December 2016 ProHealth Provider Relations Update · 2017-01-04 · 1 December 2016 ProHealth...
9
1 December 2016 ProHealth Provider Relations Update I NSIDE T HIS I SSUE : 1 New & Terming Plans - 2017 1 Gold & Silver ID cards - 2017 2-4 New Providers, effective 12/1/2016 5 Termed Providers 6-7 2017 E/M Boot Camp 8 VHG - Healthcare & Business Consulting 7 Provider Relations Staff Directory Gold & Silver Plan ID Cards for 2017: *Please Note* Gold and Silver Plans for 2017 will NOT have a PCP listed on members’ ID cards. The Gold Plan is a PPO plan and Silver Plan is an HSA plan, so neither require a PCP on the card. Both enrollment materials and ID card inserts will note that members are strongly encouraged to pick a PCP to help guide their care. Members will still be instructed to call ProHealth customer service in order to update their PCP in our system, it just will no longer be stated on the ID cards at this time. New Payors for CHNw Employed/CPN Providers: CareSource Medicaid/HIP, effective 1/1/2017 - (ALL Employed/CPN providers, no PA’s or Ls) CareSource Hoosier Choice (MarketPlace Exchange Plan), effective 1/1/2017- (ALL Employed /CPN providers) IU Health Plan (Commercial/Employed Plan), effective 1/1/2017 - (ALL Employed/CPN Providers) Your Choice (MarketPlace Exchange Plan), effective 1/1/2017 - (ALL Employed /CPN providers) Payors Terming, effective 12/31/2016: Assurant Health Advantage 360 PHP Marquee Advantage HMO UHC Marketplace St V-CHN EPO New Partnership with Walgreens in 2017: Community Health Network has partnered with Walgreens to provide more convenient pharmacy services for employees and patients. There are now three Walgreens stores located on the campuses of Community Hospitals East, North, and South. These Stores make it easy for patients to fill their prescriptions as they leave provider appointments at adjacent medical offices, or as they are discharged from the hospital. Walgreens also plans to expand the bedside delivery program at Community hospitals to help patients successfully transition back to their homes. Walgreens is now the preferred pharmacy provider for those on Community Health Network medical insurance plans (Gold & Silver plans). Members receive the lowest copays when they fill their prescriptions at Walgreens, and have access to 8,200+ Walgreens locations across the country, with many of them open 24/7. Walgreens is the preferred specialty pharmacy as well. Have questions about Community’s pharmacy benefit? Please call the ProHealth Pharmacy Managed Care Team at (317)621-7575, Option 2, then Option 5.
Transcript of December 2016 ProHealth Provider Relations Update · 2017-01-04 · 1 December 2016 ProHealth...
1
December 2016
P r o H e a l t h P r o v i d e r R e l a t i o n s
U p d a t e
I N S I D E T H I S I S S U E :
1 New & Terming Plans - 2017
1 Gold & Silver ID cards - 2017
2-4 New Providers, effective
12/1/2016
5 Termed Providers
6-7 2017 E/M Boot Camp
8 VHG - Healthcare & Business
Consulting
7 Provider Relations Staff
Directory
Gold & Silver Plan ID Cards for 2017:
*Please Note*
Gold and Silver Plans for 2017 will NOT have a PCP listed on
members’ ID cards.
The Gold Plan is a PPO plan and Silver Plan is an HSA plan, so
neither require a PCP on the card. Both enrollment materials and ID
card inserts will note that members are strongly encouraged to pick a
PCP to help guide their care. Members will still be instructed to call
ProHealth customer service in order to update their PCP in our
system, it just will no longer be stated on the ID cards at this time.
New Payors for CHNw Employed/CPN Providers:
CareSource Medicaid/HIP, effective 1/1/2017 - (ALL Employed/CPN providers, no PA’s or Ls)
CareSource Hoosier Choice (MarketPlace Exchange Plan), effective 1/1/2017- (ALL Employed /CPN providers)
IU Health Plan (Commercial/Employed Plan), effective 1/1/2017 - (ALL Employed/CPN Providers)
Your Choice (MarketPlace Exchange Plan), effective 1/1/2017 - (ALL Employed /CPN providers)
Payors Terming, effective 12/31/2016:
Assurant Health Advantage 360
PHP Marquee Advantage HMO
UHC Marketplace St V-CHN EPO
New Partnership with Walgreens in 2017:
Community Health Network has partnered with Walgreens to provide more convenient pharmacy services for
employees and patients.
