El Paso Health | About Your Health | Fall 2019

Be ready for the 2020 coding updates Claims denials can become a big burden and affect your revenue cycle if left unattended. Remember to incorporate the 2020 coding changes in your practice management software. Even a small coding error can be the reason for a claim denial. ICD-10-CM / PCS codes for fiscal year 2020 are effective as of Oct. 1, 2019. Updates for CPT and HCPCS codes will be effective on Jan. 1, 2020. Be sure to review new additions, deletions, and revisions to prevent claim denials due to diagnosis or procedure codes. Did something change? In an effort to adhere to Texas Health and Human Services and Texas Department of Insurance standard requirements, El Paso Health must provide the most current and updated information to members and Providers. It is important to notify El Paso Health of any demographic changes that occur within your organization. HOW PROVIDERS CAN HELP Providers assist us in keeping our information current. We don’t know when a change is made in your office unless you let us know. Speak up! To be compliant with our regulators, we ask that you please notify us when any change has been made. You may check the information we have listed for you in our online directory on our website at elpasohealth.com . If you see a discrepancy, please report it. Changes to report include: ■  ■ Practice location ■  ■ Phone and fax numbers ■  ■ Billing updates ■  ■ Provider names ■  ■ Practice name ■  ■ Website URL ■  ■ Office hours Please help us decrease the amount of incorrect information in our directories by reporting all changes to contracting_dept@elpasohealth.com or by fax to 915-298-7870 . E l Paso Health wants all Providers to be satisfied. If at any time you are not satisfied, you have the right to file a complaint with El Paso Health. Complaints must be submitted in writing by fax, secure FTP through our web portal, or by mail to: El Paso Health Attn: Complaints and Appeals Department 1145 Westmoreland Drive El Paso, TX 79925 Fax at: 915 - 298-7872 elpasohealth.com Once we receive your complaint, we will send you an acknowledgment letter within 5 business days from the date it was received and a resolution letter within 30 calendar days. You also have a right to appeal a request for reconsideration of a previously dispositioned claim. El Paso Health recognizes 2 levels of appeals: first level and second level. Appeal letters must be submitted for each member, specifying the reason for the appeal. Your letter must include: ■  ■ Date ■  ■ Contact name (first and last name) ■  ■ Mailing address ■  ■ Phone number ■  ■ Provider name and NPI number ■  ■ Member name, date of birth, and ID number ■  ■ Date of service ■  ■ Claim number ■  ■ Detailed reason for appeal Include the following information: ■  ■ Copy of remittance advice ■  ■ Medical records (if necessary) ■  ■ Proof of timely filing ■  ■ Any pertinent information for review. Once we receive your Level 1 appeal, we will send you an acknowledgment letter within 5 business days from the date it was received and a resolution letter within 30 calendar days. If you are not satisfied with the resolution of the Level 1 appeal, you can submit a Level 2 appeal by following the same process as Level 1. You will also receive an acknowledgment letter and resolution letter for this appeal. If you are not satisfied with the resolution of the Level 2 appeal for STAR claims, you may file a complaint to the Health and Human Services Commission. For CHIP claims, you may submit your complaint to the Texas Department of Insurance. Complaints and appeals 2 resources