Present the offer
Request: 30% increase for FL Blue, Federal Employee Plans, BC State Plans, and Cigna Plans
Offer:
Anthem (G8), FL Blue (R6), Cigna (B6), FL Blue (Q6) increases below:
99203 = $43 99213 = $30 98940 = $33
98941 = $38 98942 = $42
Present the offer...
You have requested a 30% increase for FL Blue, Federal Employee Plans, BC State Plans, and Cigna Plans.We are able to offer you an increase for specific fee schedules for the below clients:
Anthem (G8), FL Blue (R6), Cigna (B6), FL Blue (Q6)
CPT codes increased are:
99203 = $43 99213 = $30 98940 = $33
98941 = $38 98942 = $42
A Cigna PNW MT provider said they can't accept the base rate... what do you do next?
Ask them what they would be willing to accept for a 1 hour massage and check the O:drive folder for an appropriate jump and send that to them first (even if its less)
PAR provider called into the queue and wants to negotiate...what do you advise?
Email their request to ProviderRequestPCC@ashn.com
You have a Rehab request - what format do we want to see on the Universal Request Tracker?
Daily max request with 'pe' or 'all'
What shortcut causes errors in the Universal Tracker and should not be used?
Copy+paste
Request: $80 flat rate
Offer: $72pe jump from O:drive. WM1.5 (approx 10%)
You requested an $80 flat rate.
We can offer you a 10% increase which is $72 daily max with evaluations paid in addition when billed. YOu will need to bill up to the daily max rate of $72 to get that amount, ASH cannot offer 'flat rates'.
When negotiating with a provider after getting their rate what are other things you should ask/get from your provider
any other barriers?
Qualifications/specializations?
PAR provider calls into the queue and says they are INN for CA but need an app to join for their new office in AZ...what do you do?
Get them to PRL and inform them they will need to fill our a PSCR form. They do not need to go through credentialing again.
Your provider requests:
Evals at $50 for 99202; 97810 - $60; and and 97811 at $50
What do they want for a 30 min follow up visit and what do we need written on the tracker as their request?
Visit = $110
Let the provider know that we can only negotiate the Acu treatment itself and ask them what they want for an acu "visit" (not by CPT code)
When an LOA is received signed, or the offer has been marked 'no room', what do you put in the 'request status' column of the Negotiation tracker after informing your provider?
Resolved
Request: Daily max $85 - wants CPT codes to match Medicare rates
Offer: $85pe billed charges (explain billed charges to the provider in presentation)
You have requested $85 as a daily max with CPT codes to match Medicare rates.
We can offer you the daily max of $85 with evals paid in addition and CPT codes to match your usual and customary billed charges. Whatever you bill for CPT codes you will get paid that rate per code up to the maximum of $85 with evals paid in addition when billed. The FS will be used for reference as a list of covered codes
When your provider gives you a list of CPT codes they want increased - what do you do with them?
See what category they fall in on the Fee Schedule and ensure they are covered and then guide your provider to format a request in line with what ASH can offer
Provider calls back after just getting an FSRA increase 1 month ago and they want an increase for additional health plans - what do you do?
Advise them to contact their recruiter. Recruiter may refer to the resolution email that states the request is resolved and providers may only put in one request per year - refer to the resolution email date and calculate one year from that date for when they may put in another request
If a DC makes the below request,
a. What should you advise them to make their request acceptable?
b. Tell us what is the one code from the below we will entertain negotiating
Evals:
99203 125$ for 99204 140$ for 99213 80$
Adjunctive Therapy:
97110 40$ per 15 minute increment. for 97140 25$ per 15 minute Increment. for 97530 45$ per 15 minute increment
Chiropractic Manipulative Treatment (CMT):
98940 $45
a. Inform them that ASH evaluates increases CMT codes - what do you need for chiropractic treatment?
b. 98940 - it is the only CMT code listed.
When using ASHCore what columns do you filter to have the results display only participating active locations as results
Edit Column 'Status': does not equal 'N'
Edit Column 'Clinic Status': does not equal 'C'