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August 2009 - Volume 9, Issue 2
The August 2009 issue of MedNet News includes information about a new business alliance between Mednet and athenahealth, the latest on Quality Recognition Programs (PTE, BTE, and NCQA Standards), major payor updates, and MedNet's activation with HCAS/CAQH for provider credentialing.

MedNet Affiliates with athenahealth
Meaningful use of Health Information Technology
UHC Important Radiology Notification Reminder
UnitedHealthcare Purchases TPA Operations from FISERV Health
HPHC Newsletter & Network Information Distribution Changes
Medical Claims Service (MCS) Acquired by EBS-RMSCO, Inc.
Credentialing News
Application Process Changes

MedNet Affiliates with athenahealth

MedNet has aligned forces with athenahealth, Inc., a leading provider of Internetbased business services to physician practices. As a result of this alliance MedNet
providers can now have preferred access to athenahealth's revenue cycle management service, athenaCollector and integrated electronic health record (EHR), athenaClinicals.
Additionally, this relationship has the potential to give MedNet providers a greater ability to participate in and garner benefit from the Health Information Technology for Economic and Clinical Health (HITECH) Act.

The HITECH Act was enacted by President Obama on February 17th, 2009 as part of the larger stimulus package known as the American Recovery and Reinvestment Act (ARRA) of 2009. The act includes incentives to qualified medical providers demonstrating "meaningful use" of an EHR starting in
2011.

MedNet became quickly impressed with athenahealth's products and services which have the potential to significantly improve a physician's ability to deliver quality care, helping to link rural physician practices and
avoid unnecessary and costly duplication of services, while reducing the administrative complexity of practice operations. Additionally, athenahealth's suite of services is wholly web-based, allowing for a more affordable
solution for smaller provider practices. athenahealth's services are designed to deliver consistent financial and clinical results with very low initial investment and
a rapid implementation and training cycle. athenahealth's athenaCollector is a physician revenue cycle management service offering integrated practice management software,
continually updated payer knowledge, and back-office processing support into a single service. athenahealth's proprietary payer and clinical rules engine, athenaRules,
is a real-time database of payer rules and regulations with new rules being continuously added. MedNet providers can access athenahealth's award-winning athenaCollector
practice management and billing service, which is designed to deliver faster reimbursement, increased revenue, and ultimately, improved practice workflow and operations.

athenahealth and MedNet share a common goal to introduce technology and services that will allow medical providers in Maine to elevate the quality-of-care delivered while
minimizing administrative hassles associated with operating a medical office. Also as medical groups, especially small independent physician practices, look to deal with the inherent challenges presented by emerging
and existing pay-for-performance and quality recognition programs it will be critical that they consider network-based clinical services that are aimed at maximizing care delivery and the payment for it.

For additional information on specifics around this affiliation, or athenahealth's practice management and EHR service offering please contact:
Deidre DeRoche, MedNet Provider Relations Manager, 207-773-5116, ext. 128

Tom Drottar, MedNet Director of Networks and Business Development, 207-773-5116, ext. 106

For a review of their products and the company profile, visit the athenahealth website at www.athenahealth.com.

Meaningful use of Health Information Technology

According to the California HealthCare Foundation, "chronic conditions are the major cause of illness, disability, and death in the United States". Much is known about how to prevent or delay many related complications of chronic disease, yet national statistics consistently demonstrate suboptimal outcomes. The truth is - achievement of optimal quality and effectiveness from chronic care delivery requires a systematic and comprehensive approach. Such an approach requires range of different interventions. A disease registry is one tool for capturing, managing, and providing access to conditionspecific information for a list of patients to support organized clinical care. Disease registries can exist in many forms. They can be part of a larger electronic medical records (EMR) system, a homegrown database, or a simple off-the-shelf software program. Successful disease registries are also created with pen and paper. The form in which the registry exists is secondary; realization depends on the consistent entry of data and the daily use of the system.

The benefits are well documented. However, the up-front costs, information technology resources, and expertise necessary to implement and support these applications can be burdensome for some physician practices. A typical transformation cycle may include many of the following activities:

Practice Assessment
Solutions Research
Product Selection
Implementation & Staff Training
Office Flow Redesign
Evaluation
Reporting

If you would like to discuss how MedNet can help support your efforts towards practice transformation please contact Penny Thomas by phone at 800-556-1144 / 773-5116, ext. 118 or by email pthomas@mainemednet.com.

UHC Important Radiology Notification Reminder

United Healthcare implemented its new Radiology Notification Program on December 3, 2007 for all advanced outpatient-imaging procedures to include CT, MRI/MRA, PET and Nuclear Medicine. All participating physicians, facilities, and allied healthcare professionals were required to comply. To follow procedure, Ordering Physicians must provide notification by using one of the following three options. By Phone: 1-866-889-8054, by Fax: 1-866-889-8061 or Online at www.unitedhealthcareonline.com (click Notifications, Radiology Notification Submissions & Status). Ordering Physicians are strongly encouraged to document the authorization number provided as a result of the notification process.

