AUGUST 2013
ProHealth Provider Relations Update
Page 2-4
New Providers Effective 9/1/2013
Page 6
IMPORTANT UPDATED
INFORMATION FOR
HUMANA Medicare
Advantage and
Commercial Fully
Insured Plans
Pre-Authorization and
Notification List’s
Page 4
Termed Providers
Page 6
Important CIGNA Claims
Notification
Page 5
New SpecPrime Providers effective
8/1/2013 and 9/1/2013
Page 7
Provider Relations Staff Directory
Page 5
IMPORTANT RENEWAL
DEADLINE-Indiana Medical License
Renewal Dates and Information
Provider Relations Department
8180 Clearvista Parkway Suite 230
Indianapolis, IN 46256
Phone: 317/621-7581
www.ecommunity.com/prohealth
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C o n tr a c ti n g a n d C r ed e n ti a lin g Co r n e r
Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective September 1, 2013. Hospital affiliations
will be listed with each provider.
Abraham, Tanya M., MD
Pediatrics
Prime SCP
Ashraf, Komal H., DO
Neurology
Prime SCP
Berry, Jessica M., NP
Family Medicine
Prime PCP
Mid-Level
MedCheck
NA
Carpenter, Angel LCSW
Behavioral Health
Spec Prime
Community Howard Regional
N/A
Carr, Rachel MD
OB/GYN
Prime OBG
Washington Women's Care
CHE/CHN
Ceh, Paula J., PA
Physician Assistant
Prime PCP
Mid-Level
Speedway Family Physicians
Community
Westview
Clark, Jesse N., DO
Family Medicine
Prime PCP
Community Group Family Medicine
CHE/CHN
Codding, Julie NP
Acute Health
Life's Journey
N/A
MedCheck
NA
Coker, Gregory T., NP
Family Medicine
Prime SCP
Mid-Level
Prime PCP
Mid-Level
Kids Express
Neurology Care
Community Behavioral Professionals
CHE/CHN
CHE/CHN
Coplan, Benjamin M., DO
Psychiatry
Spec Prime
CHE/CHN
Cox, Erik D., MD
Pediatrics
Prime SCP
Kids Plus
CHA
Crichlow, Sarah J., PA
Physician Assistant
Prime SCP
Mid-Level
Pulmonary and Critical Care
NA
Dalton, Jim L., PhD, HSPP
Clinical Psychology
Spec Prime
Damar Services, Inc
NA
Dave, Krupa H., PA
Physician Assistant
Prime SCP
Mid-Level
Pulmonary and Critical Care
NA
Epstein, Tolly E., MD
Allergy & Immunology
Prime SCP
Allergy Partners, PC
CHE/CHN
Fisher, Daniel J., MD
Family Medicine
Prime PCP
Community Group Family Medicine
CHE/CHN
Fossum, Erik S., MD
Emergency Medicine
Prime SCP
Medical Associates, LLC
CHE/CHN
Foxlow, Leslie A., MD
OB/GYN
Prime OBG
Southside OB/GYN
CHS
Godambe, Anjali S., DO
Pathology
Prime SCP
AmeriPath, PC
NA
Grayson, Marci LMHC
Behavioral Health
Spec Prime
Gallahue Mental Health Services
N/A
Grimm, Ryan T., MD
Pediatrics
Prime PCP
Pediatric & OB/GYN Care
CHS
Hartmann, Christy L., MD
OB/GYN
Prime SCP
Castleton OB/GYN
CHE/CHN
Herrman, Sara K., PA
Neonatal Care
Prime SCP
Mid-Level
Community Neonatal Nurse
Practitioners
NA
House, Beve P., MD
Emergency Medicine
Prime SCP
Medical Associates, LLC
CHE/CHN
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C o n tr a c ti n g a n d C r ed e n ti a lin g Co r n e r
Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective September 1, 2013. Hospital affiliations
will be listed with each provider.
