To assist you better, please see the following for the most up to-date provider changes related to new benefits, billing, reimbursement, authorization, coding, etc.

• Update:  Sleep Studies:  Effective for services rendered on 04/01/2011 and going forward, sleep studies do not require prior authorization from Managed Health Services.  Please check eligibility prior to appointment date.        

• Update: the MHS Provider Manual Section 14, Provider Credentialing – Network Practitioner, Provider Appeal of Suspension or Termination of Contract Privileges has been updated. For further details, please click here.

• “Urgent Service Authorization”:
  Update (01/25/10): In the event the provider indicates or MHS determines that following the non-urgent services timeframes could seriously jeopardize the Member’s health or life, MHS will make an expedited authorization determination and provide notice to the Provider within 72 hours with “no extensions”.Previously, the turnaround time given MHS was within one calendar day, where MHS may extend the time period for up to five calendar days if the member or Provider request an extension or if MHS need additional information and the extension is in the member’s best interest).

• Entering & Tracking Adult Immunizations

  MetaStar, Wisconsin’s quality improvement organization, is offering free technical assistance for practices who wish to electronically report adult immunization data to the Wisconsin Immunization Registry (WIR).

  Adult vaccinations are important because immunity can begin to fade over time, newer vaccines have been introduced over the years, some adults were never vaccinated as children, and age can make people more susceptible to serious diseases caused by infections. WIR, operated by the Wisconsin Department of Health Services, collects immunization data from health care providers to create complete records for individuals in the state. Providers can access and update vaccination information for their patients and can use this information to notify patients who are due or past due for vaccinations. Public access can reduce the number of requests to providers for immunization records from their patients and can allow for better coordination of care. DHS recommends that providers offer this service to their patients and participate in efforts to eliminate vaccine-preventable diseases in Wisconsin.

  Staff from MetaStar’s WHITEC division can work with a practice’s electronic health record (EHR) vendor to set up an interface with WIR, or can assist with establishing electronic batch submissions. WHITEC is currently working with more than 1,600 primary care providers in the state to help them adopt and meaningfully use EHR technology. For more information or to sign up for this free assistance, please contact Michael Wall at mwall@whitec.org or 1.866.710.4212.

  Learn more: http://metastar.com/web/Default.aspx?tabid=511