There are now three Walgreens stores located on the campuses of Community Hospitals East, North, and South. These
Stores make it easy for patients to fill their prescriptions as they leave provider appointments at adjacent medical
offices, or as they are discharged from the hospital. Walgreens also plans to expand the bedside delivery program at
Community hospitals to help patients successfully transition back to their homes.
Walgreens is now the preferred pharmacy provider for those on Community Health Network medical insurance plans
(Gold & Silver plans). Members receive the lowest copays when they fill their prescriptions at Walgreens, and have
access to 8,200+ Walgreens locations across the country, with many of them open 24/7. Walgreens is the preferred
specialty pharmacy as well.
Have questions about Community’s pharmacy benefit? Please call the ProHealth Pharmacy Managed Care Team at
(317)621-7575, Option 2, then Option 5.
2
Contract ing and Credentia l ing Corner Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective January 1, 2017
Hospital affiliations will be listed with each provider.
Prime SCP Advanced Practice Practitioners
Becker PA, Matthew - Physician Assistant
Pulmonary and Critical Care (Employed)
Drouin NP, Heather - Nurse Practitioner
Pulmonary and Critical Care (Employed)
Hermina NP, Dina M. - Nurse Practitioner
Pulmonary and Critical Care (Employed) - CHE/CHN, CHV, CHW
Higgins NP, Wendy M. - Nurse Practitioner
Advanced Pain Management of Central Indiana, PC
Hight PA, Melinda - Physician Assistant
Urology of Indiana
Karr PA, Ashley - Physician Assistant
Urology of Indiana
Kelly NP, Erin R. - Nurse Practitioner
MedCheck (Employed)
Motto CRNA, Sherry E. - Certified Nurse Anesthetist
Community Group CRNA (Employed)
Mushtaq PA, Maham - Physician Assistant
Pulmonary and Critical Care (Emplouyed)
Peglow NP, Ashley C. - Nurse Practitioner
Pulmonary and Critical Care (Employed) - CHE/CHN, CHV
Pulfer NP, Jenna R. - Nurse Practitioner
Community Hospitals Oncology Physicians (Employed) - CHE/CHN, CHV, CHW, CHS
Puzio NP, Loretta C. - Nurse Practitioner
Allergy Partners of Central Indiana
Staggs NP, Ann D. - Nurse Practitioner
Diabetes and Endocrinology Care (Employed) - CHE/CHN, CHV
Summers PA, Steele E. - Physician Assistant
Radiology of Indiana, PC - CHE/CHN, CHW, CHS
Whitis NP, Gwendolyn E. - Nurse Practitioner
St. Francis Medical Group / IIMC
Yarling PA, Jadyn L. - Nurse Practitioner
Allergy Partners of Central Indiana
3
Prime PCP Advances Practice Practitioner
Cottey NP, Angela - Nurse Practitioner
St. Francis Medical Group / IIMC
Culbreath NP, Danielle L. - Nurse Practitioner
Northpoint Pediatrics
Prime PCP
Adams MD, Anne M. - Internal Medicine
Internal Medicine Care (Employed) - CHE/CHN, CHW, CHV
Prime SCP
Abuleda MD, Kamal - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Abu - Sultaneh MD, Samer M. - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Ackerman MD, Veda - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Beardsley MD, Andrew - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Bennyworth MD, Brian W. - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Ellis MD, Jeffrey - OB/GYN
Community Physician Network, OB/GYN Care (Employed) - CHE/CHN, CHV
Friedman MD, Matthew - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Hobson MD, Michael J. - Pediatric Critical Care
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Keller MD, Emily C. - Dermatology
IndyDerm, LLC - CHS
Leland MD, Brian - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Lutfi MD, Riad - Pediatric Critical Care
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Malik DPM, Khawar Z. - Podiatry
Podiatry Associates of Indiana, PC - CHE/CHN, CHW, CHV, CSC-N
Contract ing and Credentia l ing Corner Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective January 1, 2017.
Hospital affiliations will be listed with each provider.
