Devon Health Wire May 2011 - Volume 1, Issue 3

Welcome to the Devon Health Wire -
Our New Client Newsletter

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Welcome to the Devon Health Wire! The purpose of this newsletter is to keep you informed on the happenings around Devon Health, new services and solutions that will better serve you, and tips on keeping your members healthy. We are committed to staying in touch with our clients and providing you with the best service possible. We want to empower you to make the best decisions possible for the welfare of both your company and your members. As your choice for your managed care vendor, Devon Health’s sincere hope is to offer you full service solutions that lower costs.

Devon Health 2011 Group Health Fee Schedule

The 2011 Group Health Fee Schedule information was sent to all clients on or around April 1, 2011. The new fee schedule will be effective May 1, 2011. The letter you received will explain some important changes to reimbursements under the Devon fee schedule, including inappropriate place of service and undefined codes.

While Devon Health eliminated undefined CPT codes with the previous update to the Group Health Fee Schedule, as a reminder, please be advised that undefined CPT codes are no longer recognized and if used on a claim it will be repriced at a $0.00 dollar amount. We have encouraged our providers to use the code closest in specificity to the care being rendered. If the provider believes an undefined CPT code to be most appropriate, then documentation must be submitted and a review will be conducted to determine if the use is appropriate. If deemed appropriate, then a payment rate would be negotiated. If any clients receive any provider calls regarding reimbursement for these codes, please have them contact Devon’s toll-free provider hotline at 866.498.4773 for issue triage and resolution.

Place of Service:

The previous update to the Devon Health fee schedule also eliminated reimbursements for inappropriate place of service. When services that are only appropriate in a facility setting are billed in the outpatient setting they will be repriced at $0.01. This $0.01 should be considered a flag that something on the claim is inappropriate; this is not considered a reimbursement.

Questions about Devon Health’s fee schedule can be directed to your Client Account Manager.

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Introduction & Implementation of Modifiers

Beginning on 6/1/11, Devon Health will begin to apply the following Modifiers to payments: 27, 50, 51, 52, 53, 54, 55, 56, 62, 66, 73, 74, 78, 80, 81, 82, 91, 92, 99, AA, AS, QK, QY and QX. These are industry standard adjustments and the provider community is well aware of such adjustments.

Please note: Your organization should have received a communication in late January regarding Devon Health’s implementation of modifier payment policies. If you have not yet responded to your Client Account Manager at 800.431.2273 with your organization’s preference on utilizing these reductions, please do so promptly. If your claims are repriced at Devon Health, the modifier reductions will NOT be applied without your authorization.

Injury Management Fee Schedule Updates

In addition to the adjustments made to our Group Health Fees, adjustments have also been made to the Injury Management fee schedule which was released in March to all of our clients who access the Devon Workers' Compensation Network. The Devon Workers’ Compensation fee arrangements are primarily region-specific. Some providers’ reimbursements pertain to the actual fee schedule; whereas, others are specifically concerned with rate sheets or state-mandated fee schedules. The Fee Type field in our clients' monthly data load is where each client can easily tell what kind of reimbursement each provider is contracted for. Please refer to the letter that was sent out in March for further clarification. This fee schedule should be used for all workers’ compensation claims with dates of service on or after April 1, 2011. Should you have any questions or concerns about this 4/1/11 release, contact your Client Service Representative at 800-431-2273 at your earliest convenience.

Devon Health Works with Clients on HIPAA 5010 Standards

On January 1, 2012, the health care industry will be required to upgrade electronic data interchange (EDI) transactions from the current X12 ANSI 4010/4010A1 versions to the 5010 version. HIPAA X12 version 5010 is a new set of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claims and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to HIPAA 5010 standards.

The new industry standard was developed to increase consistency and usage of electronic data interchange transactions. We have made it a priority to analyze and identify the gaps between HIPAA 4010A1 and 5010 to prepare for the transition. We are in the process of working with all of our EDI clients and their software vendors to establish which technical and business components will be impacted by the transition.

In order to begin preparation for this upgrade, we sent all of our clients and/or their software vendors a project survey to determine everyone’s testing capabilities and status in upgrading to 5010 version. Devon Health is currently working with a handful of clients to begin testing 5010 EDI files and will continue working with all of our clients and/or their software vendors throughout the year to meet the required compliance date of January 1, 2012. As we are working with you to transition to the 5010 version, we are prepared to continue to accept the 4010A1 version until the required compliance date, then we will transition solely to the HIPAA 5010 version.

If you have any questions about the transition to the 5010 version, please contact Marie McDaniel, Director Claims Operations at 610.757.4125 or mmcdaniel@devonhealth.com.

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Health Thoughts- “Bad Foods” That Can Aid Weight Loss

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“Bad foods” such as eggs, nuts, and coffee can help the weight loss process. The key? Eating foods that will help the body feel fuller for longer. In moderation, a couple eggs a week, a handful of nuts a day and a cup of black coffee can help boost the metabolism and encourage weight loss in the body. High protein foods, such as eggs and nuts, have the ability to make people for fuller for a longer amount of time than most foods. Two scrambled, poached, or boiled eggs can increase weight loss by two-thirds, according to several studies. By eating eggs for breakfast, people tend to eat less during the day. The metabolism is boosted by eating breakfast, and eggs are a great source of protein, which help to make the body feel satisfied for longer periods of time. Eggs are only 85 calories each and contain vitamins such as A, D, and E, as well as amino acids, zinc, and iron.

Even though eggs are high in cholesterol, foods that contain saturated fat are worse for the body. A way to counteract cholesterol is to eat nuts. Raw walnuts, peanuts, hazelnuts, pistachios, pecans, and almonds are types of nuts that are healthy and nutritious. Nuts have even been proven to lower the risk of heart disease. A handful can be used to substitute highly saturated fat snacks or even add crunch to a salad by replacing the croutons with nuts.

Along with eggs and nuts, black coffee has been said to help the weight loss process along. Drinking a cup in the morning helps to boost the metabolism and burn calories throughout the day. According to Harvard University, coffee, in moderation, may even help protect against diseases. The study concluded that coffee drinkers were less likely to develop certain cancer and type 2 diabetes. It may also help to prevent Parkinson’s disease in men, strokes, and heart disease. Although these studies are unproven because the researchers were unaware of the patients’ lifestyle routines, it is a fact that coffee does contain antioxidants. Antioxidants are known to be found in fruits and vegetables, but most Americans get their antioxidants from coffee.

Coffee, if drank in moderation, can provide multiple health benefits for adults, but drinkers must be aware of the harm that coffee can inflict. Most Americans drink coffee for the energy boost that caffeine gives them, but caffeine can have negative effects on a person’s health. Underlying heart conditions can become worse, insomnia can occur, as well as anxiety. One way to counteract the caffeine negatives and still reap coffees benefits is to drink decaffeinated coffee.

With all this said, two eggs, a handful of nuts, and a cup of coffee a day can help individuals lose and maintain weight, as well as a healthy lifestyle. When looking for a healthy meal and trying to lose weight, take into consideration the food’s protein count. Protein is the key to success. Feeling fuller longer, even if the food is higher in fat or cholesterol than some, is what will lead to weight loss. For protecting against disease, antioxidants are proven to lower chances of cancer, diabetes, stroke, and heart disease. Along with exercise, these are just a few tips to ensure a healthy life.

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