|
Happy New Year from Provider Network!
Welcome to the 1st edition of One Call Connector (OCC) for 2023. OCC is back to update you on all of the important and exciting news happening in Provider Network. This year is already off to a successful start!
| |
|
Patient Safety Awareness Week (PSAW) is March 12th - March 18th.
This week acknowledges the importance of patient safety while under medical care. For injured workers, this is especially crucial, as unsafe business practices or medical errors can cause delay in recovery, preventing an injured worker from returning to work healthy and in a timely manner.
| |
As we recognize PSAW, we say "Thank you" to our many providers who not only get injured workers the care they need, when they need it, but provide dependable and trustworthy care while doing so.
"While Patient Safety is commonly thought of as being between 'Patient and Provider', One Call's partnership with our Network Providers and Patient Scheduling, means we ALL contribute to the safety and well-being of One Call patients."
~ Vanessa Compagni, Director – Network Quality Governance & Risk, One Call
| |
|
From the providers we select for our network, to the departments we have in place when issues arise, at One Call the patient's well-being is always in mind.
Some of those departments and their influence on safety include:
-
Operations - Schedules patient with the correct provider
-
Provider Engagement - Addresses inquires regarding providers, including patient safety through One Call reeducation and the Remediation Program
-
Credentialing - Ensures network providers meet One Call and licensing requirements
We also encourage injured workers to take the Provider Network Patient Satisfaction Survey, allowing them to provide feedback on the care they received - good or bad. Read more about the survey and our current standings here.
For more information about PSAW 2023 and to download a PSAW Toolkit for your organization, visit the Center for Patient Safety website at: centerforpatientsafety.org.
| |
|
New Year, New Endorsements!
Provider Network kicked off the New Year with a new endorsement. In January, we announced the partnership between One Call, Walmart Claims Services, and Corporate Remedies, Inc.
This partnership aligns all Texas Physical Medicine services for Walmart injured associates. This is another important win for One Call, and we’re excited for this collaboration. Read the official announcement here.
| | | |
|
Seven More Years
One Call and the New York State Insurance Fund (NYSIF) announced a 7-Year Renewal of their longstanding agreement for diagnostic services.
Under this agreement, One Call (OCM IPA, Inc.) along with Navigere IPA LLC remains an approved NYSIF-contracted Diagnostic Testing Network (DTN) through October of 2029.
The renewal was finalized in November of 2022 but was formally publicized
by One Call in January of 2023. Read the official announcement here.
| | | |
|
California Physical and Occupational Providers
The California Department of Workers' Compensation has set forth requirements that may affect your participation in the California Medical Provider Networks.
Pursuant to the Business and Professions Code §13400 (Moscone-Knox Professional Corporations Act), in order to participate in an MPN, an entity must be registered with the California Secretary of State (SOS) as a Professional Corporation (as opposed to a General Corporation, LLC, etc.) and in good standing (i.e., not suspended, terminated, etc.).
In order to ensure your continued participation in California MPNs, you may want to confirm your entity’s filing status with the SOS.
You can check your status here.
Please be on the lookout for forthcoming communication from One Call regarding new developments as they pertain to this requirement.
| | | |
|
Colorado Interpreter Invoice Form WC203
Effective January 01, 2023, Colorado has updated Rule 18-7 (H) - Use of an Interpreter.
Use of an Interpreter is as follows:
(1) Payers shall reimburse for the services of an interpreter when interpretation is reasonable and necessary to provide access to medical benefits. Interpreter services provided in a hospital or ambulatory surgery center are included in the facility reimbursement and are not separately payable.
An interpreter may be provided on-site or via video or audio remote interpreting service, based on availability and the preference of the treating Provider.
(2) Providers are prohibited from relying on minor children and should refrain from using adult family members and friends as interpreters, except in an emergency.
