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News & Press: Insurance/Provider

Premera BC/BS AK - Preferred Provider Contracts and Massage Therapists Update

Thursday, March 16, 2017   (1 Comments)
Posted by: Sheri Ryan
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In 05/2015, ACS reported via email to our membership and on the ACS website News/Press article that Premera was requiring Massage therapists who work for a Premera-contracted provider to be credentialed and added under the contract once they obtained their license and that Premera was no longer going to allow claims for services rendered by the licensed massage therapists to be billed under the supervising provider’s name.

For chiropractic offices that did NOT add Massage Therapy employees to their contract when the LMT received their license in 2015 - you should be aware of an approaching Premera deadline.  I contacted Provider Relations at Premera on Thursday 3/16/2017 at 800-722-4714, option 4 to find out more information for contracted provider chiropractic offices.  

Effective 07/01/2017, all licensed massage therapists who have employee status (not independent contractors) operating out of Premera Preferred Provider chiropractic offices are required to go through the credentialing process and be added to the chiropractor's existing preferred provider contract.  

Failure to add the LMTs to your existing Premera contract by 07/01/2017 will result in the LMTs being treated as out-of-network providers.  Reimbursement rates are different for in-network vs. out-of-network providers in most cases.    

You will no longer be able to bill for massage therapy services under the DC's NPI number.  You will need to bill for massage services under the LMT's NPI Number.  

Here's the steps to complete to ADD a LMT to YOUR contract:

  1. Apply for an NPI number for the employee.  https://nppes.cms.hhs.gov/NPPES/Welcome.do  You can find more information on how to apply for an NPI on the ACS website News/Press article dated 06/6/16.  
  2. Download an application to add a practitioner from the Premera website https://www.premera.com/documents/010207.pdf  Washington and Alaska share the same application.  Complete the 15 page application.  Tax identification number is from the existing DC preferred provider contract.  You may also complete this process online through your OneHealth Port account with Premera.  It is suggested that if completed online, you contact Premera to let them know there's an application out there to add a practitioner to your preferred provider contract.  
  3. Use the Practitioner Application Checklist (Word doc) to ensure Premera receives all the required documents.  NOTE:  You only have to submit a W-9 if you are requesting a NEW contract.  Since you are adding a practitioner to your EXISTING contract, the W-9 is not required.  NOTE: Documents expiring within 90 days will delay your application process.  LMT licenses are coming up for renewal after 07/01/2017.  Read more on license renewal for massage therapists on the Alaska Board of Massage Therapists website.  
  4. Mail your completed application with supporting documents to Premera Blue Cross, ATTN:  Credentialing, MS 263, PO Box 327, Seattle, WA 98111-0327 or email to credentialing.updates@premera.com or fax to 425-918-4766 with ATTN:  Credentialing on the cover sheet.  NOTE - the credentialing process takes 60-90 days to complete.  

Questions regarding the credentialing process should be directed to Premera Provider Relations, 877-342-5258, option 4.  You can also find this information on the Premera website under Credentialing at https://www.premera.com/ak/provider/reference/forms/

Sincerely,  

Sheri Ryan  |  Chief Operating Officer

Alaska Chiropractic Society | 550 E. Tudor Rd., Suite 202 |  Anchorage, AK 99503

Direct/Mobile: (907) 903-1350 | Fax: (907) 770-3790

sryan@akchiro.org | Facebook  |  Twitter  | Website

Comments...

Sheri Ryan says...
Posted Friday, March 17, 2017
Massage therapists who are independent contractors - not employees - who want to contract with Premera need to complete a credentialing application and request their OWN contract with Premera. Independent contractors cannot be added to an existing Preferred Provider agreement.

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Phone: (907) 903-1350   Fax:  (907) 770-3790   Email:  info@akchiro.org