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Telephone
855-454-5584
502-719-8600
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FAX
To:
Providers
Fax:
From:
CoventryCares of Kentucky
Date:
April 11, 2014
Re:
Important Reminders & Updates
Pages:
pages including cover
CC:
New edit implementation
ASC Billing
Provider Survey
 Urgent
 For Review
 Please Comment
 Please Reply
 Please Recycle
Notes:
We appreciate your participation in the CoventryCares of Kentucky provider network
and hope you find the enclosed information helpful.
IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may
contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of
this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you
are hereby notified that any dissemination, distribution, or copying of this information is STRICTLY PROHIBITED. If you have
received this message by error, please notify us immediately and destroy the related message.
To:
From:
Date:
RE:
CoventryCares of Kentucky Providers
CoventryCares of Kentucky
April 11, 2014
Notice of Claims Edit Implementation and Ambulatory Surgical Center (ASC) Claims Form
1. Claims Edit Implementation
On April 29, 2014, CoventryCares of Kentucky will implement additional claims edits. These
edits are part of the health plan’s initiative to ensure the quality of care provided to our
members. The edits being implemented will look for services and procedures billed by
providers who are not by conventional wisdom held to have the training or hold the requisite
experience to provide the service or perform the procedure. The denial code on remittance
advices will be, “Not A Covered Service For Provider Specialty.”
Edits being implemented include:
Allowed Provider Type(s)
Service or Procedure

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Otolaryngology
Neurology
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Cardiology
Cardiovascular Surgery

Vestibular Function Tests, With Recording
Auditory evoked potentials for evoked response
audiometry and/or testing of the central nervous
system; comprehensive
Cardiovascular procedures
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Family and General Practice
OB-Gyn
Reproductive Endocrinology
Neonatal-Perinatal Medicine
Radiology
Critical Care
Hospital Medicine
Neurology
Otolaryngology
Pulmonary
Sleep Disorders
Asthma and Allergy
Cardiology
Critical Care
Hospital Medicine
Pulmonology

Ultrasound, pregnant uterus

Sleep testing

Pulmonary laboratory services
Allowed Provider Type(s)
Service or Procedure



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
General Surgery
Nephrology
Radiology
Urology
Vascular Surgery


Ultrasound, retroperitoneal
Ultrasound, transplanted kidney

Otolaryngology

Evoked otoacoustic emissions
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

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Cardiology
Cardiovascular Surgery
General Surgery
Interventional Cardiology
Podiatry
Radiology
Vascular Surgery
Orthopaedics
Physical Medicine
Physical Therapy
Occupational Therapy
Family and General Practice
Podiatry
Neurology
Multispecialty
Cardiology
Cardiovascular Surgery
Emergency Medicine
Family and General Practice
Internal Medicine
Pulmonary Medicine


Extremity Arterial Studies
Extremity Venous Studies

Physical Medicine and Rehabilitation Services

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
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Interpretation and Report for EKG
Cardiac stress test interpretation and/or supervision
Interpretation of cardiac rhythm ECG
Interpretation of External mobile cardiovascular
telemetry
2. Ambulatory Surgical Center Billing
As you likely remember, the Department for Medicaid Services (DMS) implemented required
billing of a provider’s NPI and taxonomy in Fall 2013 for encounters (provider claim data plus
adjudication details). DMS uses encounter data for a number of purposes including
determination of enhanced primary care payments under the Affordable Care Act, and
incentive payments for Electronic Health Record providers.
To date, CoventryCares of Kentucky has allowed Ambulatory Surgical Centers (ASC) to bill using
either a UB 04 or a CMS 1500 claims form. However, after review of encounter rejections and
consultation with DMS, ASCs will only be allowed to be claims on a CMS 1500 claims form going
forward. Since this is a change, we are notifying ASC providers that effective July 1, 2014,
CoventryCares of Kentucky will no longer accept ASC claims submitted on a UB 04 claims form.
Claims will be either denied or rejected.
3. Provider Survey
We are always interested in receiving feedback from our providers. Your provider
representative or any CoventryCares of Kentucky representative is willing to receive your
feedback at any time. However, at least once a year, we want to give our providers a formal
method for feedback by conducting a provider survey. This year’s provider survey period is
open from April 11, 2014 through May 15, 2014. Please access the following website to
participate in the survey: https://www.surveymonkey.com/s/W3BB99B. We have also posted
the link for the survey at www.coventrycaresky.com on the Provider Page. You can click on the
Provider Satisfaction Survey link on that page. Thank you in advance for you participation.
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(502) 612-9958
(812) 660-1394
(502) 719-8743
(502) 719-8604
rlgullo@cvty.com
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ldlewis@cvty.com
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(270) 498-1443
axwilson4@cvty.com
(502) 612-9958
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rlgullo@cvty.com
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(606) 331-1075
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Rev 4.10.14