2022 Provider Contract Updates

A summary of updates and an opportunity for feedback was emailed to everyone on March 10th, 2022 for the following:

• Incomplete patient accounts. I've updated all superbill forms to include a patient's date of birth and mailing address if they have not completed a Patient Registration Form. To avoid providers being unable to get paid for months, any incomplete patient claims would be set to "Balance Due Patient" and allow them to receive statements until there is an insurance policy on file. For Medicaid eligible newborns without an ID, claims will remain incomplete for 90s before receiving any statements.

• Past due accounts. Accounts that have received the maximum number of statements and/or Final Demand Notices for severely past due balances will be moved to "Collections". This does not actually send the patient's account to a collections agency unless the provider has hired an agency and linked their account for me to forward patient information. What this will do is better communicate to providers which patients are no longer receiving printed statements and make a decision on how best to handle these delinquent accounts.

And from September 1, 2021

• TRICARE / VA / TriWest / CHAMPVA. Outlining why CDMs/CPMs should not be accepting patients with active TRICARE or VA policies without an overseeing and billing provider whos credentials and specialty is an accepted provider type - even when the patient has other insurance.

The most current Provider Guide & Contract is always posted on the provider page here and updates are emailed to every provider in real-time. The google-doc format allows providers to have real-time access to any updates and I encourage providers to look to this Guide first as a resource to your every day billing questions.