(3) Payment requirements:
a. Interpreters for certifiable languages must be listed as certified on the Certification Commission for Healthcare Interpreters Registry (available here) OR the National Board of Certification for Medical Interpreters Website Directory (available here).
| |
Certifiable Languages:
· Spanish
· Cantonese
· Mandarin
· Russian
· Korean
· Vietnamese
· Arabic
| |
b. For all other languages, or in the event a certified interpreter is unavailable, the interpreter shall be qualified. Qualified means the interpreter has documentation showing completion of at least 40 hours of healthcare interpreter training.
c. When a qualified interpreter is used in lieu of a certified interpreter, Payers must document a good faith effort was made to obtain a certified interpreter and submit this documentation to the Division upon request.
By way of example, the payer may document a good faith effort by contacting at least two certified interpreters who are unavailable for the requested date and time.
d. Prior authorization is required for on-site interpreters except for initial and emergency treatment.
Interpreters shall use the Interpreter Invoice Form (Form WC203), available here, to bill Interpreter service within 120 days of the date of service.
| | | |
|
Register for our New and Improved
Provider Training Portal!
In the 2022 4th Quarter edition of One Call Connector, we announced the launch of the NEW Provider Training Portal.
One Call Provider Trainings cover “How to Work with One Call” via several topics, including:
- Billing
- Provider Protocols
- Provider Manual Reviews
-
Provider Portals, and
-
Notes/Document Requirements
Trainings are open to anyone within your provider organization. This includes practitioners, office managers, billing associates, etc.
To register for the One Call Provider Training Portal, access the portal registration here.
Registration is quick and easy and requires the following:
- Email Address
- Password
- Full Name (First & Last Name)
- Organization Name
- Business Phone Number
Important: Please ensure to acknowledge the Confirmation Email to complete registration.
If you need assistance registering in the portal, access our helpful One Call Provider Training Portal User Guide.
For questions regarding the Provider Training Portal or assistance completing registration, contact: ProviderRelations_occm@onecallcm.com
| | | |
|
Are You Staying Informed?
One Call communicates with our providers primarily through email. We regularly distribute important communication reminders and updates for the following:
- Educational opportunities
- Provider Protocols and Manuals
- Endorsement announcements
- Compliance requirements (state and federal)
- Impacts to business (weather alerts, technical issues, etc.)
As a One Call in-network provider, it is imperative to stay informed and current. Overlooking an important communication could impact your role as a provider and also affect injured workers.
We encourage you to confirm you are subscribed to One Call emails.
If your email address has changed, please submit a demographic change request to the applicable email listed below:
| | | |
Important news and updates from each department within the Provider Network | |
Compliance
Congress Reverses Medicare Payment Cuts
Congress passed numerous policy changes in a massive year-end omnibus measure signed into law by President Joe Biden on December 29, 2022.
Faced with the prospect of inadequate funding of government operations, Democratic leadership garnered enough Republican support to pass the bipartisan measure. Included in the law is a reversal of a recently finalized reduction of Medicare provider payments by the Centers for Medicare and Medicaid Services (CMS).
Specifically, CMS finalized the FY2023 (Fiscal Year) Physician Fee Schedule Rule, which included a 4.5% reduction in the conversion factor used to calculate rates. With Congressional intervention, the conversion factor rates will increase by 2.5% in 2023 and 1.25% in 2024.
Several states utilize the Medicare conversion factor to calculate provider reimbursement rates in workers' compensation.
Read more about this topic in CMS’ MLN Matters.
More information about the omnibus spending bill, from the perspective of the American Hospital Association, is available here.
| | | |
Credentialing
One Call Aligns with The Council for Affordable Quality Healthcare, Inc. (CAQH) ProView
One Call has aligned with CAQH ProView to collect Practitioner credentialing data. CAQH is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. If you haven’t already signed up with CAQH ProView to maintain your credentialing data, here is some helpful information:
What is CAQH ProView?
CAQH ProView is the healthcare industry’s premier resource for self-reporting professional and practice information to health plans and other healthcare organizations. This system streamlines the credentialing process by allowing practice information to be easily entered and maintained for submission to selected organizations.
CAQH's goal is to make the credentialing process simpler, secure, and efficient by:
- Improving healthcare access,
-
Enhancing patient quality, and
- Reducing administrative burdens for physicians, healthcare providers, and staff
| |
How Do I Join/Access CAQH ProView?
