MUTUAL NEWS Volume 4, Issue 3 • 3rd Quarter 2011

This material is considered part of the Provider Manual for

Medical Mutual of Ohio®, Consumers Life Insurance Company® and Carolina Care Plan®

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ePrescribing – Manage Patient Safety ................................ 2Medical Policy Updates .................................................... 2 Modifier 59 ...................................................................... 3

Electronic Claims Processing .......................................... 3Updates to Provider Manual ............................................. 3Reduce Paper in Your Office ............................................. 3 Provider Contracting Offices ....................................... back

New Mutual Health Services ID CardMutual Health Services™ (MHS), a wholly owned subsidiary of Medical Mutual of Ohio®, provides customized solutions for managing claim costs and member wellness.

MHS is an expansion of our administrative services to a targeted market segment, that maintains the Company’s high standards for operations, processing and management. With an innovative benefit design and our vast vendor relationships, MHS provides the opportunity to reduce costs and increase organizational efficiency.

To better identify MHS members enrolled in our preferred SuperMed® network, new identification cards are being issued at the time of renewal. Please see the sample MHS ID card displaying our SuperMed logo for easy recognition of our members.

If you have any questions regarding this update, please contact your provider contracting representative.

ID Card SurveyIn an effort to better meet your needs, the Medical Mutual Family of Companies is looking to enhance our SuperMed ID cards. We are requesting provider input to determine what information is vital for you and your practice, improvements to card design, and the viability of smart card technology within your office.

To assist in our SuperMed ID card redesign, please visit the Provider ID Card Survey located on Provider.MedMutual.com. We value your input and request that all surveys be completed by September 16, 2011.

5010 HIPAA TransitionIn anticipation of the January 1, 2012, HIPAA 5010 compliance date, the Medical Mutual Family of Companies is working toward implementing the new format with Emdeon® on September 30, 2011. At that time, Emdeon will transmit all claims to Medical Mutual in 5010 format. Additionally, Medical Mutual will require a National Provider Identifier (NPI) number to process claims.

Please contact your vendor/clearing house for information on testing. Providers who submit directly to Emdeon should visit http://www.hipaasimplified.com. Additional information is available at http://www.x12.org or in the In the Spotlight section of Provider.MedMutual.com.

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ePrescribing – Manage Patient SafetyElectronic prescribing (ePrescribing) can help put critical clinical information at the fingertips of physicians at the point of care. ePrescribing is a proven way of enhancing patient safety while reducing administrative cost and the workload in a physician’s office.

Providers can use a personal computer, handheld device or tablet to electronically submit a prescription to the pharmacy of choice.

Benefits of ePrescribing include: Reducing potentially harmful drug interactions by alerting physicians of possible risks. Eliminating medication errors due to illegible handwriting. Providing physicians with formulary information when writing the prescription, resulting in an

increase in the use of generics and preferred drugs, which translates into savings for the patient. Furnishing physicians with benefit plan details at the point of prescribing so that changes will not be

needed when the prescription is presented at the pharmacy.

For additional information on ePrescribing visit the Tools & Resources, Provider eServices, ePrescribing section of Provider.MedMutual.com.

Medical Policy UpdatesThe following Corporate Medical Policies (CMPs) were developed or revised April 1 to July 29, 2011. For a complete list of CMPs, please visit the Tools & Resources, Care Management, Corporate Medical Policies section of Provider.MedMutual.com.

For services requiring prior approval or considered investigational, please consult the website’s Tools & Resources, Care Management, Prior Approval & Investigational Services section.

Policy Service94002 Breast Reconstruction and Related Procedures94041 Obstetrical Policy94059 Esophageal pH Monitoring Procedures96011 Radionuclide Cardiac Imaging200204 Heart Transplantation200205 Heart-Lung Transplantation200206 Lung Transplantation200207 Liver Transplantation200231 Air Ambulance Transportation200312 Vertebroplasty200416 Uterine Artery Embolization200501 Laser Therapy for the Treatment of Cutaneous Vascular Lesions200703 Cardiac Computed Tomography and Angiography of the Coronary Arteries200704 Intensity Modulated Radiation Therapy200815 Kyphoplasty201009 Stereotactic Radiosurgery and Stereotactic Body Radiotherapy201011 Radiofrequency Therapy for Treatment of Stress Urinary Incontinence in Women2010-C Minimally Invasive Approach for Lumbar Fusion201103 Orthoptic Therapy - New201107 Belimumab (Benlysta) - New201108 Pegloticase (KRYSTEXXA) - New2011-A AmniSure - New2011-B Bioimpedance Spectroscopy - New2011-C Wireless Gastrointestinal Motility Monitoring System - New2011-E Suit Therapy - New2011-F Ovarian Adnexal Mass Assessment Score Test Systems - New

