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HMSA Updates
HMSA Offers New Online FeatureGo Online To Complete HMSA Forms HMSA recently modified the forms in its Provider E-Library. Users may now type the information requested into the forms while online. Once the form is completed, it can be printed and mailed or faxed to the appropriate location. Completing forms by typing the information decreases the chance of data entry error due to illegibility and enhances the integrity of the information received. HMSA hopes this new feature will assist you in streamlining your workflow.
HMSA Seeks Your Input for New Online FeatureIn the near future HMSA will expand its online resource by adding a section for frequently asked questions (FAQs). This ia an upgrade to HMSA’s Provider E-Library that includes reference material and forms designed to make it easier for phsycians and their staffs to do business with HMSA. The FAQs feature will be geared particularly to new office staff who are unfamiliar with HMSA’s policies and procedures. HMSA invites physicians and their staffs to submit commonly asked questions they hear when a new employee joins their staff. Your questions will help HMSA develop a user-friendly FAQs function for inclusion on both the Hawaii Healthcare Information Network (HHIN) and www.HMSA.com/portal/provider. E-mail your questions to the Provider Communications unit at PSComm @HMSA.com. Please note that this e-mail address is for FAQ submissions only. HMSA will not respond to individual e-mails except with a system-generated acknowledgment of receipt. In a future Provider Update, HMSA will share more details about the FAQs feature – and about other planned enhancements intended to assist with your HMSA-related staff training. Find Out More ~ Visit the HMSA Portal
Medical AlertLimitations on Access to Iressa Announced Effective September 15, 2005, Iressa can only be used for patients who are benefiting or have benefited from the drug. As of September 15, 2005, the drug manufacturer, AstraZeneca, will renew prescriptions through its IRESSA Access Program. Under the IRESSA Access Program, HMSA members currently using Iressa will be able to gain access to refills by contacting the single mail-order pharmacy contracted with the program, Priority Healthcare, at: No new patients will be allowed access to Iressa unless they are enrolled in a clinical trial that: * Is approved by an Institutional Review Board (IRB) prior to June 17, 2005, or is part of a clinical study conducted under an investigational new drug application (IND).
Of Special Interests to Billing StaffHMSA Reminds You to Use Correct Code for Sales Tax HMSA reminds phsycian officers that a claim must include the sales tax charged to the patient. They ask you to use HCPCS code S9999 when billing the sales tax, whether the claim is submitted through EDI or on hard copy. Recently HMSA sent out a notice to physicians and their staffs’ explaining some guideline to get claims processed expediently. To streamline the claims process, HMSA uses an Optical Character Recognition (OCS) system. Properly prepared forms are more readily accepted by the system and processed. Problem form must be processed manually, lengthening the processing time. Here are so some Helpful Hints. * Use Arial or Times New Roman fonts. Standard fonts are clear and easy to scan. Font sizes are critical – font size smaller than 10 are generally difficult to scan with clarity, and font sizes larger than 12 do not fit in the fields properly. Dot-matrix printers may produce characters that are fuzzy and difficult to read. Please review your printed claims to ensure that the print output is of high quality and the print characters are sharp and clear. Handwritten claims take longer to process Although handwritten claims are accepted, such claims need to be entered manually, increasing the possibility of keystroke errors and lengthening the processing time for those types of claims. Clean copies are the best HMSA’s eligible charge for a tuberculin skin test includes the administration, injected material and follow-up reading of the test result. These components should not be billed separately. Do not use CPT code 90471 to bill for the administration portion of the TB skin test. This code is used for immunization administration, NOT TB skin test. HMSA private business plans will cover the administration of FluMist for the 2005-2006 flu season. Only the administration of the vaccine may be billed to HMSA. Submit claims for the administration portion of FluMist by using CPT code 90473 with modifier SL appended. The maximum allowable fee is $12.00. Use the ICD-9-CM code V04.81 for the diagnosis. Do not bill for the free vaccine material obtained through DOH.
Medical AlertSynagis for Respiratory Syncytial Virus Season In Hawaii, the peak season for Respiratory syncytial virus (RSV) is October through February. Found worldwide, it is the leading cause of lower respiratory tract disease in infants and young children. Effective October 1, 2005, Synagis will be authorized for one dose at intervals not less than 28 days to provide prophylactic coverage through the peak season. If prophylaxis begins around October 1, a maximum of five doses will be authorized, with the last dose administered at or about February 1, 2006. Pre-certification is required. The maximum dosing schedule is: * October 1 to October 15 the maxium number of doses: 5 The dosing for Synagis is determined by the patient’s weight. HMSA asks that physicians include the patient’s weight when submitting documentation for pre-certification and when submitting claims (include it in field 19). Please refer to the Provider E-Library for a complete version of this policy. |
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