ATTENTION PROVIDERS: Change to Payment Policy of Emergency Room Professional Services Effective Date: February 1, 2018

Date: 12/07/17

Managed Health Services (MHS) is committed to delivering cost-effective quality care to our members. This effort requires us to ensure our members receive medical attention at the most appropriate care setting. As part of this effort, MHS has adopted a payment strategy that will align with the level of complexity for services rendered.

Effective February 1, 2018, MHS will provide reimbursement rates consistent with the complexity or severity of services rendered in the emergency room. This may result in lower levels of reimbursement for conditions charged at Level 4/Level 5 procedure codes.

When a claim comes in with a Level 4/Level 5 ER visit and the final discharge diagnosis appearing on the bill indicates a lower level of complexity or severity, MHS will auto-adjudicate the claim to reimburse providers at a Level 3 (99283) reimbursement rate.

Please note, providers retain the right to appeal by providing evidence for medical complexity of procedures performed.

Nothing in this policy excludes the provider’s responsibility to perform the medical screening examination.

Please contact us with any questions regarding this change of payment policy. MHS Provider Services is available to answer your questions from 8 a.m. to 8 p.m., Monday through Friday. Contact us by phone at 1-877-647-4848 or online at mhsindiana.com/contact-us.

Thank you for being our partner in care.

Sincerely,

Robert B. Baker, MD

MHS Chief Medical Director