Volume 05 | February 19, 2021

Your Guide to News & Updates
News & Updates
Check out the Peach State / WellCare Resources Page on the KHF Intranet!

Please see below for the link to our Peach State/WellCare Resources Page on the Intranet.

It is located in the resources section of the intranet. This page will have updated information as we receive it, including our PA meeting recordings, sample letters, and other resources you may need.

Please reach out to Toni (twilliams@khfirst.com), Tandric (tbowden@khfirst.com) or Laura Baldwin (lbaldwin@khfirst.com) if you have any questions or if we can assist in any way.

Please let us know if you have any trouble accessing the resources on the intranet. Thank you!
Peach State / WellCare Merger: What You Need to Know

We have summarized the information given at our last Practice Administrator meeting. Please check out our bulleted list of hot topics and be sure to check out the recorded webinar and resources on our intranet page listed here!
Helpful E / M Tools:

Please check out the following resources for additional information on the 2021 E/M changes:

  • AMA: 2021 E/M Office Visit Changes (What changes can you expect?) - video here

Dr. Tuck Pediatric Coding Seminar- Slides and Recording

Thank you to all who joined us for our informative pediatric coding seminar with Dr. Tuck!
Please click the links below for a pdf version of the slides (we improved the layout slides 36 and 37 of the presentation from yesterday for clarity) and well as the recorded webinar.

Action Items
Aetna Claims Issues

Please let us know if you are still experiencing issues with claims for CPT 96160.

If you are having issues, please send an email to payorconcerns@khfirst.com and answer the questions listed below.

Are you still experiencing issues with CPT 96160?
  • Include the date range
  • Estimated amount of outstanding payments.

Please list any changes that you made (modifiers etc.) if any, to get the claims paid.

Multiplan / PHCS Claims Issues

We are seeing a lot claim issues related to network participation status.

Please follow the steps below to verify participation and reprocess claims.

  1. Please call 1-800-950-7040 with the patient’s demographics and the EOBs.
  2. Confirm that the provider is participating.
  3. Ask that the claim be priced and reprocessed. You will be given a reference number.
  4. The representative may request that you fax the EOBs.

*Please reach out to Toni Williams if the steps listed above do not work.*

Please submit an email with the information listed above to payorconcerns@khfirst.com.
Payor Updates
Note about Aetna Whole Health Plan

KHF does not participate with the Aetna Whole Health Plan which is offered by Coca Cola and other employers in the Atlanta area.
CAQH Reminder

Please make sure that your CAQH files are updated at least 3 months prior to recredentialing time for providers.
Correction of claims for CPT 96110

Per our representative, the error causing issues with CPT 96110 has been corrected.

Affected claims will be automatically reprocessed.
Toni's Tips
Reminders & Quick Tips
Please do not only rely on the patient’s ID cards to confirm if a practice participates with a payor. We are seeing denied claims that cannot be reconsidered due to eligibility issues.

When in doubt about benefits, reimbursement policies, and other revenue cycle issues please reach out to the payor's provider relation’s customer service line and/or KHF.
Resources For You