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Happy Fall from Provider Network!
Welcome to the 3rd Quarter edition of One Call Connector.
We're officially past the mid-year point and in the home stretch for 2023.
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Your Opinion Matters!
One Call is always open to feedback, so be sure to tell us what you think about this edition of One Call Connector by taking a brief newsletter survey. Access it here!
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International Translation Day is September 30th.
From the United Nations, to every day conversations, translators and interpreters play an important role in society. That's why Provider Network is acknowledging our more than 1,400 Language Services Providers who dedicate their time and services facilitating communication between injured workers and medical Providers.
Ensuring injured workers can communicate their medical needs clearly and effectively is part of One Call's mission of getting people the care they need when they need it; proper communication means proper care.
We say "Thank You!" for being the voice of the injured worker during their most vulnerable time.
To learn more about the history and purpose of International Translation Day, click here.
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ENDORSEMENTS
During the 3rd Quarter, Provider Network secured and reaffirmed multiple partnerships.
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June 2023 - One Call announced their partnership with Sedgwick and
Albertsons Companies to streamline Physical Medicine ancillary claims for Albertsons Companies injured workers in all states, now including California. The official announcement is available here.
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July 2023 - One Call announced their partnership with PepsiCo to streamline all Physical Medicine ancillary claims for PepsiCo workers' compensation injured workers. This partnership was effective May 01, 2023. An official announcement was distributed to One Call Physical Medicine Providers, read it here. | | |
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July 2023 - One Call announced their partnership with Cottingham & Butler Claims Services (CBCS) to streamline Home Health and Durable Medical Equipment ancillary claims for CBCS
workers’ compensation injured workers. One Call also has a partnership with CBCS for Diagnostic Services, Physical Medicine, and Transportation & Language Services.
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July 2023 - One Call announced their partnership with ESIS, Inc., which streamlines all Durable Medical Equipment (DME) needs on behalf of workers’ compensation clients served by ESIS, Inc., a leading global provider of third-party administration and risk management services. Read the official announcement here. | | |
IMPORTANT REMINDERS
The following state and specialty updates ensure Providers are aware of any applicable rules or regulations and are compliant. Please review and take action as needed.
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1199 Bilateral Breast Ultrasound Requirement - Modifier 50
Applies to: Radiologists
Effective: September 01, 2023
Per the Centers for Medicare & Medicaid Services (CMS) Billing Standards, 1199 claims billed with Current Procedural Terminology (CPT) codes 76641 and 76642 must now be billed with a modifier 50.
The previous Left (LT) and Right (RT) body modifier billing requirement for a bilateral service has been eliminated.
Any 1199 claims billed to One Call for CPT Codes 76641 and 76642 with the previous LT and RT modifier may have an impact or delay in reimbursement.
An official announcement was distributed to Diagnostic Services Providers in August, read it here.
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Florida - Updated Evaluation and Re-evaluation Codes
Applies to: Physical and Occupational Therapy
Effective: July 01, 2023
The Florida Department of Financial Services has announced a NEW fee schedule for Workers’ Compensation.
This new fee schedule includes the adoption of the 2020 evaluation and re-valuation
Current Procedural Terminology (CPT) codes for Physical and Occupational therapy. The 2016 CPT codes are invalid after Date of Service (DOS) July 01, 2023.
Reimbursement for bills received by One Call for DOS after July 01, 2023, with the 2016 CPT codes may be impacted or delayed.
The current 2020 evaluation and re-evaluation CPT codes and the 2016 discontinued codes are available in the official communication, available here.
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Texas - Modifier CQ and Modifier CO
Applies to: Physical and Occupational Therapy
One Call recently identified a trend among Physical and Occupational Therapy claims regarding the use of CQ and CO Modifiers. As a reminder:
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If a Physical Therapy Assistant (PTA) furnishes in whole or part of the Outpatient Physical Therapy services, then modifier CQ is required for billing.
