june 2016 prohealth provider relations update · june 2016 prohealth provider relations update ......
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June 2016
P r o H e a l t h P r o v i d e r R e l a t i o n s
U p d a t e
I N S I D E T H I S I S S U E :
1 ePower 1 Claim Editing Software 1 MDwise CHNw - eff 7/1/2016
2-3 New Providers, effective
7/1/2016
4-5 Termed Providers
6-7 Veterans Choice Program
8 PH Provider Satisfaction
Survey Results - 2016
9 Provider Relations Staff
Directory
Claim Editing Software Effective 7/1/2016 :
Pro Health has installed new claim editing software effective
July 1, 2016. The claim editing software automates
processing of the same industry-standard claim edits which
have been in use by ProHealth for several years. There is no
change in ProHealth reimbursement policies, but the policies
will be enforced consistently and automatically by the claim
editing software.
If your practice encounters any issues related to claim editing,
please send your usual provider claim appeal letter, along with
supporting documentation, to: ProHealth, Attention Provider
Claim Appeal, 6626 E 75th Street, Indianapolis, IN 46250.
MDwise Community Health Network - effective 7/1/2016:
Community Health Network will become a Delivery System
in the MDwise HHW (Medicaid) and HIP programs, effective
July 1st, 2016. ALL Employed providers will be loaded with
these plans, and patients assigned to CPN PCPs within MDwise will be a part of the MDwise Community Health Net-work delivery system and will be required to see providers within Community Health Network for their medical care.
The ProHealth Medical Management department will be do-
ing Prior Authorizations and Case Management for this popu-
lation. Claims Administration will continue to be performed
by MDwise.
Provider Representative –
Salena Woodson
Phone#: (317)621-7593
ProHealth Medical Management & PA contact info. -
Phone#: (317)621-7575 or 1-800-344-8672
Fax#: (317)983-7757 or 1-844-309-4009
**Please see additional information attached to email**
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Contract ing and Credentia l ing Corner Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective July 1, 2016.
Hospital affiliations will be listed with each provider.
Prime SCP
Boe MD, John - Emergency Medicine
Medical Associates - CHE/CHN, CHS, CHW, CHV
Burke LCSW, Michael - Behavioral Health
CPN - Behavioral Health Professionals Inpatient (Employed)
Childers LCSW, LMHC, Donald - Behavioral Health
Childers Counseling Service
Conover MD, Wayne - Maternal/Fetal Medicine
Kleckner Family Medicine - CHE/CHN, CHW, CHV
Cottone LMHC, Maria - Behavioral Health
Gallahue Mental Health Services (Employed)
Golan LCSW, Kelsey - Behavioral Health
CPN - Behavioral Health Professionals Inpatient (Employed)
Klootwyk MD, Thomas - Sports Medicine
Methodist Sports Medicine - CHE/CHN, CHW, CHV
Schubert MD, Frank P. - Maternal/Fetal Medicine
Maternal-Fetal Medicine Comprehensive Care (Employed) - CHE/CHN, CHW, CHV
Theertham MD, Muni K. - Internal Medicine
Community Howard Regional Health Hospitalists (Employed) - CHRH
Prime PCP
Brenner MD, Tracy - Rheumatology
Rheumatology Associates, PC - CHS, CHE/CHN, CHW, CHV
Kleckner MD, William C. - Family Medicine
Kleckner Family Medicine - CHE/CHN. CHW, CHV
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Prime SCP Mid-Level
Alder NP, Heather J. - Nurse Practitioner
Jane Pauley Community Health Center
Fehrman NP, Stephanie J. - Nurse Practitioner
Life’s Journey Choices in Care (Employed)
Henning NP, Nadine C. - Nurse Practitioner
Heart and Vascular Care (Employed) - CHE/CHN, CHW, CHV
Johnson NP, Audre N. - Nurse Practitioner
Jane Pauley Community Health Center
Jones PA, Melissa - Physician Assistant
Urology of Indiana
Mazanowski PA, Emily M. - Physician Assistant
Orthopedic Specialty Care (Employed) - CHE/CHN, CHW, CHV
Reedy NP, Kristin - Nurse Practitioner
Jane Pauley Community Health Center
Seifert NP, Dena - Nurse Practitioner
Dena Seifert
Shepler NP, Daniel - Nurse Practitioner
Advances Healthcare Associates
Contract ing and Credentia l ing Corner Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective July 1, 2016.
Hospital affiliations will be listed with each provider.
