Provider News & Updates – June 2022

The Medicare sequestration adjustment that was suspended during the COVID-19 pandemic to address financial challenges by health care providers, was reinstated effective
April 1. The sequestration amounts are being rolled out as follows:

The mandatory sequestration adjustments are applied to all claims submitted for Medicare Advantage members and will appear on your provider remittance advice as
“CO-104: Contractual Obligation, Managed Care Withhold.” The reduction is taken from the calculated payment amount after all member responsibilities and other adjustments occur and are based on date of service. The mandatory adjustment has been in effect since 2013 but was suspended from May 1, 2020, through March 30, 2022, as part of the CARES Act. For more information regarding Medicare sequestration, please review this Medicare and Budget Sequestration guide.

IHN-CCO Members Now Receiving Claim Denial Notices

IHN-CCO members are receiving Notice of Adverse Benefit Determinations letters when one of their claims in whole or part is denied. Per OAR 410_141_3885, members are notified which service was denied, the reasons for the adverse benefit determination and their appeal rights. Please be aware, that these letters may increase member calls to providers when denials are received.

Sterilization Forms Required for IHN-CCO Members

Oregon law requires informed consent to be obtained from any IHN-CCO member who requests voluntary sterilization or a hysterectomy. Without proper consent, it is prohibited to use state or federal dollars to perform these services. The Oregon Health Authority has specific online forms that need to be completed at least 30 days, but no more than 180 days, prior to the procedure. IHN-CCO is required to submit consent forms to OHA for any sterilization or hysterectomy claims we receive. If the consent form is not correctly completed, claims will be denied. To assist you with completing this follow these tips:

• All fields must be complete.
• Member signatures on the consent form should be collected at least 30 days, but no more than 180 days, prior to the procedure. Electronic signatures are not allowed.
• Any interpreter’s statement must be signed and dated the same day as the member’s signature.
• The statement of the person collecting the consent must be signed and dated on the same day as the member.
• The physician’s signature must be dated on the date of the procedure.

Sterilization forms can be found on the Oregon Health Authority website in English and Spanish.

EFT & ERA Available Through InstaMed

Samaritan Health Plans has contracted with InstaMed to deliver a simplified payment experience with free electronic remittance advice and electronic funds transfer also known as EFT/ERA. Sign-up now to begin receiving electronic payments. For more information and how to sign-up, please visit Enroll in EFT or ERA on the SHP Provider website.

Provider Directory Verification Is Required

Samaritan Health Plans has partnered with Quest Analytics to streamline your verification process through its BetterDoctor solution. Each quarter you will receive an email from BetterDoctor with an access token and directions about how to attest and verify your information.

Providers are required to review the information and make any needed changes to the data. If there are no changes to the data, the provider is still required to attest the information is accurate. Providers who do not attest each quarter that they have completed the validation process are at risk of removal from the SHP directory due to non-compliance with the No Surprises Act.

For more information, visit BetterDoctor or contact Quest Analytics at support@betterdoctor.com. You may also phone them at 844-668-2543, Monday through Friday, 9 a.m. to 5 p.m. Central time.