Jul 29, 2013 | Medical billing basics
What is Hospice? Hospice is a program of care and support for people who are terminally ill. It is available as a benefit under Medicare Hospital Insurance (Part A). The focus of hospice is on care, not treatment or curing an illness. Emphasis ...
Jul 23, 2013 | Medical billing basics
Purpose: ** To optimize therapeutic outcomes for individual patients. ** Optimize drug therapies. ** Improve medication use. ** Reduce risk of adverse events and drug interactions. ** Increase patient adherence and compliance with prescription drugs. ** Identify...
Jul 17, 2013 | Medical billing basics
The Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system to measure Medicare beneficiaries’ experience with their health plans and the health care...
Jul 11, 2013 | Medical billing basics
Claims Submission Claims are to be submitted to Simply Healthcare Plans with appropriate documentation by mail or filed electronically for CMS-1500 and UB-04 claims. For those members that may be assigned to a delegated medical group/IPA that does its own claims...
Jul 2, 2013 | Medical billing basics
Providers are encouraged to first communicate any concerns or dissatisfaction about an SHP process or decision verbally through the Provider Relations telephone lines at 1-800-887-6888 ext. 6005 Monday through Friday between 8 AM and 7 PM EST, excluding state...
Jun 21, 2013 | Medical billing basics
Overview SHP is responsible for all aspects of the credentialing and recredentialing process for all providers who join or participate in the SHP Network. This process is under the QI Department and is designed to meet all regulatory and accreditation requirements and...
Jun 17, 2013 | Medical billing basics
Overview SHP maintains an active Quality Improvement Program (QIP) that provides structure and processes for our ongoing commitment to proved and continually improve upon the care and services that are offered to our members. The QIP goals are based upon our ongoing...
Jun 10, 2013 | Medical billing basics
Member’s Rights & Responsibilities SHP Members have the right to:* be treated with courtesy and respect, and with due consideration of his/her dignity and privacy. * receive information on available treatment options and alternatives, presented in a...
Jun 4, 2013 | Medical billing basics
Family Planning Services – Family Planning Services include education, information, referral, counseling, diagnostic procedures and contraceptive drugs and supplies. Members have freedom of choice in choosing a contraceptive method and the services are...
May 29, 2013 | Medical billing basics
MISSED APPOINTMENTS: * Missed appointments by the member must be followed-up by the Provider. The CarePlus Member Services Department will assist the Provider in this process if necessary. If thepatient does not go to the previously scheduled appointment without...
