1. CARE IMPROVEMENT - Attention: Participating Providers Effective April 20, 2015, Care Improvement Plus (CIP) will begin to perform a concurrent medical necessity review for acute hospital stays for participating providers and integrate the Center for Medicare and Medicaid Services (CMS) Two Midnight Rule as part of the clinical criteria for the concurrent medical necessity review. This means that Participating providers should submit a notification and the supporting clinical documentation that will support the clinical review process. - 2015 Benefits Overview

2. UNITED HEALTHCARE - There are 3 Orthopedic Procedures that will be added to the advanced notification or prior authorization required list as of April 6 th : - 29914, 29915, & 29916 - Coverage updates for March: - * UPDATED: Speech Generating Devices, Telemedicine/Telehealth Services, Ventriculectomy, Partial - * REVISED: DME, GI Services & Procedures, Incontinence, Medications/Drugs, Neurophysiological Studies, Non-covered Services, Preventative Health Services, Spine Procedures & Vision services.

3. AETNA - They are offering at home bone density scans to Medicare patients including skilled nursing facilities. - Female patient 67-85 with a fracture within the previous 6 months - Additional information: 714.460.7545

4. HUMANA - Humana has set up email addresses for questions related to ICD-10 for facilities and providers: Facilities: ICD10Inquiries@humana.comICD10Inquiries@humana.com Physicians: ICD10Physician@humana.comICD10Physician@humana.com - Preauthorization of facility-based sleep studies (PSG) will now be managed by HealthHelp, a benefit management organization - Beginning January 26 th, providers should submit claims with drug codes HCPCS with the corresponding NDC

5. ISSUES - Care Improvement observation appeals

6. CONTACT INFORMATION - Email: Leanne_layne@yahoo.com