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If an Occupational Therapy Assistant (OTA) furnishes in whole or part of the Outpatient Occupational Therapy Services, then modifier CO is required for billing.
The CQ and CO modifiers are required along with the appropriate GP and GO modifier.
Failure to bill with the appropriate modifiers could result in delayed claim processing or claim denial.
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New Mexico - Anesthesia and Sedation Administration
Applies to: Dental Services
Effective: May 31, 2004
The New Mexico Board of Dental Health Care released regulations addressing guidelines and procedures for Anesthesia and Sedation Administration by dentists. These regulations apply to dentists located in offices in New Mexico who administer specific anesthesia and sedation. See the anesthesia and sedation list here.
An official document containing registration, certification, and permit information is available here.
Important:
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Dentists who administer nitrous oxide inhalation analgesia in New Mexico are required to be registered with the board.
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Dentists who administer minimal sedation, moderate sedation, deep sedation, or general anesthesia in New Mexico are required to obtain an anesthesia permit from the board.
To look up a permit, visit the New Mexico Regulations & Licensing Department website here.
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Oregon - House Bill 2696
Applies to: Language Services
Effective: January 01, 2024
Oregon House Bill 2696 will require Sign Language Interpreters to be licensed by the Oregon Health Licensing Office.
Effective January 01, 2024, a licensed sign language interpreter may not:
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Provide sign language interpretation services in a medical setting without a medical sign language interpreter license.
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Provide sign language interpretation services in a medical setting without a legal sign language interpreter license.
Access the complete Oregon House Bill 2696, which includes a section regarding exceptions (Section 8: A-D) here.
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West Virginia - Senate Bill 665 (Massage Therapy)
Applies to: Massage Therapy
Effective: October 01, 2023
West Virginia Senate Bill 665 will require massage therapy establishments to be licensed by the West Virginia Massage Therapy Licensure Board. This includes a place of business that is not a sole practitioner, that advertises or offers massage therapy or other massage services.
Important: A massage establishment license must be renewed every two years.
Access the West Virginia Massage Therapy Licensure Board website here.
The complete West Virginia Senate Bill 665 is available here.
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Arkansas - House Bill 1237 - Insurance Liability
Applies to: Transportation Services
Effective: January 01, 2024
Arkansas House Bill 1237 changes the liability Insurance for vehicles for hire. Two notable changes:
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An increase in the value of the bond required in lieu of carrying insurance, and
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Owners of taxicabs, automobiles, and vehicles for hire will not be permitted to be self-insured.
Access the complete Arkansas House Bill 1237 here.
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Important news and updates from each department within the Provider Network | |
Compliance
CMS Releases Medicare Annual Physician Fee Schedule Proposal
On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the Physician Fee Schedule (PFS) for calendar year 2024.
The rule proposes a decrease in the conversion factor by 3.34%, resulting in a rate of $32.75, compared to $33.89 in 2023. CMS also proposes delaying the implementation of a policy regarding split visits and introduces provisions to improve access to behavioral health services. Furthermore, there are suggested changes to the Quality Payment Program, including the introduction of new reporting pathways and increased performance thresholds.
Telehealth waivers are set to be extended, and updates will be made to various payment policies. The annual Medicare PFS is an important influencing factor for numerous state workers' compensation fee schedules. In addition, several states utilize the Medicare conversion factor as a component in determining provider payments. Read more about the new schedule in the CMS Newsroom here.
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Credentialing
Reminder
Providers, including subcontractors, must not render or offer services until they have successfully completed One Call’s credentialing approval process. In addition, providers must be licensed (including mandated certifications such as New York State Workers’ Compensation Board - NYWCB) in the state services will be offered and rendered.
If a location or practitioner renders and offers services that have not been credentialed by One Call, and have missing licenses or certifications, the location or practitioner may experience delayed payment, up to denied bills.
Important: Diagnostics product specific providers are required to supply an updated medical report with a co-signature from a fully approved credentialed physician.
