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TPA Briefing: June 2010
In this issue:
The Alliance has agreements with UW Hospital, UW Medical Foundation, and Chartwell Midwest Wisconsin that include timeliness of payment language. This language determines whether or not your organization retains a discount on claim payments for your Alliance enrollees.
Please review the following and share with appropriate members of your staff to ensure that discounts are retained for our mutual clients.
The four important items to remember when processing claims from these providers:
Failure of any payer to process clean claims within 30 days of The Alliance receipt may void the pricing arrangement regardless of proof of loss.
"Clean claims" are defined as claims with all the proper fields completed with sufficient information for The Alliance to reprice the claim. This includes claims that may be delayed in the payment process because itemizations, questionnaires, medical records, subrogation, reinsurance, third-party liability, or other items are needed. If you received the repriced claim from The Alliance, it is a “clean claim” under the terms of the agreement and should be paid within 30 days.
The 30-day time period begins on the day The Alliance receives the claim for repricing and ends on the day the UW or its associated entities receive payment. It does not start on the day the claim is received by the payer and end when the check is dated.
When in doubt, pay the claim — the timeliness of payment provision includes a guarantee of a timely refund, as long as the request occurs with 6 months of payment.
To help your organization meet the timeliness of payment agreements and retain The Alliance discount on your claim payments, please consider incorporating the following steps in your adjudication process.
Review The Alliance weekly report of repriced and forwarded claims from the previous week to (a) verify your organization has received each claim affected by the UW and associated entities contract, and (b) identify claims that might require expedited processing. If you’d like to receive a copy of this report, please contact
Carlene Boehmer, 608.210.6601.
Request and receive itemizations from the UW via e-mail to avoid delays with U.S. mail. The UW Hospital recommends that your organization use the following e-mail addresses to request itemized bills:
Alliance enrollees with last names of A-DENZ:
Karen Banfi 608.262.7438
kbanfi@huwhealth.org
Alliance enrollees with last names of DEO-I:
Debbie Blaska 608.263.0217
dblaska@uwhealth.org
Alliance enrollees with last names of J-MOO:
Cindy Moore 608.262.7470
cmoore2@uwhealth.org
Alliance enrollees with last names of MOP-SED:
Cheryl Lewis 608.265.5166
clewis@uwhealth.org
Alliance enrollees with last names of SEE-ZZZ:
Sandy Sweeney 608.263.6225
ssweeney@uwhealth.org
Transplants:
Mary Pat Teasdale 608.263.2369
mteasdale@uwhealth.org
Physician Billing – (HCFAs):
Suzanne Zimmerman 608.829.5625
sue.zimmerman@uwmf.wisc.edu
Use a special mailing address for payments to the UW and its associated entities that require a recipient’s signature if sent through an overnight delivery service, such as Federal Express, UPS, or express courier. The normal mailing address is for lock boxes, which cannot accept overnight payments and will lead to unanticipated delays.
UWHC
Account Representative
University of Wisconsin Hospital & Clinics
Patient Accounts
Suite 200
635 Science Dr.
Madison WI 53711
UWMF and UCC
Payment Posting Department
University of Wisconsin Medical Foundation
8007 Excelsior Dr.
Madison WI 53717
CMW
Mary Eckstein
Business Services Manager
Chartwell Midwest Wisconsin
2241 Pinehurst Dr.
Middleton WI 53562
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Summer is just around the corner; which means our summer hours are about to begin. Between Friday, June 4 and Friday, September 3, our office closes at 11:30 on Fridays. For your reference, here are our hours during the summer:
Main Switchboard: 608.276.6620
Monday-Thursday: 8:00 a.m. to 4:30 p.m.
Friday: 8:00 a.m. to 11:30 a.m.
Customer Service: 608.276.6630 or 800.223.4139
Monday-Thursday: 7:30 a.m. to 4:30 p.m.
Friday: 7:30 a.m. to 11:30 a.m.
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Annually, 5.1 billion years of potential life is lost due to cigarette smoking in the United States. Cigarette smoking increases the risk for many types of cancer, including cancers of the lip, oral cavity, pharynx, esophagus, pancreas, larynx (voice box), lung, uterine cervix, urinary bladder, and kidneys. The risk of dying from lung cancer is more than 22 times higher among men who smoke cigarettes and about 12 times higher among women who smoke cigarettes compared with those who have never smoked.
On July 5, 2010 the state of Wisconsin will follow in the footsteps of many other state governments and implement Act 12 into law. Act 12 requires that all workplaces, restaurants and bars must be a smoke-free establishment. This law will be enforced by the Department of Justice, and individuals and/or establishments that are in violation of the law will be fined $100 to $250 per incident. Local authorities also have the right to further restrict outside smoking on public properties such as parks, fairgrounds, etc. Establishments do have the right to designate an outside area that is a reasonable distance from any entrance where people can smoke.