To create an online profile for healthcare entities to access your information, the following is required:
- CAQH ID
- Username
- Password
Note: Obtain a CAQH ID directly from the website.
Access the CAQH ProView Log In screen page here, then create a CAQH Proview Profile OR sign into an existing account.
An overview of CAQH ProView is available here.
What if an office manager/administrator usually handles credentialing information for multiple providers in our practice?
The CAQH ProView Office Manager Module facilitates the data entry process. Data that is the same for multiple providers (e.g., clinic name, address, and phone number) can be entered once by an office manager rather than being repeatedly entered for each individual provider.
How much does it cost to use CAQH ProView?
There is no cost for physicians and other health care providers to maintain their data in CAQH ProView.
How do health plans and other healthcare organizations access my information?
When completing your CAQH ProView profile, you can choose which healthcare organizations are authorized to access your data. Global authorization can also be granted, which gives any participating organization access to your information.
Who do I contact for administrative support/questions regarding the CAQH database?
Access the CAQH Help Desk via live chat OR call: 1-888-599-1771.
Note: To access Live Chat, log into to your account and click the chat icon at the top of the page.
CAQH ProView Resource Link
Access the CAQH ProView Provider User Guide here.
| |
Dental Providers:
Access and set up a CAQH ProView Profile through the ADA portal here.
Note: A CAQH ProView profile can also be set up at: www.ADA.org/credentialing. Under ADA Credentialing Service for Dentists, click “Submit Credentials Now.”
Do I need to be an ADA member?
ADA Membership is not required however, it is recommended to still register for CAQH Proview via the ADA portal.
For assistance retrieving our 9-digit ADA User ID, contact the ADA Member Service Center at:
1-800-621-8099.
CAQH ProView Resource Link
Access the CAQH ProView Dentist Quick Reference Guide here.
| | | |
Provider Engagement
A Note of Gratitude to our Providers!
Provider Engagement would like to take the time to show gratitude to our One Call in-network providers.
We have several Providers in our network who truly envelop One Call's Core Values Core Values:
- Think BIG!
- Go Fast
- Deliver Awe
- Win Together
Read inspiring testimonials about our network providers from One Call Provider Engagement Specialists here.
| | | |
This quarter, One Call is proud to spotlight ATF Medical, a Custom Mobility and Complex Care Provider | |
|
The workers’ compensation industry requires effective communication and streamlined services. ATF understands these demands and is dedicated to exceeding their partner’s needs through three Core Partnership Commitments:
- Bringing deep cost savings to the partner and their carriers
- Consistent and proactive communication to One Call teams
- Delivering orders with best-in-class speed
ATF is committed to providing experienced Mobility and Home Accessibility/Modification care coordinators to One Call and is readily available to serve injured workers with compassion and care. The relationship between ATF and One Call is deeply valued and they look forward to continuing to help injured workers on their path to increased function and independence.
ATF Medical One Call testimonial:
“We are extremely proud of the deep and long-term relationship we have built with One Call over the 10+ years of our partnership and we look forward to further strengthening our partnership and collaborating as deep as possible, ensuring we provide the highest level of Service Excellence to our shared injured workers and all partners at One Call!"
-Brendan Swift, Vice President, Payer Partnership & Marketing
| |
|
Did You Know:
One Call Provider Protocols for Referral and Invoice & Payment are part of the standard terms and conditions of your Provider Agreement?
Provider Protocols are high-level overviews of provider responsibilities and expectations when providing services to a One Call Injured Worker.
One Call offers Provider Protocols for all products on our website. We often review and update these protocols to reflect modified policies, processes and/or procedures due to amended regulatory requirements.
| |
|
Protocols are accessible by anyone within your organization.
Important: Please share the Invoice & Payment Protocols with any outside billing vendors associated with your organization.
Access current One Call Provider Protocols here.
| |
|
Your Opinion Matters!
One Call is always open to feedback. Tell us what you think of this edition of the Provider Network Newsletter by taking a brief survey: One Call Connector Newsletter Survey
| | | | |
