In-Patient Facilities Solutions^SM is One Call's Solution to Post Acute Care

There are times when a workplace injury requires continued care, even after discharge. Linda Colsen, One Call's SVP of Product Management, explains the benefits of One Call's In-Patient Facilities Solutions and how our partnership with rehab and skilled nursing facilities helps injured workers get the post-acute care they need. Read more here. 

New York Providers:

Important Reminder

New York Providers must adhere to the New York State Workers’ Compensation Board (NYSWCB) requirements - new and old. Adherence to these requirements ensures provider compliance and prevents delays in scheduling and care.



As of January 01, 2020, New York providers eligible for authorization must become a NYSWCB Authorized Provider to be certified to treat injured workers in New York.

Individual Practitioners who are not a NYSWCB authorized provider, risk services rendered to Injured Workers being denied.

Providers who must be authorized to treat Injured Workers in New York: 

• Physicians, including Radiologist
• Chiropractors
• Physical Therapists
• Occupational Therapists
• Acupuncturists

For information on how to apply to be a NYS Workers’ Compensation Board Authorized provider, visit the NYSWCB website here:

Important note: One Call is doing an extensive review of all Providers who fall under the listed requirements. If you do not hold a current certification with the State of New York, One Call cannot refer services to you. Please verify you have an active certification in New York here.

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The NYS Workers’ Compensation OnBoard Initiative was released in phases in February of 2022 (see table below).

An official One Call NYS Workers' Compensation OnBoard Initiative and requirements communication was also sent out in February of 2022. It is available here.

Please Note: Per Phase 2, Durable Medical Equipment (DME) items not listed on the New York Workers' Compensation Fee Schedule OR DME items needing Prior Authorization are required to go through the PAR Process. The NY Official Workers' Compensation DME Fee Schedule, with codes designated as "PAR" is available here.

Other upcoming releases include the New York Medicaid ID requirement to provide Durable Medical Equipment. This requirement is expected to be effective October 2022.

For more information regarding the NYS OnBoard Initiative, visit the NY Workers’ Compensation Board website here.

Compliance

The Centers for Medicare and Medicaid Services (CMS) released the 2023 calendar year Medicare Physician Fee Schedule Proposed Rule. Read more about the proposed rule here.  

The proposed rule presents several potential implications for providers in the workers' compensation industry. More than half of state workers' compensation fee schedules are directly tied to Medicare rates and relative value units. In addition, several states utilize Medicare's conversion factor to calculate fee schedule rates.

In the proposed rule, CMS intends to reduce the conversion factor by more than four percent. This has led to criticism towards the agency from many provider organizations and has prompted lobbying for Congressional intervention. Additionally, CMS is in the second of a four-year transition period of updating the clinical labor practice units used to calculate rates relating to providers' practice expense.

CMS is also proposing to rebase and revise the Medicare Economic Index (MEI) cost share rates for 2023. This could potentially impact relative value units for many procedures. The final rule is expected to be released in early November of 2022.

Please note: Many states adopt CMS rates and rules however, other states make changes to the conversion factors or only adopt limited rules. If you feel the CMS changes will have a significant effect to the rates and payment in your state, we advise you to reach out to your State Commissioner and share your concerns.

Credentialing

The Credentialing Team is working hard to process all provider applications to join or continue in the One Call Network.

You may receive email/phone requests from the Credentialing Team to collect additional documents/and or information to complete your application, or to clarify a submitted response. 

Important Reminders:  

• We have temporarily paused our recredentialing process, but will resume in the next few months. Please be on the look-out for these requests. 
• A dedicated team has been established to support our Delegated Providers. Our Delegated Credentialing Coordinators will be reaching out to you to align on your next Delegated Audit.

For questions regarding Delegated Credentialing, please reach out to Delegated Credentialing Manager, Lisa Stewart at  lisa_stewart@onecallcm.com. 

Provider Contracting

As an active One Call provider partner, you play an integral part in our mission of getting patients the care they need when they need it.

Your partnership with One Call also allows you to be among other leaders within your field. Additionally, you regularly experience the benefits of network participation, including (but not limited to):

•  Reduced Administrative Burden
• Opportunity to increase revenue
• Set Payment Terms
• Exposure to additional referral sources

One Call offers a full suite of products including,

•  Dental
•  Diagnostics
• Durable Medical Equipment
• Inpatient Facilities
• Home Health
• Language
• Physical Medicine, and
• Transportation



If you know any providers who fall under the products listed above and are interested in being part of One Call’s mission, please encourage them to contact us here.

Provider Data Management

The Provider Data Management Team (PDM) is responsible for maintaining your practice, location, and professional data in the One Call Business Systems (i.e., billing and scheduling).  

As the Credentialing Team processes provider applications, you may also receive email/phone requests from the PDM Team. 

Please forward all documents and responses to requests received from PDM to one of the following email addresses based on your specialty :

• Physical/Occupational Therapy:  PT_ProviderCredentialing@onecallcm.com
• Radiology/Neuro Radiology (Diagnostics): Provider_Credentialing@onecallcm.com
• Dental: Expressddcredentials@onecallcm.com
• Transportation & Language: TL_Credentials@onecallcm.com 
• Durable Medical Equipment / Home Health /Inpatient Rehab Facilities: credentials@onecallcm.com

Provider Engagement

Assisting Network Providers via the Provider Remediation Continuum = Provider Success!

It is through the work of our Provider Engagement Specialists and the continuous efforts of our network providers that allows One Call to maintain a quality network.

One Call utilizes an effective provider performance and compliance process known as The Provider Remediation Continuum. Let's take a look at what it entails.

Provider Remediation Continuum

Grievances: Should a grievance arise; a Provider Engagement Specialist will contact the provider to identify root cause and educate the provider on appropriate steps for future use. Grievances can be against the provider or One Call. In either situation, the Provider Engagement Specialist will assist the provider to remedy the error.

Provider Education and Advocacy: In some circumstances, a grievance is considered a misunderstanding. In these situations, One Call educates the Client and, if necessary, the provider. Provider Engagement continuously strives to understand each situation individually and advocate for the provider, when needed

Corrective Action Plan: One Call implements a Corrective Action Plan when a provider exhibits a trend with an issue and would benefit from specific guidance and dedicated oversight from a Provider Engagement Specialist.

Note: The following steps in the Continuum fall under the purview of One Call’s Provider Quality and Credentialing Committee.

Probation: Occasionally, a provider may experience a grievance substantial enough to warrant a probationary period. The goal is to allow the provider to correct the issue and reset for a successful future.

Termination: One Call terminates providers from the One Call Provider Network when the steps above are unsuccessful or the situation is egregious.