SPRING 2012 
  In This Issue:

Medicare and Medicaid Updates

Introducing Care360

EmblemHealth Injectable Drug Utilization Management Program Begins

Claims Corner

Utilization Review Criteria Update

Medical Director Availability After an Adverse Determination

Member Rights and Responsibilities

Provider Advisory Webinars a Success

CAHPS Member Satisfaction Surveys Are in the Field!

Behind the Scenes

Colorectal Cancer Screening

Medication Adherence for Chronic Conditions

Medical Management of COPD

Dental Hygiene Is Important

How to Help Your Patient With ADHD

Your Role in Slowing the Obesity Epidemic

Health and Wellness Programs

What Is a Health Outcome Survey?

Clinical Corner

News&Notes Archive

Claims Corner

Claims Corner is an online resource for updated information on claims policy, best practices for claims coding, regulatory-driven payment methodology and other useful claims-related tips. Visit us often to view important claims topics and updates that may have an impact on your practice's management system. Select any topic of interest to read the expanded discussion.

Required Use of Occurrence Codes 40 and 41 for Presurgical and Preadmission Testing

Effective March 1, 2012, occurrence codes 40 and 41 must both appears on claims submissions for presurgical and preadmission testing for all lines of business.

Discontinue Use of CPT Codes Retired January 1, 2012

Effective immediately, please discontinue use of CPT codes retired January 1, 2012, and use the alternate CPT codes assigned until further notice.

Category II CPT Codes

Category II Current Procedural Terminology (CPT®) codes do not have a relative value associated with them and are not separately valued or reimbursable. They are used to report quality measures only. Use of Category II CPT codes is optional (not required for correct coding) and may not be used as a substitute for Category I CPT codes.


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