Huddleston, Erica R., MD
Family Medicine
Prime PCP
Washington Adult & Children's
Care
CHE/CHN
Huggins, Jihan Y., MD
Family Medicine
Prime PCP
Washington Adult & Children's
Care
CHE/CHN
Keating, Vincent P., MD
Electrophysiology
Prime SCP
Heart and Vascular Care
CHE/CHN
Primary Care
Prime SCP
Mid-Level
Community Regional Cancer
Center South
N/A
Leclair, Bridget S., PA
Physician Assistant
Prime SCP
Mid-Level
Pulmonary and Critical Care
N/A
Lill, Diane M., LMHC
Behavioral Health
Spec Prime
Gallahue Mental Health
Services
N/A
Malhi, Amrish S., MD
Internal Medicine
Prime SCP
CPN Heart and Vascular Care
CHE/CHN
Maxey, Kathleen E., MFT
Behavioral Health
Spec Prime
Integrative Health Resources
NA
McCarthy, Michelle J., MD
Family Medicine
MedCheck
MedCheck
CHE/CHN
OB/GYN
Prime OBG
OB/Gyn Care, Anderson
CHA
Cardiovascular Disease
Prime SCP
Community Howard Regional
Health-Bernard Fogelson
Community
Howard
Neucks, Joshua S., MD
Neurology
Prime SCP
JWM Neurology
Ofstein, Richard H., MD
General Surgery
Prime SCP
Vascular Surgeons
CHS
Power, Megan E., NP
Family Medicine
Prime PCP
Mid-Level
MedCheck
NA
Rabadi, Andrea S., NP
Psychiatric and Mental
Health
Prime SCP
Mid-Level
Gallahue Mental Health
Services
CHE/CHN
Schiffli, Evan R., MD
Internal Medicine
Prime PCP
Internal Medicine Associates
CHE/CHN
Schinbeckler, Sarah A. NP
Psychiatric and Mental
Health
Prime SCP
Mid-Level
Gallahue Mental Health
Services
N/A
Schneider, Steven M., MD
Psychiatry and Neurology
Spec Prime
Community Behavioral
Professionals InPatient
CHE/CHN
Siccardi, Bobbi J., LCSW
Behavioral Health
Spec Prime
Gallahue Mental Health
Services
NA
Smith, Ginger LMFT
Behavioral Health
Spec Prime
Community Howard Regional
N/A
Staehler, Sandra S., NP
Gerontology
Prime SCP
Mid-Level
Community Hospital
Oncology Physicians
CHS
Stallion, Ashlie N., MD
Pediatrics
Prime PCP
Pediatric Care
CHE/CHN
Lain, Teresa A., NP
Moss, Valerie K., MD
Nahlawi, Ghaith M., MD
CHE/CHN
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C o n tr a c ti n g a n d C r ed e n ti a lin g Co r n e r
Providers Joining ProHealth
We would like to welcome the following providers to the ProHealth Network effective September 1, 2013. Hospital affiliations
will be listed with each provider.
Storer, Kendra M., NP
Adult Health
Prime SCP
Mid-Level
Heart and Vascular Care
N/A
Swindler, Shaun F., MD
Opthamology
Prime SCP
Eye Physicians, Inc.
Community
Howard
Taulman, Jessica R., DPM
Podiatry
Prime SCP
Foot and Ankle at Westview
Community
Westview
Thyen, Sarah J., PA
Physician
Assistant
Prime SCP
Mid-Level
Pulmonary and Critical Care
N/A
Cardiovascular
Disease
Prime SCP
Pulmonary and Critical Care
Medicine
CHE/CHN
Family
Medicine
Prime PCP
Community Family Health
Center
Community
Howard
Neonatal Care
Prime SCP
Mid-Level
Community Neonatal Nurse
Practitioners
NA
Uppuluri, Sarada C., MD
Yamamoto, Joseph Michael E., MD
Yeo, Stacey L., NP
The following providers will no longer be participating
with ProHealth
Provider Name
Primary Specialty
Term Date
Allyson N. Boodram, M.D.
Pediatrics
8/31/2013
Michael L. Boothe, M.D.
