November 2016 ProHealth Provider Relations Update · 2017-01-04 · 1 November 2016 ProHealth...

1

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

jwhite2@ecommunity.com

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

2

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

3

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.

4

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.

5

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 Jreed-cable@eCommunity.com Anita Huse, RN, CAPPM Business Consultant Physician Services PH#: (317)621-4090 ahuse@eCommunity.com Jamie L. McAllister, MA Account Coordinator Ph#: (317)621-7521 Fx#: (317)957-2794 jschroth@eCommunity.com Stracy Faulkner Billing/Coding Team Manager - Practice Management Ph#: (317)621-1537 Sfaulkner@eCommunity.com

6

7

8

9

10

11

Department Staff

Jenny Bouck, Provider Relations Manager

jbouck@ecommunity.com

Business Information Coordinator

Hollie Putzback, hputzback@ecommunity.com

Provider Relations Coordinators:

Carol Boyd, cboyd@ecommunity.com

Dawn Widgery, dwidgery@ecommunity.com

Amanda Bobo, abobo@ecommunity.com

Medicaid Program Manager:

Salena Woodson, swoodson2@ecommunity.com

Medicare Program Manager:

Lori White, lwhite4@ecommunity.com

Credentialing Enrollment Supervisor: Jenna White, jwhite2@ecommunity.com

Credentialing Coordinators:

Julia Chumbley, jchumbley2@ecommunity.com

Julie Starr, jstarr2@ecommunity.com

Kim Tibbets, ktibbets@ecommunity.com

Credentialing Specialist:

Adrianne Stocks, astocks@ecommunity.com

Provider Enrollment Coordinators:

Aletha Burnett, aburnett@ecommunity.com

Amy Walls, awalls@ecommunity.com

Denise Smith, dasmith6@ecommunity.com

Dianne Castillo, dcastillo@ecommunity.com

Jessie Eskew, jeskew2@ecommunity.com

Sharon Harlan, sharlan@ecommunity.com

Provider Relations Department

6626 E. 75th St, #500

Indianapolis, IN 46250

Phone: 317-621-7581

www.ecommunity.com/prohealth