Health Care Policy Board

The information provided here is intended to keep members informed about their rights, current pertinent issues, and additional resources. Please check back regularly for new information! If you have any questions please contact the Insurance/Medicare Chair:

  David Kazar, PhD, ABPP -  DrDavidKazar-Office@Tampabay.RR.com

 News:  

• BCBS Mental Health Parity & Member Responsibility
  BCBS Information Q & A
  
• BCBSental Health Parity Issue
  The phone number for people who have not received a letter yet or for any questions about the new “contract” is 1-800-727-2227.
• APA Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008 Q & A
• Worker's Compensation System Guide
  
• Florida Psychologist Medicaid Practice Opportunities
• Medicaid Suit Gaines Status as a Class Action - Florida Times-Union (2/14/2008)
  
• According to Mulitplan Provider Relations: if you have a signed contract with Beechstreet,  Dimention, or PHCS and you are a Muliplan provider then some, not all United plans will process their claims through Multiplan and you have to accept the rate you have agreed to with Multiplan/Beechstreet.  If you are not a United Behavioral provider you must still look at the patients United insurance card to see if Multiplan logo is written.  But, even if there is no Mulitplan logo it still could be going through Multiplan and the only way is to call and asks who administers the plans. For more information contact Dr. Hibel or Dr. Bordini.
• New Medicare Billing Rules for Testing - Effective October 1, 2006
• HIPPA requires that as of May 23, 2007 all health care professionals including licensed psychologists use a NPI when they bill any government or private health insurer electonically.  In additon any private health insurer can require that health professionals who bill the insurer use an NPI even if the billing is done by mail.(Information and an application for obtaining  a National Provider Number is available online at https://nppes.cms.hhs.gov.  Paper copies of the application can be downloaded from www.cms.hhs.gov/cmsforms). 

• Florida Dept. of Financial Services - The DFS Helpline at 1 800 342 2762 assists policyholders in resolving disputes with insurance companies regarding payment of claims.  They do their best to ensure that insurance companies process claims according to the policyholders written policy. (read more) 
• National Mental Health Association - NMHA has developed a series of resources to help advocates in their parity campaigns. In addition, NMHA will research additional questions on this important topic. The following documents are available through their Advocacy Center. (read more)
• Statute 641.3156 Treatment authorization; payment of claims - This statute addresses treatment authorization denials.  Insurance companies still deny payment on the basis of an expired insurance benefit. (read more)
• Statute 641.3155 Prompt Payment - This statute defines prompt payment. (read more)
   

Medicare Information:

All providers interested in seeing patients over 65 years old or disabled should enroll in Medicare.  You may then choose to participate by filling out a separate participation form (opt in), or not participate by not filling out the form.  If you participate, you are called a Participating provider and must abide by participating fees for your region.  If you like, then you may choose to Opt out , renewing every two years, then no longer may file claims and your patients can't file claims.  If you are participating or nonparticipating after you enroll, you must file claims. Participating and nonparticipating providers must abide by their respective fee schedules.

• Medicare Customer Service Contacts
  
• Provider Contact Links
• Medicare Application and Change of Address Form
• CMS Payment Rule Gravely Impacts Medicare Mental Health Services
• New Provider Enrollment Form As of May 2006 there has been a new provider enrollment form for Medicare. Changes to information can currently take up to four (4) months to go through. Many members have expressed difficulty with the process and FPA Director of Professional Affairs, Carolyn Stimel, Ph.D. has written an update.  
• Medicare Opt-in/Opt-out Procedures Or, to Opt-out, you must first Opt-in for the Florida Psychologist

Links: 

• Medicare Physician Guide
• Florida Department of Financial Services 
• Florida Office of Insurance Regulation / Hotline: 1-800-342-2762
• Florida Statutes for Insurance Regulation
• The National Mental Health Association Advocacy Center
• Guide for Completing a Medicaid Provider Enrollment Application
• Approved HCPCS Codes and Modifiers
• Insurance Regulation in the state of Florida: Regarding prompt payments of claims and Florida statutes governing prompt payment. 
• Please Note: out-of-state claims have no Florida statues governing their processing must rely on the host state's laws regarding health insurance processing Florida Department of Financial Services Insurance Library: click here (type in "health claims" in search box for list of resources regarding processing of health insurance claims)
• Civil Remedy Consumer Complaint Form (against an insurance company). Be sure you have a statute which had not been followed.
• Filing Complaints of Health Insurance Companies Who Fail to Pay Claims Form
• Sample Complaint Letter pdf. Must have acrobat reader to view.