November 2016 ProHealth Provider Relations Update · 2017-01-04 · 1 November 2016 ProHealth...
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1 November 2016 ProHealth Provider Relations Update I NSIDE T HIS I SSUE : 1 New & Terming Plans - 2017 1 Gold & Silver ID cards - 2017 1 Credentialing New Providers 2-3 New Providers, effective 12/1/2016 4 Termed Providers 5 VHG - Healthcare & Business Consulting 6-8 2017 PMCC Registration info 9-10 2017 CPT & Diagnosis Coding Updates 11 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. Credentialing of New Providers: *Please Note* Credentialing through ProHealth for ALL new providers can take anywhere from 90-120 days from notification to completion. The Credentialing fee has increased to $200 for ALL new providers wishing to join the Community/ProHealth network, effective 11/1/2016. ProHealth Credentialing/Enrollment Supervisor: Jenna White [email protected] Phone#: (317)621-9312 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 (Market Place Exchange Plan), effective 1/1/2017- (ALL Employed /CPN providers) IU Health Plan (Commercial/Employed 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
Transcript of November 2016 ProHealth Provider Relations Update · 2017-01-04 · 1 November 2016 ProHealth...
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November 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 1 Credentialing New Providers
2-3 New Providers, effective
12/1/2016
4 Termed Providers
5 VHG - Healthcare & Business
Consulting
6-8 2017 PMCC Registration info
9-10 2017 CPT & Diagnosis
Coding Updates
11 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.
Credentialing of New Providers:
*Please Note*
Credentialing through ProHealth for ALL new providers can take anywhere from 90-120 days from notification to completion.
The Credentialing fee has increased to $200 for ALL new providers wishing to join the Community/ProHealth network, effective 11/1/2016.
ProHealth Credentialing/Enrollment Supervisor:
Jenna White
Phone#: (317)621-9312
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 (Market Place Exchange Plan), effective 1/1/2017- (ALL Employed /CPN providers)
IU Health Plan (Commercial/Employed 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
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Contract ing and Credentia l ing Corner Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective December 1, 2016.
Hospital affiliations will be listed with each provider.
Prime SCP Advanced Practice Practitioners
Armenoff PA, Don - Physician Assistant
MedCheck (Employed)
Boivin PA, Janine - Physician Assistant
Urology of Indiana
Brinson PA, Kyle D. - Physician Assistant
Heart & Vascular Care (Employed)
Brodhead PA, Jerica - Physician Assistant
Urology of Indiana
Cornan NP, Stephanie - Nurse Practitioner
Urology of Indiana
Dirksen NP, Stacey M. - Nurse Practitioner
IIMC / St. Francis Medical Group - CHS
Dougherty NP, Lorraine - Nurse Practitioner
Medical Associates - CHRH
Etherington NP, Courtney E. - Nurse Practitioner
Pulmonary and Critical Care (Employed) - CHE/CHN, CHW, CHV
Finkelmeier PA, Nicole B. - Physician Assistant
Pulmonary and Critical Care (Employed) - CHE/CHN, CHW, CHV
Fuhrer PA, Amanda - Physician Assistant
Urology of Indiana
Hall PA, Nicole K. - Physician Assistant
Pulmonary and Critical Care (Employed)
Kraber PA, Kyle - Physician Assistant
Urology of Indiana
Litton NP, Kristina - Nurse Practitioner
Urology of Indiana
Mulholland NP, Teena N. - Nurse Practitioner
IIMC / St. Francis Medical Group - CHS
Parker NP, Lisa A. - Nurse Practitioner
MedCheck (Employed) - CHE/CHN, CHW, CHV
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Prime SCP Advances Practice Practitioner (Continued)
Quade PA, Ashley - Physician Assistant
Urology of Indiana
White NP, Juli D. - Nurse Practitioner
