Health Insurers

Medicare

• Accountable Care Organizations (ACOs)
  • Overview of ACOs - WSMA Reports [PDF]
  • ACOs - Pioneer model
  • ACOs - Proposed Rule: WSMA Comments, Dec. 3, 2010 [PDF]
    
  • ACOs - WSMA Comments, June 2, 2011 [PDF]
  • Centers for Medicare and Medicaid Services: Medicare Shared Savings Program (ACOs)
• CMS Medicare Annual Wellness Visit
• Medicare at-a-Glance Fact Sheet
• Medicare Contractor J2 Update
• Medicare Recovery Audit Contractors (RAC)
  • AMA & Medical Assn. - Letter to CMS regarding RACs [PDF]
  • RAC Expansion Schedule [PDF]
  • RAC Outreach Session Video - July 20 [.WMV file]
  • HealthDataInsights, Inc. (HDI) Recovery Audit Contractor Website

Organizations

• Centers for Medicare and Medicaid Services (CMS)
  • Physician Resource Center
  • Practice Administration Resource Center
    
  • Medicare Internet Only Manuals
• HealthDataInsights, Inc. (HDI) Recovery Audit Contractor  - Washington
• Noridian—Medicare Part B Carrier for Washington
  • Noridian Medicare E-mail ListServ
• SHIBA HelpLine

Billing, Coding, Coverage, and Payment Resources

• Advance Beneficiary Notice (ABN)
  
  • Advance Beneficiary Notice [PDF]
  • ABN Instructions [PDF]
• Billing and Coverage Policy
  • Covered Medical and other Health Services
  • Physician/Practitioner Billing
• Compliance Guidance for Small Practices
• Compliance Guidance for Third Party Medical Billing Companies [PDF]
• Conversion Factors [PDF]
• E&M Documentation Guidelines (1995 and 1997 Versions)
• E&M Services Guide [PDF]
• Opt Out: Objective Guidance for Physician Practice [PDF]
• Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals [PDF]
• Preventive Services for Physicians, Provider, Suppliers, and Other Health Care Professionals
• Provider Identifiers
  
  • NPI Registry - Allows you to search for individual or organizational provider NPIs

Programs

Part B 

• Medicare At-a-Glance Fact Sheet

Part C – Medicare Advantage (Managed Care)

• Advantage (Managed Care) Fact Sheet
• Medicare Private Fee-for-Service Plans
• Medicare Advantage and Cost Prescription Drug Plans - Washington 

Part D – Prescription Drugs

• Prescription Drug Coverage - General Information
• Resources on the Medicare Prescription Drug Benefit
• Part D Formularies via Epocrates
• Part D Formularies via Medicare.gov

Medicaid

• Conversion Factors [PPT]
• Medicaid - CMS website
• Washington Medicaid 
  • Advanced Imaging Pre-authorization Process (website, PDF)
  • Medicaid Generic Prescriptions: Generic News [PDF]
  • Provider Publications (Numbered Memos)
  • Tamper-resistant Prescription Pads
    • List of Suppliers [PDF]
  • Washington State Agency Medical Directors' Group
    
  • Medicaid Generic Prescriptions and Preferred Drug List
• Innovation Proposal
• Medicaid and Health Reform
• Medicaid Healthy Options (Managed care)
  • Healthy Options - Providers and Plans
  • Healthy Options - Procurement 2011-2013
  • Healthy Options - Request for Proposals [PDF]
• Medicaid Integrity Contractors (MICs)
  • The MIC initiative seeks to recoup overpayments made by state Medicaid programs. For questions, contact Bob Perna at the WSMA (rjp@wsma.org).
  • CMS Medicaid Provider Audits
• Medicaid News and Reports
• Opt Out: Objective Guidance for Physician Practice [PDF]
• ProviderOne
  • Resources to help you [PDF]
  • "Services Cards" video brochure [YouTube video]
  • Tips Sheet [PDF]
• Six Steps to Provider Readiness [PPT]

Washington State Agencies

Provider Open Communication Forum

• July 13, 2011 - Slides [PPT]
• November 30, 2011 [PDF]

Industrial Insurance (Workers Compensation)

• Conversion Factors [PPT]
• Washington Department of Labor and Industries (L&I) Medical Provider Topics
• L&I Provider Network and COHEs
  • Provider Network Advisory Group
• Fee Schedule Information
• Utilization Review - Qualis Health
  • Advanced Imaging

Washington State Health Care Authority

• Basic Health
• Washington Health Program (Non-Subsidized Basic Health) - link, summary [PDF]  
  • Community Health Plan of Washington
• Health Information Infrastructure Advisory Board (HIIAB)
• Health Technology Assessment Program (HTA)
• Uniform Medical Plan
• Washington State Agencies Technical Advisory Group (TAG) - now inactive; see Provider Open Communication Forum (above)
• Washington State Health Care Authority (website)

Commercial Insurance

• Medical Directors of Washington Health Insurers [PDF]
• Aetna
• CIGNA
• First Choice Health Network
• Group Health
• KPS Health Plans
• HMO Settlements - Multi-District Litigation (MDL)
  • Physicians Advocacy Institute Article: Blue Cross Blue Shield Settlement Agreement [PDF]
  • Coding Provisions in Blue Cross Blue Shield Association Settlement
• PacifiCare
• Premera Blue Cross
  • BCBSA provider security breach-faqs [PDF]
  • BCBSA security breach provider letter [PDF]
• Regence BlueShield
  • BCBSA provider security breach-faqs [PDF]
  • BCBSA security breach provider letter [PDF]
• United Healthcare

• WSMA Coding and Billing Assistance/Advocacy
• Practice Management Seminars/CEUs
• Health Insurers
  • Medicare Practice Toolkit
• Practice Management Operations
• Practice Resources, Products and Services
• WSMA Practice Alerts/Sign Up
• Contact Practice Resource Center