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Modifier 59The Medical Mutual Family of Companies applies Medicare National Correct Coding Initiative (CCI) edits to its professional and institutional outpatient claims. Modifier 59 should be used to indicate non-Evaluation and Management (E/M) services or procedures that are distinct or independent from other non-E/M services performed on the same day by the same provider. Modifier 59 is intended to indicate performance of separate services or procedures that would usually NOT be performed together but is medically necessary and appropriate in this particular instance.

When using modifier 59, medical record documentation should establish medical necessity for the:

Different session or patient encounter

Different procedure or surgery that is distinct and independent

Procedure or surgery on different site or organ system

Separate incision/excision

Separate lesion

Separate injury (or area of injury in presence of extensive injuries)

The Company strongly encourages that providers ensure the correct use of modifier 59 to avoid misuse and misrepresentation of performed services or procedures.

For additional information please visit the Claims Submission section of the Provider Manual located under Tools & Resources at Provider.MedMutual.com.

Updates to Provider ManualTo keep you more effectively informed of healthcare developments, the Medical Mutual Family of Companies has allocated select sections of the Provider Manual to review each quarter. Revised topics will be clearly annotated in the Table of Contents with advanced notification of any implementation. Visit the Provider Manual in the Tools & Resources section of Provider.MedMutual.com to access updates on Adjustments & Inquiries, Appeals, and Care Management Programs.

Electronic Claims ProcessingThe Medical Mutual Family of Companies accepts electronic submissions of commercial Coordination of Benefits (COB) for Professional and Institutional claims. A paper Explanation of Benefits is not required when commercial COB claims are submitted electronically. Additionally, any Medicare secondary claims where code MA18 does not appear on the Explanation of Medicare Benefits, indicating that the claim was not automatically sent from the Medicare intermediary to the Company, should be submitted electronically.

To begin submitting claims electronically to Medical Mutual, please notify your billing service or practice management software vendor.

Reduce Paper in Your OfficeReceive this newsletter and other provider communications electronically by enrolling in the Provider ePortal at Provider.MedMutual.com. Providers already registered can update their electronic subscription settings through the My Accounts section.

This material is considered part of the Provider ManualMutual News, Volume 4, Issue 3, 3rd Quarter 2011

Published by the Provider Communications Department • 2060 E. Ninth Street, Cleveland, OH 44115-1355Medical Mutual of Ohio, Consumers Life Insurance Company and Carolina Care Plan

2060 East Ninth Street • Cleveland OH 44115-1355X7902 R9/11 • PCAT-1763

Northeast Ohio (Cleveland)MZ: 01-5B-75092060 East Ninth StreetCleveland, OH 44115-1355216.687.6064 / 800.625.2583Fax: 216.687.7994

Northwest Ohio (Toledo)MZ: 22-2S-38453737 Sylvania AvenueToledo, OH 43623-4482419.473.7455 / 888.258.3482 Fax: 419.473.7024

Central/Southeast Ohio (Columbus)MZ: 08-75029961 Brewster LanePowell, OH 43065-7571614.932.7270 / 800.235.4026Fax: 614.932.7254

Southwest Ohio (Cincinnati/Kentucky)MZ: 05-7502300 E. Business Way, Ste 370Cincinnati, OH 45241-2369513.684.8140 / 800.589.2583Fax: 513.684.8121

GeorgiaMZ: 31-87521899 Powers Ferry Road SE, Ste 400 Atlanta, GA 30339-5619678.742.9100 / 800.677.8028Fax: 678.742.9170

IndianaMZ: 27-3825630 West Carmel Drive, Ste 275Carmel, IN 46032-2515317.587.8000 / 888.636.3622Fax: 317.587.8001

South Carolina (Columbia)MZ: 30-7706201 Executive Center DriveColumbia, SC 29210-8406803.750.7400 / 800.868.6734Fax: 803.561.7772

Provider Contracting Offices

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