Physicians and Physician Assistants also will have the opportunity to provide a brief statement explaining the circumstances that led to the judgment or settlement. The proposed rule also provides for the reporting and publication of other background facts including the physician’s education, specialty certification, criminal history, and peer review discipline. Click on link to view the NCMB Proposed Profiling Rules.

Do you know who your candidates are for the NC House, NC Senate, and US Congress? Do you know your state and federal legislative districts?

Visit the NCMS Election Center to identify districts and candidates for the NC General Assembly and US Congress. Profiles and website links for candidates are available, along with information on North Carolina voter registration, key dates, state polling sites, etc. Starting next week, a series of articles will be run in the Bulletin entitled “Election 2008 – Races to Watch,” highlighting primary-challenged or open-seat races in North Carolina. For more information, contact Allison Clipp.

If you did not receive this letter, contact your Aetna provider relations representative to avoid being automatically added to its network. Find more information at http://awca.aetna.com.

The Network is the result of a three-year effort and collaboration between US medical society leaders, liability carriers, health plans, consumer advocacy groups, government leaders and industry, including major pharmaceutical manufacturers.

Registration for US physicians is available immediately at http://www.hcnn.net, where physicians may find more information about online safety Alert services.

It is important to obtain your NPI immediately in order to have time for testing transactions and sharing it with payors, clearinghouses, vendors and other health care providers.

CIGNA Government Services previously announced that effective March 1, 2008, all 837P and CMS-1500 claims must include an NPI or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause Medicare claims to be rejected.

More information is available at http://www.bcbsnc.com/ (access Blue e) or at http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM4023.pdf.

In a March 5 meeting at Aetna headquarters in Hartford, Connecticut, PAI President and NCMS EVP, CEO Robert W. Seligson, NCMS Associate General Counsel Carol Scheele and Aetna Compliance Dispute Facilitator Cameron Staples described the impact of the policy on hospital-based physicians and potential implications for physician relationships in general.

They suggested that the policy impacts not only non-participating physicians but also participating physicians, who may believe that reduced reimbursement for non-participating services will be utilized by insurers as a tool during the negotiation process. Aetna provided data indicating that these circumstances affect a relatively small proportion of Aetna’s claims.

As of April 1, 2008, all Medicaid recipients’ paper prescriptions must be on pads that include specific features, as defined in the memo, satisfying at least one of the following tamper resistant characteristics:
• Prevent unauthorized copying of a completed or blank prescription form.
• Prevent erasure or modification of information written on the prescription by the prescriber.
• Prevent the use of counterfeit prescription forms.

As of October 1, 2008, all Medicaid paper prescriptions must include features satisfying all three tamper resistant characteristics. Medicaid prescribers may implement use of fully compliant tamper resistant prescription pads anytime. DMA encourages providers to implement pads with ALL security features as of April 1, 2008 to avoid the necessity of reordering new pads for use by October 1, 2008.

HighMark Settlement Deadline: Physician practices received claim forms for a second settlement with Highmark Blue Cross Blue Shield, which is in addition to and separate from the earlier Blue Cross settlement. The deadline for submission of this claim form is February 27, 2008. For a copy of the claim form, go to http://www.hmosettlements.com/.

Medicare Fee for Service Billing: Go to
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0802.pdf for information regarding guidelines for inclusion of Medicare legacy identifiers and NPIs on all claims to ensure timely processing and payment. As of May 23, 2008 and beyond, all claims and transactions must include an NPI only in the primary provider and secondary provider fields and will be paid/processed only if there is an NPI/legacy match on the NPI Crosswalk.