Date

Re: Effective January 1, 2014:

Expanded Prior Authorization Requirements for Outpatient Services for

Today’s Options® PPO

Dear Provider:

As a follow-up to our letter dated September 9, 2013, we’d like to remind you that we have expanded our current prior authorization program, as outlined below. In addition, we’d like you to know about our upcoming series of provider webinars that explain these new prior authorization requirements.

Today’s Option PPO contracts with CareCore National to pre-authorize outpatient diagnostic imaging procedures. With your cooperation, our partnership with CareCore National has helped to improve the quality and ensure the appropriateness of these services by reducing variations in use of these services.

Beginning January 1, 2014, our prior authorization requirements administered by CareCore National for our Today’s Options PPO members have expanded to include the following outpatient procedures:

·  Cardiac Imaging and Implantable Devices (Transthoracic Echocardiography/Stress Echocardiography/Cardiac Computed Tomography Angiogram/Diagnostic Heart Catheterization and Cardiac Implantable Devices)

·  Musculoskeletal Procedures (Physical Therapy/Occupational Therapy/Chiropractic Services/Pain Management Services/Joint Replacement Surgery and Spinal Surgery)

·  Sleep Diagnostics and PAP Therapy

·  Medical Oncology

·  Radiation Therapy (EBRT/Brachytherapy/IMRT/IGRT/Proton Therapy/Stereotactic Radiosurgery)

·  Laboratory Testing specific to Genetic/Molecular/Cytogenetic/Pharmacogenomic/

Anatomic/Immunohistochemistry/Flow Cytometry/Fluorescent In-situ Hybridization

- more -

Prior Authorization Process:

Beginning December 16, 2013, physicians may request a prior authorization for services with dates of service on or after January 1, 2014 by contacting CareCore National using one of the following methods:

§  Phone: 1-800-792-8814

§  Online: www.carecorenational.com

You can find additional information about the prior authorization requirements for each of these procedures on our website at www.TodaysOptionsPPO.com and on CareCore National’s website at www.carecorenational.com.

CareCore National is also hosting a series of webinars for providers about the new pre-authorization requirements. Please see the table below for the schedule of webinars and the procedures that are covered.

Today’s Options PPO and CareCore National

Provider Webinar Schedule

December 10, 2013
9:00 a.m. – 11:00 a.m. Eastern Time
Topics/Programs to be Covered: Overview of Provider requirements; Overview of Musculoskeletal, Sleep, and Laboratory Programs, followed by Q&A period
Dial-in number: Toll-free - 1-877-668-4493
Meeting ID: 732 832 866
Login information: To join this meeting, go to this link https://carecorenational.webex.com/carecorenational/j.php?J=732832866
December 11, 2013
10:00 a.m. – 12 p.m. Eastern Time
Topics/Programs to be Covered: Overview of Provider requirements; Overview of Radiation Therapy, Medical Oncology, and Cardiology Programs, followed by Q&A period
Dial-in number: 1-877-668-4493
Meeting ID: 738 916 062
Login information: To join this meeting, go to this link: https://carecorenational.webex.com/carecorenational/j.php?J=738916062
December 12, 2013
10:00 a.m. – 11:30 a.m. Eastern Time
Topics/Programs to be Covered: Overview of DME Provider requirements for Positive Airway Pressure (PAP) Compliance monitoring
Dial-in number: 1-877-668-4493
Meeting ID: 736 318 903
Login information: To join this meeting, go to this link: https://carecorenational.webex.com/carecorenational/j.php?J=736318903

We value our relationship with you and look forward to working with you to administer these changes as efficiently as possible. If you have questions, please contact Today’s Options PPO at

1-866-422-5009.

Sincerely,

Dr. Don Beck

Chief Medical Officer

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