Winter 2012 
  In This Issue:

Provider Directory Validation Survey Begins

Upcoming Medical Record Audits for 2012


Claims Corner

Medicare and Medicaid Benefit Changes for 2012

Emblem Behavioral Health Services Program Underway

More Information on ICD-10

Good Notices for our Medical Manual on Religio-Cultural Competence

Behind the Scenes


Introducing Patient Health Profiles

Adolescent Immunizations

Vaccines For Children

Flu: It’s Not Too Late to Vaccinate

Medication Safety and Adherence

Health and Wellness Programs

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.

Submit Claims to New HealthCare Partners Address
HealthCare Partners (HCP) has moved to a new location. Please send your paper claims to: 501 Franklin Ave., Suite 300, Garden City, NY 11530-5807.

EmblemHealth 5010 Transaction Standard Companion Guides
The federal government has revised standard transactions and code sets for HIPAA compliance, which must be implemented consistently across all organizations involved in the electronic exchange of health information. EmblemHealth has created companion guides to help our providers and trading partners with these changes.

EDI Transactions: What to Know to Make Them Work for You Revised
HIPAA has adopted new guidelines for electronic health care transactions. The Version 5010 rules for transactions became effective on January 1, 2012. EmblemHealth has furnished information to assist our providers and trading partners when submitting electronic claims.

EmblemHealth Does Not Reimburse for PQRS Codes
Physicians should not submit PQRS codes in their claims to EmblemHealth.

HCPCS S2900 (robotic-assisted surgery)
Surgeons should bundle HCPCS code S2900 with the main surgical procedure code when submitting claims for surgical techniques performed using a robotic surgical system.

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