4
Prime SCP
Caress LMHC, Anna - Behavioral Health
Gallahue Mental Health Services (Employed)
Davis-Peck LMFT, LMHC, LCAC, Lisa - Behavioral Health
Lisa M. Davis-Peck, LMFT, LMHC
Jester LCSW, Jennifer M. - Behavioral Health
Jennifer Jester, LLC
Messiha MD, Ahdy G. - Diagnostic Radiology
Summit Radiology, PC - CHRH, CHSH, CHA
Morales PhD, Roberto - Psychology
Psychology and Counseling Associates of Carmel
Nitu MD, Mara - Pediatrics
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Patel MD, Vinit - Pediatrics Critical Care
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Raj MD, Shekhar S. - Pediatrics Critical Care
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Ranginani MD, Anil K. - Cardiovascular Disease
Heart & Vascular Care, Howard (Employed) - CHRH
Reed LCSW, Racheael - Behavioral Health
Indy Counseling Professionals
Rowan MD, Courtney M. - Pediatric Critical Care
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Scott MD, Kenneth G. - Diagnostic Radiology
Radiology of Indiana, PC - CHE/CHN, CHV, CHW, CHS
Singleton LMFT/LMHC, Diana - Behavioral Health
Diana Singleton, LMFT LMHC
Tekulve LMHC, Erin M. - Behavioral Health
Gallahue Mental Health Services (Employed)
Tori MD, Alvaro - Pediatrics Critical Care
Community Pediatric Hospitalists (Employed) - CHE/CHN, CHW, CHV
Whitehead LCSW, Kay E. - Behavioral Health
Life Integration Therapies, PC, Inc.
Wilbrandt MD, Thierry - Ophthalmology
Community Eye Care of Indiana - CHE/CHN, CHW
Contract ing and Credentia l ing Corner Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective January 1, 2017.
Hospital affiliations will be listed with each provider.
5
Termed Providers The following providers will no longer be participating with ProHealth:
Arnold NP, Alison J. - Nurse Practitioner, termed 12/4/2016
MedCheck (Employed)
Beck NP, Lori J. - Nurse Practitioner, termed 12/31/2016
Community Hospital Oncology Physicians
Cater MD, Robert C. - Internal Medicine, termed 12/31/2016
St. Vincent Medical Group
Dill NP, Jody E. - Nurse Practitioner, termed 12/31/2016
OB/GYN Care Triage (Employed)
Dubois MD, Michael B. - Internal Medicine, termed 12/31/2016
Low T Center, LLC
Dustin MD, John U. - Family Medicine, termed 12/31/2016
MedCheck (Employed)
Furniss LCSW, LMFT, Margaret R. - Licensed Clinical Social Worker, termed 12/31/2016
Mercury Counseling Center
Gavardinas CNS, Tara - Clinical Nurse Specialist, termed 12/31/2016
Osman Clinic and Associates
Hague MD, John M. - Rheumatology, termed 12/31/2016
Rheumatology Associates, P.C.
Kent NP, Kathleen A. - Nurse Practitioner, termed 12/31/2016
Northpoint Pediatrics, P.C (Employed)
Nelson PsyD, Amanda - Clinical Psychology, termed 12/20/2016
Community Psychological Consultants
Power NP, Megan E. - Nurse Practitioner, termed 12/31/2016
MedCheck (Employed)
Ross LCSW, Susan - Licensed Clinical Social Worker, termed 12/31/2016
Gallahue Mental Health Services & CPN-Community Behavioral Professionals
White NP, Jennifer H. - Nurse Practitioner, termed 12/31/2016
The Dermatology Center of IN, PC
Zia MD, Subalia - Pulmonary Disease, termed 12/31/2016
St. Francis Medical Group, LLC / IIMC
6
Friday, March 3, 2017
8:00 am - 5:00 pm
6626 East 75th Street, Suite #200, Indianapolis, IN 46250
Presenter: Ann Silvia, CPC, CPC-I, CEMC
Topics
How To Find The Right Level
The Gray Areas
Audit The Record
Registration Information
Fee - $325.00, per attendee
To Register – Fill out registration form and include payment
Registration deadline – Monday, February 27, 2017
To register and pay with credit card, email
[email protected] or call 317.621.7197
To register and pay by mail, make checks payable to Visionary
Health Group or provide credit card information. Mail to VHG,
Attn: Deb Charrlin, 6626 East 75th Street, Suite #525, Indianapo-
lis, IN 46250
Presented by:
Visionary Health Group
Physician Services
6626 E. 75th St, Ste. 525
Indianapolis, IN 46250
O 317.621.7197
F 317.621.6989
www.Veicorp.com/consulting
7
LOCATION –
6626 E. 75th Street Suite 200 Indianapolis, IN 46250
DATE -
