A Note from Dr. Wilson
Allow me to introduce myself, I'm Keith Wilson, M.D., Senior Vice President, Medical Management and Chief Medical Officer for AltaMed Health Services' new AltaMed Health Network—our restricted Knox Keene health plan. I joined AltaMed this past March, and I'm excited to be a part of such a talented and dynamic team.
AltaMed is changing as we continue to embrace value-based care and expand our managed care presence in the marketplace. New at AltaMed is our management services organization, AltaMed Management Services. On April 1, AltaMed brought its prior authorization and claims payment processes in-house. This team is working diligently to address and improve the claims and payment process, allowing us to be more responsive to the needs of our provider community.
I'm also happy to announce that we have entered into a capitation arrangement with The Oncology Institute of Hope and Innovation for hematology/oncology services effective June 1, and Western Drug Medical Supply for DME services effective July 1, throughout Los Angeles and Orange counties. All
new referrals will be directed to these outstanding provider groups. Please see our previously mailed
Provider Bulletins
for details.
Additionally, effective July 1, AltaMed began administering authorizations, claims payment, and case management for CalOptima Whole Child Model/CCS eligible children. Submit referrals via the
I look forward to meeting you. As always, let us continue to do our best for our patients.
Sincerely,
Keith Wilson, M.D., FACOG
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Network Management Updates
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New Claims Address and Customer Support Services
Reminder: AltaMed
Management
Services has a new
claims address.
Please send claims to:
AltaMed Health
–
Claims Department
P.O. Box 7280
Los Angeles, CA 90022-7280
For Electronic Claims:
1. Office Ally:
(866) 575-4120;
Payer ID # ALTAM
2. Change Healthcare/Emdeon:
(877) 363-3666; Payer ID # 95712
To file a claims by phone or to inquire about a claim's status, call
(855) 848-5252
.
The prompts are: Option 1 (providers), then Option 1 (claims)
Thank you for your continued participation in the AltaMed network.
If you have any questions, p
lease contact AltaMed Management Services at
(855) 848-5252
for assistance.
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Payments Simplified
Effective July 22,
AltaMed will be offering additional options for payment.
This is in response to recent provider feedback for quicker reimbursement and more efficient payment reconciliation. AltaMed will collaborate with
Change Healthcare and ECHO Health, Inc.
to provide
new electronic payment methods.
Outlined below are the payment options and any action items needed by your office:
1.
Virtual Card Services
If you do not currently receive payments electronically, beginning the week of July 22, you will automatically receive "virtual credit card" payments with your Explanation of Benefits (EOB).
- Your fax notifications will now include a number unique to your payment transaction and an instruction page for processing.
- The electronic payment process is similar to the manual process.
- Be sure to enter the payment information for the full amount of the card's value prior to the card’s expiration date. (Transaction fees will apply.)
No action is needed
for you to start receiving your "virtual credit card" payments. Please note, future payments will appear as
“HNB – ECHO.”
To receive payments via EFT you must enroll and validate your account:
Action:
As part of the enrollment authentication process, you must
provide bank account information, ECHO payment draft number, and payment amount. Please note, in the future, payment will appear as
HNB – ECHO.
3.
Paper Checks
To receive paper checks and explanation of benefits:
- Opt out of Virtual Card Services or remove your electronic funds transfer (EFT) enrollment
Action:
To opt out of Virtual Card Services, contact ECHO Health at
(833) 629-9725.
4.
Payment Explanation
You can now log on to access a detailed explanation of payment for each transaction.
Action:
Click here
to
l
og on and view
payment transactions.
We appreciate your support as we roll out the new payment options. If you have additional questions regarding your payment options, please contact ECHO Health’s provider support at
(833) 629-9725.
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New Process for Faxing Authorization Requests and Referrals
Documents may be faxed
to support authorization requests and referrals. The process for faxing multiple authorizations or referrals has changed from faxing bulk referrals with one fax cover sheet to including individual cover fax sheets for each patient authorization or referral.
Click here
for detailed instructions.
Please send faxes to
(323) 720-5608.
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2019 Incentive Program – Medicare Health Assessment
MHA incentive program reminder: Submit all Annual Wellness Visits before June 30 to receive full incentive payout. To participate, begin scheduling your Medicare Advantage and Cal MediConnect members for their annual physical, and submit wellness forms via Cozeva.
New in Cozeva
:
Annual Wellness Visit Template is
now available for all our contracted providers.
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Senate Bill 137 – Provider Directory Accuracy
In an effort to remain compliant with California’s SB137, we will provide current and accurate health plan provider directory updates to patients about our provider network. Our newest bi-annual provider directory update was mailed on April 1, 2019.
If you did not receive or would like us to resend the provider directory validation request,
email us
immediately for a supplemental copy.
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Well-Child Visits
Back-to-school time is around the corner, which is
the
perfect time to begin reaching out to parents and children about their annual well-child visit.
This visit is an opportunity for early detection of diseases and adverse health conditions.
Here are a few quick tips for this back-to-school season:
In August, AltaMed will send a reminder letter to families of patients aged 3
–
6 years who are due for their well-child visit. Patients will be directed to call your office to schedule an appointment—please be on the lookout for these calls.
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Compliance Attestation Coming Soon
AltaMed ensures our vendors and contractors comply with applicable laws and regulations. We request an attestation regarding adherence to specific compliance, fraud, waste, and abuse requirements annually. This year’s attestation survey will be emailed the last week of July.
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Cultural & Linguistic Competency
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Activate Interpretation Services!
Patients should receive communications in their preferred language. Here are some tips that can help with patient-provider communication:
- Inform the patient of interpretation services at no cost to the patient at the time they book the appointment.
- Prepare in advance because some services require 7 – 10 days advance notice, like American Sign Language (ASL).
- Patients’ health plans have dedicated interpretation services. Click here to find and schedule interpreters’ services.
- Phone interpretations are available via three-way calls.
- To avoid adverse outcomes, do not use family members or non-certified interpreters.
- Refusing services to patients due to interpretation needs is non-compliant.
- Patients have the right to refuse interpretation; however, this information should be documented in their medical records.
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