CCNV 2 nd Annual Client Conference “Managed Care Organizations and NPI Procedures” Evelyn Pena-Morton, BA Director of Contracting.

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Presentation transcript:

CCNV 2 nd Annual Client Conference “Managed Care Organizations and NPI Procedures” Evelyn Pena-Morton, BA Director of Contracting

2 Managed Care Organizations Who are they? –Any CCNV Master Network Agreement negotiated on behalf of the centers

3 Managed Care Organizations –Currently CCNV has 30 master network agreements –Includes 22 delegated credentialing agreements –Our contracts include an average of 75,000 enrollees, generating substantial revenue for the health centers

4 CCNV COMMERCIAL AGREEMENTS 8 Direct Commercial Agreements Aetna Corvel Optima CCN Southern Health United Healthcare/MAMSI Health Net Federal Services Unicare

5 CCNV MEDICAID AGREEMENTS 5 Medicaid Agreements AMERIGROUP CenVANet Optima Medicaid Southern Health / Care Net Virginia Premier

6 CCNV MEDICARE ADVANTAGE 3 Medicare Advantage Participation Agreements Humana Choice Care PPO Optima Medicare Advantage Pyramid Today’s Option

7 CCNV DENTAL AGREEMENTS 4 Dental Agreements Aetna Dental Benefits Providers Delta Dental Doral

8 CCNV NETWORK AGREEMENTS 7 Network Participation Agreements –4Most Health Network –Galaxy Health Network –Gateway Health Alliance/Halifax PHO –National Capital Preferred Provider Organization (NCPPO) –Three Rivers Provider Network –Virginia Health Network/Great West Healthcare, Inc. –Wellmont/Highlands Physicians (SWVA centers only)

9 Other CCNV agreements 3 Other agreements Virginia Coordinated Care (VCC) Mid-Atlantic Health Solutions Veterans Administration (VA)

NPI Procedures CCNV Network Contracts

11 NPI Procedures Organization (Entity Type1) –Medical Center –Pharmacy Individual Provider (Entity Type 2) –(MD, DO, PA, NP, LCSW, Dentist, Pharmacist, ect.) –Center site must be his/her primary location

12 NPI Procedures Direct Commercial Payors –Will use the both entity and provider NPI’s for billing CCNV Participating Network’s –Are currently collecting from CCNV all entity and provider NPI’s –These are being passed on to their commercial payors

13 NPI Procedures Medicaid –Requires the entity and provider NPI for billing purposes Dental –Requires the both entity and provider NPI for billing purposes

14 Other CCNV agreements NPI Procedures Virginia Coordinated Care (VCC) Uses Virginia Premier as their administrator for payment. Requires the entity and provider NPI Veterans Administration NPI numbers are included with invoice as provided by contract

15 CCNV Contracting NPI Procedure CCNV sent provider and entity NPI numbers to all contracted payor organizations in July 2006 For newly credentialed providers who have been accepted by the CCNV Board of Directors, the demographic spread sheet is updated to include NPI numbers For non-delegated agreements the NPI numbers are included in the applications CCNV continues to respond to requests for NPI information going forward