I thought I would post a follow up on the topic of reimbursement under the new UHC Veterans Affairs Community Care Network being contingent upon referrals, and the fact that might be a problem for many hospital based radiologists. After several phone calls with various people at UHC Optum, I finally connected with a lady named Tanya Archer, who seemed knowledgeable enough to address my concerns, though not in the way I had hoped.
Bottom line, she was unable to determine whether Optums system has been designed to handle services rendered by hospital based providers like radiologists, either in terms of generating referrals, or processing claims without referrals. I suspect that means it isn't.
After consulting with her superiors, she advised that if other hospital based providers decline the contract amendment, as we did, that should generate enough attention to get this issue addressed. She agreed that I could share this with others.
If anyone hears anything different, I would like to hear about it.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
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Original Message:
Sent: 04-23-2019 12:19
From: Leslie Lochmann
Subject: UHC Veterans Affairs Community Care Network
A few weeks ago, we contacted UHC regarding the program at the number on the letter. UHC stated more information will be provided on their website on 4/26/19 and will likely include a list of exams that do not require prior authorization. We plan to check on Friday to see if information becomes available before deciding about the program. We share the same concerns.
Thanks.
Leslie Lochmann, M.B.A.
llochmann@caperadiology.com
Billing Systems Manager
Cape Radiology Group
#70 Doctors' Park
Cape Girardeau, MO 63703
Phone: 573/334-6071, x. 214
Fax: 573/334-4739
Original Message------
I recently received a contract proposal from UHC for their new VA Community Care Network program. As I read the proposed agreement, a referral from the VA would be required in order to be paid.
I have a hard time imagining how the VA is going to issue a referral to a hospital based radiologist/group. I presume they would be referring to physicians who would be seeing patients and ordering imaging studies that would be presented to us.
Has anyone been able to learn how this program is supposed to work for hospital based radiologists? I have a call in to UHC. The person I spoke with initially had no clue.
Thanks for any insight!
David Smith, FACMPE | Executive Director | 785.393.8387