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Termed Providers
The following providers will no longer be participating with ProHealth:
Albrecht MD, John E. - Internal Medicine, termed 6/30/2016
Post Acute Care Specialists, LLC
Apple PA, Drew W. - Physician Assistant, termed 6/30/2016
Central Indiana Orthopedics
Barker MD, John C. - Family Medicine, termed 6/30/2016
Arlington Family Medicine, Inc
Burg LMFT, Jonathan M. - Licensed Marriage and Family Therapist, termed 6/30/2016
Community Hospitals of IN, Inc / Gallahue Mental Health Services (Employed)
Carter Jr, MD, Charles B. - Nephrology, termed 6/30/2016
Nephrology & Internal Medicine, Inc.
Cox MD, Erik D. - Pediatrics, termed 6/30/2016
Community Physicians of IN, Inc / Kids Express & Pediatric Care (Employed)
Ferry MD, Thomas G. - Pulmonary Disease, termed 6/30/2016
Community Physicians of IN, Inc / Pulmonary & Critical Care (Employed)
Glover FNP, LMFT, LMHC, Jeffrey A. - Nurse Practitioner, termed 6/30/2016
Community Physicians of IN, Inc / Family Medicine Care (Employed)
Groves MD, Elizabeth L. - Ophthalmology, termed 6/30/2016
St. Vincent Medical Group, Inc
Jepkorir MD, Carolyne J. - Nephrology, termed 6/30/2016
Nephrology & Internal Medicine, Inc.
Jones NP, Brayton E. - Nurse Practitioner, termed 6/30/2016
Community Physicians of IN, Inc / Touchpoint Senior Living (Employed)
Komari MD, Habib J. - Cardiovascular Disease, termed 6/30/2016
Community Physicians of IN, Inc / Heart & Vascular Care (Employed)
Loehr LCSW, Shannon J. - Licensed Clinical Social Worker (LCSW), termed 6/30/2016
Center for Pain Management / Shadeland Anesthesia and Pain Associates
Mimms MD, Anthony W. - Pain Management, termed 6/1/2016
Mimms Functional Rehab
Murphy PhD, Patrick J. - Psychology, termed 6/30/2016
Community Hospitals of IN, Inc / Gallahue Mental Health Services (Employed)
Oxley LMHC, LCAC, Amy L. - Licensed Mental Health Counselor, termed 6/30/2016
Community Hospitals of IN, Inc / Gallahue Mental Health Services (Employed)
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Termed Providers
The following providers will no longer be participating with ProHealth:
Paino MD, Jane - Family Medicine, termed 6/30/2016
Post Acute Care Specialists, LLC
Paulsen MD, Dean D. - Obstetrics and Gynecology, termed 6/30/2016
Community Physicians of IN, Inc / Community OBGYN (Employed)
Perni MD, Praveen C. - Orthopedics, termed 6/30/2016
American Health Network of IN, LLC
Sabharwal MD, Hemant - Plastic Surgery, termed 6/30/2016
Hemant Sabharwal, MD PC
Small MD, George R. - Family Medicine, termed 6/30/2016
Small, George R., Jr., M.D.
Sturm MD, Barbara - Dermatology, termed 6/30/2016
Franciscan Physician Network / Central IN Dermatology
Tilmans MD, Anthony S. - Oncology-Radiation, termed 6/30/2016
Urology of Indiana, LLC
Williams MD, Timothy J. - Orthopaedics, termed 6/30/2016
Center for Orthopaedic Surgery and Sports Medicine
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ProHealth Provider Satisfaction Survey (Spring 2016) - Results
Thank you to everyone who completed the ProHealth Provider survey, below are the results for some of the key metrics:
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Department Staff
Jenny Bouck, Provider Relations Manager
Business Information Coordinator
Hollie Putzback, [email protected]
Provider Relations Coordinators:
Carol Boyd, [email protected]
Dawn Widgery, [email protected]
Amanda Bobo, [email protected]
Medicaid Program Manager:
Salena Woodson, [email protected]
Medicare Program Manager:
Lori White, [email protected]
Credentialing Enrollment Supervisor: Jenna White, [email protected]
Credentialing Coordinators:
Julia Chumbley, [email protected]
Julie Starr, [email protected]
Kim Tibbets, [email protected]
Credentialing Specialist:
Adrianne Stocks, [email protected]
Provider Enrollment Coordinators:
Aletha Burnett, [email protected]
Amy Walls, [email protected]
Denise Smith, [email protected]
Dianne Castillo, [email protected]
Jessie Eskew, [email protected]
Sharon Harlan, [email protected]
Provider Relations Department
6626 E. 75th St, #500
Indianapolis, IN 46250
Phone: 317-621-7581
www.ecommunity.com/prohealth