Rendering Providers must verify that a proper notification is on file by calling 1-866-889-8054 (option #2) or online at www.unitedhealthcareonline.com. If notification is not on file, the Rendering Provider must obtain prior notification, via the channels noted above.

United Healthcare products that require prior notification are Choice, Choice Plus, Select and Select Plus United Health care products that do not require prior notification are Medicare Advantage Secure Horizons, Ovations (all governmental products), Pacificare, Harvard Pilgrim Co-Branded, Golden Rule, and Options PPO.

List of benefit plans that do/do-not require prior notification is for illustrative purposes only; it is not exhaustive. A complete list is located at WWW.UHConline.com.

UnitedHealthcare Purchases TPA Operations from FISERV Health

UnitedHealthcare has wholly purchased the collective third party administration (TPA) operations owned by FISERV Health. FISERV Health previously aggregated a broad range of independent TPA operations around the country, such as WAUSAU, Harrington Benefit Administrators, Benesight, and Benefit Planners. UnitedHealthcare's newest acquisition integrates national TPA services and operations under the new name of United Medical Resources (UMR). Some transition will continue to occur as former FISERV Health clients migrate to UMR's platform, brand identification, and enrollee ID cards. More information regarding UMR's services can be obtained at http://www.umr.com/oss/cms/UMR/index.html. For assistance regarding proper handling of member claims, contact MedNet via our general assistance line at (800) 556-1144 or (207) 773-5116, Option 5.

HPHC Newsletter & Network Information Distribution Changes

Harvard Pilgrim now distributes its news and information electronically. The new e-newsletter is named Network Matters. Network Matters consolidates the news and information previously published in News to Use and Network Leader, and replaces both newsletters. HPHC encourages participating providers to visit www.harvardpilgrim.org/providers, submit their email address and join the distribution list for future electronic delivery.

Please be sure that Harvard Pilgrim has your e-mail address so that you won't miss an issue of Network Matters. If you haven't already, please go to www.harvardpilgrim.org/providers and click on the link under the "News" heading to join the distribution list. As always, each issue of News to Use and Network Leader is available at www.harvardpilgrim.org/providers for providers to access at any time.

Medical Claims Service (MCS) Acquired by EBS-RMSCO, Inc.

MCS is now a wholly owned and operated subsidiary of EBS-RMSCO, Inc. MCS is in the final stages of migrating its claims platform over the EBS-RMSCO, Inc. platform. Please watch for enrollee ID card changes as this process is competed, record the new mailing addresses for its variety of employer benefit plans, as well as take note of EBS-RMSCO's Emdeon payer ID# 04258 for purposes of electronic claims filing to avoid remittance delays. For more information about EBS-RMSCO, Inc. go to http://www.ebsrmsco.com/Default.aspx, or contact MedNet on our general assistance line at (800) 556-1144 or (207) 773-5116, Option 5.

Credentialing News

MedNet is pleased to announce we began participation with HealthCare Administrative Solutions (HCAS) as a partner in its collaborative and streamlined provider credentialing initiative effective March 1, 2009.

In 2007, HCAS implemented a credentialing service solution in New England that reduces the amount of time providers spend on administrative tasks. The process includes a single point-of-entry for providers to submit information used to assess a provider's qualifications to treat patients and to participate in health plan networks.

MedNet's participation in this credentialing initiative not only offers streamlined and simplified processes for network providers, but it connects MedNet's processes with the Council for Affordable Quality Healthcare's (CAQH) universal provider credentialing data source, and online application procedures.

For more information on this credentialing initiative and how it may effect your participation with MedNet, contact Carole Belliveau via email at cbelliveau@mainemednet.com, or by telephone at 207-773-5116 ext. 108.

For more information about the HealthCare Administrative Solutions collaborative, visit the HCAS Web site at www.hcasma.org.

If you are not already participating with CAQH and submitting your credentialing information to payers online, you can get more information or enroll at www.caqh.org.

Application Process Changes

MedNet's participation with CAQH has changed our application & credentialing process.

For initial provider credentialing go to http://www.mainemednet.com/services.asp, select your provider type, and download the appropriate forms you will need to complete MedNet's application process. Please pay particular attention to the HCAS Provider Enrollment Form. As designated on the website, mail your completed forms to:

Credentialing Department
Medical Network, Inc.
P.O. Box 15253
Portland, ME 04112

*** Important ***

You must participate with CAQH, complete your online CAQH provider profile, and select MedNet as a payer you are requesting access to. If you are not currently participating with CAQH, a welcome and introduction package will be sent to you from CAQH on MedNet's behalf.

For further information contact Carole Belliveau at 207-773-5116, ext. 108 or via email at cbelliveau@mainemednet.com.