Friday – March 3, 2017 TIMES - 8:00 AM – 5:00 PM PRESENTER – Ann Silvia,
CPC, CPC-I
REGISTRATION FEE -
$325.00 REGISTRATION DEADLINE – February 27, 2017
Fill out and sign where indicated and email entire form with deposit information to [email protected]; or
by US mail to: Visionary Health Group – Attn: Debbie Charrlin 6626 E. 75th St., #525, Indianapolis, IN 46250 or
to process via phone, 317.621.7197 or 877.413.4231
Practice (if applicable): ________________________________________
Workshop Date: March 3, 2017 Registration Deadline: February 27, 2017
Workshop Time: 8:00 am – 5:00 pm
Name of Attendee(s):
_________________________________ ___________________________________
_________________________________ ___________________________________
Payment Information - $325.00 per attendee
__________VISA Amount __________MC Amount __________Check Amount Enclosed
Card # _______________________________________________ Exp. Date __________
Name on Card _______________________________________
Billing Address/City/State/Zip ____________________________________________________
____________________________________________________________________________
Authorized Signature ________________________________________________
Phone Number w/Area Code (_____)________________________
Refund Policy: The registration fee is refundable if requested up thru the registration deadline. All cancellations and requests for refunds must be in writing by sending an email to [email protected].
2017 E/M BOOT CAMP Registration Form
8
Visionary Health Group
Are you an independent practice that needs consulting/financial help? ...
Integrated physician consulting services
A division of VEI since 1987, Visionary Health Group (VHG), formerly known as Indianapolis Medical Management
(IMM), has provided physician practice management and consulting services for more than 20 years. VHG prides itself
in providing comprehensive, tailor-made services that meet and exceed the needs of its physician clients. VHG’s con-
sulting and evaluation services have been designed to objectively evaluate every aspect of a medical practice and to
provide realistic solutions to the challenges faced by physicians today. VHG offers a diverse team of skilled individuals
to assist you with your various practice needs.
*Complimentary business assessment available upon request*
Consulting and practice operations
Business healthcare consulting
Revenue cycle management
Documentation and coding experts
Financial consulting and reporting
Payer credentialing and enrollment Practice/business start-up
Full suite of human resource services
OSHA/HIPAA compliance
Project management
Process improvement
Development of policy and procedures
Please Contact: Joni A. Reed, MBA, BSBA, ASB, CMA Business Consultant Physician Services Ph#: (317)621-1539 [email protected] Anita Huse, RN, CAPPM Business Consultant Physician Services PH#: (317)621-4090 [email protected] Jamie L. McAllister, MA Account Coordinator Ph#: (317)621-7521 Fx#: (317)957-2794 [email protected] Stracy Faulkner Director Provider Operations - Practice Management Ph#: (317)621-1537
9
Department Staff
Jenny Bouck, Provider Relations Manager
Business Information Coordinator
Hollie Putzback, [email protected]
Provider Relations Coordinators:
Carol Boyd, [email protected]
Dawn Widgery, [email protected]
Amanda Bobo, [email protected]
Medicaid Program Manager:
Salena Woodson, [email protected]
Medicare Program Manager:
Lori White, [email protected]
Credentialing Enrollment Supervisor: Jenna White, [email protected]
Credentialing Coordinators:
Julia Chumbley, [email protected]
Julie Starr, [email protected]
Kim Tibbets, [email protected]
Credentialing Specialist:
Adrianne Stocks, [email protected]
Provider Enrollment Coordinators:
Aletha Burnett, [email protected]
Amy Walls, [email protected]
Denise Smith, [email protected]
Dianne Castillo, [email protected]
Jessie Eskew, [email protected]
Sharon Harlan, [email protected]
Provider Relations Department
6626 E. 75th St, #500
Indianapolis, IN 46250
Phone: 317-621-7581
www.ecommunity.com/prohealth