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Provider Data Management
Demographic Update Requests
To maintain the data integrity of our system, it is important Providers inform Provider Data Management (PDM) directly, via email (see list below), of new locations, practitioner adds, or demographic updates. ALL adds and demographic update requests must be submitted by the Provider in writing via email. PDM cannot accept requests by phone.
Providers who have opted to receive Scheduling authorizations via email are still required to provide a direct written request to Provider Data Management (PDM). If requests are received outside of the team, PDM will reach out to Provider directly via the new email address.
No changes will be made until the Provider submits the request in writing.
Please note: Personal and public email domain addresses (i.e. @gmail.com, @yahoo.com, @aol.com, etc.) may not be accepted.
Demographic updates include (but are not limited to) changes to:
- Phone numbers
- Office hours
- Location Changes/additions
- Email addresses
- Physical addresses
- Name changes (updated W9 required)
- TIN/EIN changes (updated W9 required)
- Billing Address/Remit changes (updated W9 required)
Please submit adds and change requests for above information to the following email addresses based on your specialty:
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Provider Engagement
Billing Address Reminder
One Call understands the importance of timely claims processing and how this impacts prompt payments. As a valued in-network Provider, we want to ensure payments are expedient and without issues.
In September of 2022, One Call announced a mailroom transition, which included new P.O. Boxes for billing. To avoid delays, One Call requests that you submit clean claim invoices with appropriate supporting documentation within the timeframe noted in your Provider Agreement to the appropriate billing P.O. Box.
You can submit claims via one of the following billing methods listed here.
Important: Please ensure that anyone billing on your organizations behalf is informed of the correct billing address.
Thank you for your cooperation!
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This quarter, One Call is proud to spotlight First Call I.V. Pharmacy, a home infusion therapy provider. | |
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As First Call continues to grow and look towards the future, their primary focus is on the investment of resources in facilities and staff, while maintaining exacting standards for patient care. First Call remains committed to sustaining a history of clinical excellence in an ever-evolving regulatory landscape.
Learn more about First Call I.V. Pharmacy here.
Testimonial:
“For nearly 20 years, we have been honored to provide One Call’s patients with infusion medications and related services while meeting the high level of patient care and customer service excellence that they are known for. We look forward to having the privilege to serve One Call’s patients for many years to come.”
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Did You Know:
One Call closely monitors all inclement weather and natural disasters nationwide?
With hurricane season in full swing, and the spread of devastating wildfires, we want to remind our Providers of One Call’s systems and processes for keeping you informed during weather-related activity and natural disasters.
One Call's alerts are designed to notify of potential impacts to our clients and the injured workers we serve. These include:
- Up-to-date email communications
- An enhanced crisis management program
- A new emergency communication tool
- A new system of record
Provider Network distributes informative communications to Providers for each product line in affected areas.
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It is imperative to notify One Call if your business and/or patient care has been disrupted. A contact list, including invoice and submission information is available, access and save it here.
The 2nd Quarter edition of One Call Connector highlighted One Call’s weather alert protocols, view it here.
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Provider Training and Education
One Call's Provider Training and Education Team recently launched the NEW One Call Provider Training Portal, which offers several on-demand, 24/7 eLearning materials to One Call in-network Providers.
You can register and view any of our current offerings here.
For questions or suggestions regarding our available trainings, email:
ProviderRelations_occm@onecallcm.com.
Popular Session Topics
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Provider Portal Review for Diagnostics Services
Provider Portal Review for Physical Medicine
Provider Portal Review for Transportation Services
Provider Portal Review for Language Services
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Invoice and Payment Review for Physical Medicine
Invoice and Payment Review for Diagnostic Services
Provider Manual Review for All Product Lines
I-Supplier Review
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Reminder: Provider Protocols
One Call has Provider Protocols for ALL Product lines on our official website here. Protocols are reviewed and updated bi-annually to reflect modified policies, processes and/or procedures. You can also access Provider Protocols in your Provider Agreement.
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Upcoming Health Observances | | | | |
