Network Updates

Fidelis Care Authorization Requirements

NYM, FHP, CHP 1 V14.2-03/31/14 Medicaid, Family Health Plus, Child Health Plus Authorization Grid FIDELIS CARE AUTHORIZATION REQUIREMENTS Benefit/Service Detail SERVICES AND PROCEDURES WHICH REQUIRE AUTHORIZATION REVISED 3/31/14 I. Inpatient Admissions-All inpatient admissions require an authorization. Fidelis Care does not require authorization of emergency room services or any emergent service required to provide stabilization of […]

Newsletter Q1 2014

A Letter From the CEO Dear Integra Provider, First and foremost, “Thank You”, for the value, service, and professionalism you bring in serving over 40 health plans and 13 million members covered by the Integra network. As you know, 2013 was a mixed year for our industry and for healthcare more broadly.  The Affordable Care […]

LCD and Policy Article Revisions Summary

  LCD and Policy Article Revisions Summary for March 27, 2014 Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCDs) and a Policy Articles (PA) that have been revised and posted. Please review the entire LCD and each related PA for complete information. Ankle-Foot/Knee-Ankle-Foot Orthosis LCD Revision Effective Date: 01/01/2014 COVERAGE […]

Billing Reminder: Modifier Usage for Urological Supplies

Billing Reminder: Modifier Usage for Urological Supplies – The Urological Supplies Local Coverage Determination (LCD) provides for the use of modifiers with each submitted HCPCS code to indicate whether the applicable payment criteria are met (KX modifier) and to provide other information related to coverage and/or liability (GA, GZ and GY modifiers) when the policy […]

Guidelines for Medicare Primary Billing

If an item is deemed coverable by Medicare and is otherwise not on the designatedNational Coverage Determination (NCD) for Durable Medical Equipment non covered items list: https://www.noridianmedicare.com/dme/claims/noncovered_items.html then the process for billing would be as follows:   It should be explained fully to the beneficiary before the items or services are furnished that Medicare may not cover the item or service […]

Newsletter Q3 2013

October 16, 2013 Provider Newsletter An Overview of Q3 2013 Integra Partners Continues to Expand its Network!   New Lines of Business   The third quarter was a busy month for Integra as we continue to enhance our relationships with our existing payers in an effort to deliver additional value to our provider network.   HHH Choices […]

Newsletter Q2 2013

June 28, 2013 Thank You For Being Apart of the Integra Network There probably has never been a time in the history of DME and O&P like today’s challenging environment.  Delayed or not delayed, the Competitive Bidding process will have a major impact on the DME space and how the industry will evolve in the next several years. […]

Newsletter Q1 2013

March 26, 2013 30,000 Feet with CEO Andrew Saltoun First of all, thank you for being part of our network! Healthcare is evolving rapidly and the changes precipitated by President Obama are having broad impacts to our healthcare system. While the constant challenges of increased documentation standards, reimbursement     pressure, and too much news to read and digest […]

February Educational Update

The 8 Keys to Getting Paid As the contracted entity for our health plan partners Integra follows all CMS guidelines. This includes submitting the appropriate documentation at the time your claims are submitted. By submitting these 8 key pieces of information with your claim, you will be on your way to fewer denials, and a quicker […]

January Educational Update

Completing an Accurate Letter of Medical Necessity National and local Medicare policy specifies that upon complete of a face-to-face examination, the treating practitioner or physician must complete a written order containing seven specified elements. As the supplier of these services you may choose to provide physicians with a form that outlines the necessary fields to […]

Newsletter Q4 2012

  The Aftermath of Hurricane Sandy These past few months have brought difficult times to our area as we are still picking up the pieces in the aftermath of Hurricane Sandy.  Many of our providers, health plans, and employees were affected by the storm. An Integra Employee Relief Fund was established to help our employees […]

October Educational Update

Important Reminders An updated Fee Schedule was sent out this past week, current as of 9/1/2012. If you have not already received a copy please e-mail rrandazzo@accessintegra.com . Be aware that sometimes these e-mails end up in the ‘Junk’ or ‘Spam’ folder.   A special training session to review the WellCare of NY procedures has […]

September Educational Update

DME Coding Changes – Is your Head Spinning? We all know how vital DME coding is to our business and how important it is to stay current with their policies. As you may already know CMS is making significant changes to the coding system and it is changing right before our eyes. In a joint […]

August 2012

What is NEW? Integra Providers NOW have Access to Wellcare of NY We are excited to report the positive progress with the addition of WellCare of NY; our newest health plan member covering both the Durable Medical Equipment and Orthotic and Prosthetics.  Here are some fast facts about WellCare of NY: NY membership approximately 100,000 […]

December 2011

Dear Integra Providers, Happy Holidays and best wishes for a great New Year! With 2012 having just begun, we want to remind you that the 2012 Fee Schedule for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is now effective. You can find all your information on the code changes on our website. As a […]