IIMC / St. Francis Medical Group - CHS
Wilkinson PA, Kimberly M. - Physician Assistant
Community Quick Care (Employed)
Wood NP, Lauren - Nurse Practitioner
Pulmonary and Critical Care (Employed)
Prime PCP
Coleman MD, Tobechukwu - Pediatrics
Kids Expess (Employed) - CHE/CHN, CHW, CHV
Prime SCP
Budwig LCSW, Wendy A. - Behavioral Health
Gallahue Mental Health Services (Employed)
Enos LMHC, LCAC, Vanessa - Behavioral Health
Gallahue Mental Health Services (Employed)
Escobar MD, Miguel - Internal Medicine
Post Acute Care Specialists - CHS
Kheradiya MD, Nisha - Ophthalmology
Community Eye Care of Indiana, PC - CHE/CHN, CHW, CHV
King LCSW, Marsha - Behavioral Health
Family Medicine Care, Hillsdale (Employed)
Lifferth LMHC, Kathleen J. - Behavioral Health
Gallahue Mental Health Services (Employed)
Long LMFT, Elizabeth - Behavioral Health
Gallahue Mental Health Services (Employed)
Method MD, Michael - Gynecologic Oncology
Gynecological Cancer Care (Employed) - CHS
Mudhar MD, Jasjit - Internal Medicine
Post Acute Care Specialists - CHS
Tronocoso LCSW, Axa N. - Behavioral Health
Gallahue Mental Health Services (Employed)
Weida MD, Jennifer - OB/GYN—Maternal Fetal Medicine
Maternal-Fetal Medicine Comprehensive Care (Employed) - CHE/CHN, CHW, CHV
Contract ing and Credentia l ing Corner Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective December 1, 2016.
Hospital affiliations will be listed with each provider.
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Termed Providers The following providers will no longer be participating with ProHealth:
Baker CRNA, Raymond E. - Nurse Anesthetist, termed 11/30/2016
Community Group CRNA (Employed)
Brewer LMHC, Jenny L. - Licensed Mental Health Counselor, termed 11/30/2016
Gallahue Mental Health Services (Employed)
Brown NP, Gwendolyn J. - Nurse Practitioner, termed 11/30/2016
Community Physicians of IN, Inc / MedCheck (Employed)
Ceh PA-C, Paula - Physician Assistant, termed 11/30/2016
Community Physician Network, Family Medicine Care (Employed)
Davies LCSW, Kerry K. - Licensed Clinical Social Worker, termed 11/30/2016
Baume Psychological Services, PC
Doyle MD, Danielle M. - Oncology-Medical, termed 11/30/2016
Central Indiana Cancer Center - IU Health / Oncology & Hematology Associates
Halstead DO, Richard N. - Family Medicine, termed 11/30/2016
Community Physicians Network, Family Medicine Care (Employed)
Hill LMHC, Martin F. - Licensed Mental Health Counselor, termed 11/30/2016
Gallahue Mental Health Services (Employed)
Hunt NP, Sarah M. - Nurse Practitioner, termed 11/30/2016
Community Physicians of IN, Inc / MedCheck (Employed)
Kinney LCSW, Pamela D. - Licensed Clinical Social Worker, termed 11/30/2016
Hancock Physician Network, LLC / Hancock Counseling & Psychiatric Services
Mahapatra MD, Smita - Pediatrics, termed 11/30/2016
Community Pediatric Hospitalists
McTurnan MD, William G. - Emergency Medicine, termed 11/30/2016
Medical Associates, LLP
Pawlosky LCSW, Jaimie L. - Licensed Clinical Social Worker, termed 11/30/2016
Gallahue Mental Health Services (Employed)
Sharp MD, Gary C. - Family Medicine, termed 11/30/2016
Hancock Physician Network / Hancock Primary Care
Sparks NP, Ashley N. - Nurse Practitioner, termed 11/30/2016
Community Physicians of IN, Inc / MedCheck (Employed)
Thorington NP, Julia A. - Nurse Practitioner, termed 11/30/2016
Excell for Life Family Care and Pediatrics
Wolfe FNP-C, Susan A. - Nurse Practitioner, termed 11/30/2016
Indianapolis Gastroenterology & Hepatology, Inc.
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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
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 Billing/Coding Team Manager - Practice Management Ph#: (317)621-1537 [email protected]
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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
