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CCNV 2 nd Annual Client Conference

CCNV 2 nd Annual Client Conference. “Managed Care Organizations and NPI Procedures” Evelyn Pena-Morton, BA Director of Contracting. Managed Care Organizations. Who are they? Any CCNV Master Network Agreement negotiated on behalf of the centers. Managed Care Organizations.

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CCNV 2 nd Annual Client Conference

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  1. CCNV 2nd 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. Aetna Corvel Optima CCN Southern Health United Healthcare/MAMSI Health Net Federal Services Unicare CCNV COMMERCIAL AGREEMENTS 8 Direct Commercial Agreements

  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)

  10. 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

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