There are many health promotion strategies employers can implement to support and encourage their employees to stop smoking for good. Onsite smoking cessation classes, educational forums and/or presentations, nicotine replacement therapy product reimbursements and online Web tools are popular strategies being used in today’s workplaces. Health Solutions Ltd® can help identify the need for these strategies and customize a plan that will best reach employees to make positive behavior changes. For more information about Health Solutions Ltd®, or their partnership with The Alliance, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.
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The Alliance Annual Seminar, on May 4, was a morning filled with learning, networking and a little fun. More than 250 members and other guests came together to hear our two speakers and celebrate the kickoff to our 20 year anniversary celebration.
If you weren’t able to attend, event resources — including an executive summary, speaker slides and other handouts, and a video recording of Dr. Edington and Dr. Lynch’s presentations — are available In the Circle.
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Our annual seminar also included an anniversary retrospective delivered by members, which highlighted our 20 greatest accomplishments of the past 20 years. You can see the retrospective and learn more on our Anniversary page.
We thank all of our members who were able to participate in this portion of the program, including:
Pat Whitmore, Vice President of Administration, HUFCOR, Inc., member since 2006
Jerry Ward, Vice President – Operations, Seats Incorporated, member since 1994
Mike McDonald, VP Human Resources, Foremost Farms USA, member since 1993
Mary Ann Reichling, Director, Benefits, Compensation and EIS, Lands’ End, member since 1992
Tim Wolff, Director of Human Resources, The Swiss Colony, member since 1996
Jennifer Pagels, Manager of Human Resources, Trek Bicycle Corporation, member since 1993
Judy Pierick, Vice President of Human Resources, Webcrafters, Inc., founding member
Did you know that 36 percent of members have been with The Alliance 10 years or more? It’s number one on our list of 20 accomplishments for 20 years. Read them all, and learn more about our beginnings
here.
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As a founding member of WisconsinRx, The Alliance offers a preferred relationship with this cooperative of employers and organizations. Together they are able to achieve greater value for their pharmaceutical benefit dollar through deep discounts, clinical programs, a national network and enhanced data reporting. WisconsinRx/National CooperativeRx serves as employers' PBM watchdog and offers the following benefits to member companies and organizations:
Independently audits 100 percent of claims for pricing guarantees, rebates accuracy, financial accuracy and claims adjudication.
Negotiates a set rebate for every prescription, paid to members after each quarter ends.
Has secured for members a "95% Rebate True-Up”; a supplemental payment can equal or exceed the typical quarterly rebate for member-employers.
Offers a broad choice of no-cost clinical programs for members and contributes additional funds to allow members to choose among fee-based clinical programs.
Provides a full-time staff pharmacist to help members evaluate clinical programs and make recommendations for cost containment.
Returns net earnings to members in the form of patronage dividends. Historically, over 80 percent of monthly membership fees have been returned to members.
To learn more about Alliance preferred pricing from WisconsinRx, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.
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Congratulations to Alliance member Trek Bicycle for their recent award:
- Richard Burke, founder of Trek Bicycle Corporation, was inducted posthumously into the Wisconsin Business Hall of Fame.
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Connect with Jesse Oberloh, Alliance member services manager, on LinkedIn. Jesse is your contact for current Alliance members. Click here and click on Add Jesse Oberloh to your network.
You can also connect with Diane Loram, Alliance business development manager, your contact for prospective Alliance members. Click here and click on Add Diane Loram to your network.
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The Alliance’s Healthy People at Work program can help members rein in costs on workers’ compensation claims. Using the The Alliance’s comprehensive, cost-efficient network of providers for workers’ compensation health-care related claims, Healthy People at Work participants save an average of 30.1 percent on compensable billed charges.
For more information, see our product sheet or contact Jesse Oberloh, 800.223.4139 x6645.
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The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.
Just a reminder: Always check the online provider directory for the most current provider information!
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The Alliance encourages employers to distribute the monthly QualityCounts for Employees informational piece to their employees.
In advance of our upcoming release of QualityCounts (watch for more information in the coming month), this piece provides some tips for choosing same-day or outpatient surgery.
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Each month, The Alliance highlights health care and benefit management news for employers in News You Can Use, with a link to take you to the original story or report.
Read an interview with Jerry Burgess, CEO of Healthcare 21, an employer-based nonprofit coalition, and Chris McSwain, director of Global Benefits at Whirlpool Corporation, to get their perspective on the challenge of integrating care from diverse teams of vendors. From
Purchasing High Performance, a quarterly bulletin from the National Business Coalition on Health and the Commonwealth Fund.
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Each month, The Alliance TPA Briefing delivers the latest news to third-party administrators about Alliance services, programs and events as well as information on health benefit trends, issues and ideas of interest to our mutual clients.
Subscriptions are available on a complimentary basis. To subscribe, please send an e-mail with your name, title and organization to the marketing and member services department.
Reader comments, suggestions and topics are always welcome.
Cathy Lanser, Editor
Daniel Lehnherr, Design
Carlene Boehmer, Manager of Claims & Customer Service
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