HealthChoice provider network news, fall 2013

              OMES: Employees Group Insurance Division (EGID) - Network News Fall 2013
file:///Y|/Newsletters/Network%20News/OMES%20Employees%20Group%20Insurance%20Division%20(EGID)%20-%20Network%20News%20Fall%202013.htm[11/19/2013 10:13:32 AM]
OMES: Employees Group
Insurance Division (EGID)
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Home / Providers / Network News / Network News Fall 2013
In the Fall Edition of the Network News
Clinical Trials
Coverage Change for Orthotripsy Extracorporeal Shock Wave Therapy
Newborn Coverage Rule Changes
New HealthChoice Pharmacy Copay Structure
Fee Schedule Updates
Changes to the Dental Appeals Procedures
2014
Not Otherwise Classified Drugs (NOC)
Revised CMS 1500 Claim Form Timeline
Clinical Editing for Physician Visits Injectable Administration
ADA 2012 Claim Form
Orthodontic Waiting Period
Sealants and Resin Restoration Changes
MS-DRG and MS-DRG LTCH 2013-2014 Fee Schedule
Reminder!
HealthChoice Out-of-Pocket Maximum Changes
HealthChoice S-Account Changes
Reimbursement for Organ Acquisitions
Network News Via Email
Network Provider Contact Information
Clinical Trials
Posted 11/04/2013
All services associated with Clinical Trials have been excluded from coverage under the HealthChoice and Department of Corrections (DOC)
plans. However, for charges incurred on or after January 1, 2014, HealthChoice and DOC will allow coverage for routine patient costs associated
with approved Clinical Trials according to the following guidelines:
All applicable plan limitations for coverage of non-Network care will apply to routine patient care costs in clinical trials; and
Members must meet all applicable plan requirements for certification, registration, and referrals.
Certification is required by the certification administrator and EGID HealthCare Management Unit for all clinical trials services.
Prior authorization is required by the pharmacy administrator for all clinical trials for pharmaceuticals.
Treatment diagnosis must be for cancer treatment or other life-threatening diseases.
Investigation items, devices, or services themselves are not covered.
Must be registered with www.clinicaltrials.gov or www.cancer.gov.
For questions regarding coverage of clinical trials under the HealthChoice health plans, please contact our health and dental claims administrator
at 1-405-416-1800 or toll-free 1-800-782-5218.
For questions regarding coverage of clinical trials under the HealthChoice pharmacy plan, please contact our pharmacy benefits administrator
toll-free at 1-800-903-8113.
For questions regarding certification of clinical trials under the HealthChoice health plans, please contact our certification administrator toll-free at
1-800-848-8121 and EGID HealthCare Management Unit at 1-405-717-8879 or toll-free 1-800-543-6044.
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Coverage Change for Orthotripsy Extracorporeal Shock Wave Therapy
Posted 11/04/2013
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