9034
Extracorporeal shockwave lithotripsy for gall stones
7/1/19
N/A
Central Auditory Processing Disorder Hearing Exam
N/A
N/A
Proton Beam Radiation Therapy for Prostate Cancer
N/A

As a reminder, the following codes are not covered:
Code
Description
A9300
Exercise equipment
S5165
Home modifications; per service

As a reminder, the following codes are not covered for Commercial only:
Code
Description
Effective
S5160
Emergency response system; installation and testing
1/1/19
S5161
Emergency response system; service fee, per month (excludes installation and testing)
1/1/19
S5162
Emergency response system; purchase only B
1/1/19

Routine Foot Care 
Routine foot care is not covered unless a member has a qualifying condition such as diabetes. As of 1/1/19, routine foot care for members with qualifying conditions will be covered and paid for claims submitted by a qualified provider; a specialty of podiatry is not required. 

Zio Patch Authorization Lift (For Commercial)
Effective 5/1/19, Zio Patch remote monitoring will no longer require prior authorization. 

HPV Vaccine 
AllWays Health Partners now covers the HPV vaccine through age 45 for all members. 




AllWays Health Partners includes AllWays Health Partners, Inc. and AllWays Health Partners Insurance Company.