Obstetrics and Gynecology
8/31/2013
Joseph F. Ezernack, M.D.
Emergency Medicine
8/6/2013
Craig R. Johnston, M.D.
Family Medicine
8/18/2013
Jaimie L Pawlosky, LCSW
Licensed Clinical Social Worker(LCSW)
8/31/2013
James E. Schroeder, M.D.
Oncology - Medical
7/31/2013
David A. Schweck, M.D.
Family Medicine
8/31/2013
Thomas M. Whitten, M.D.
General Surgery
8/31/2013
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S P E C P R I M E C o n tr a c ti n g a n d C r ed e n ti a lin g Co r n e r
New Spec Prime Providers Joining ProHealth
We would like to welcome the following Spec Prime Providers to the ProHealth Network..
Bradbury MD, Jamie
Neurosurgery
Spec Prime
Goodman Campbell Brain &
Spine
Effective 8/1/2013
Comer MD, Brett T.
Otolaryngology
Spec Prime
North Central Indiana
Otolaryngology
Effective 8/1/2013
Evans DO, Clifford J.
Orthopedic Surgery
Spec Prime
Howard Regional Orthopedic
Center
Effective 8/1/2013
Fogelson MD, Bernard
Thoracic Surgery
Spec Prime
Howard Regional Health
Effective 8/1/2013
Godambe DO, Anjali S.
Pathology
Spec Prime
AmeriPath Indianapolis, PC
Effective 9/1/2013
Emergency Medicine
Spec Prime
Medical Associates
Effective 9/1/2013
Cardiology
Spec Prime
Community Heart & Vascular
Effective 9/1/2013
Kim MD, Daniel L.
Neurosurgery
Spec Prime
Neurosurgical Care
Effective 8/1/2013
Klim DO, J. Peter
Pain Management
Spec Prime
Howard Regional Health
Effective 8/1/2013
Magid MD, Justin A.
Internal Medicine
Spec Prime
Pulmonary & Critical Care
Effective 8/1/2013
Moore MD, Annette
Hematology Oncology
Spec Prime
Community Oncology Center
Effective 8/1/2013
Neurology
Spec Prime
JWM Neurology
Effective 9/1/2013
Salter MD, John
Hematology Oncology
Spec Prime
Community Oncology Center
Effective 8/1/2013
Urabi MD, Muaz
Internal Medicine
Spec Prime
Pulmonary & Critical Care
Effective 8/1/2013
House MD, Beve P.
Keating MD, Vincent
Neucks MD, Joshua S.
Indiana Medical License Renewal Dates/Information
NEXT RENEWAL DEADLINE OCTOBER 31, 2013
In an effort to increase agency efficiency, the Indiana Professional Licensing
Agency (IPLA), with the approval of the Medical Licensing Board (MLB) under
IC 25-1-5-4(k), has extended the current physician renewal deadline from
June 30, 2013 to October 31, 2013.
As a result, your current physician license and controlled substance registration
(CSR) will now expire on October 31, 2013.
Please complete the on-line RENEW your Medical license and all CSR's on-line by
clicking on https://mylicense.in.gov/egov It is important to complete the Indiana State
Department of Health's Survey as it will be used to determine areas of need in the future.
Renewal fee is $200.00 if renewed on or before October 31st. If renewed after October 31 st
a late fee of $50.00 will be due in addition to your renewal fee.
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IMPORTANT UPDATED INFORMATION FOR
HUMANA Medicare Advantage and
Commercial Preauthorization Notification List
Humana has updated their preauthorization and notification list for Humana Medicare
Advantage (MA) plans and all commercial fully insured plans. Please note that the
precertification, preadmission, preauthorization and notification requirements all refer to the
same process of preauthorization. These list’s represent services and medications that are
commonly reviewed and may require additional clinical information.
Please visit the website below for details and lists.
https://www.humana.com/provider/medical-providers/education/claims/preauthorization
Will Cigna Reject Your Claims Without National Provider Identifier?
The answer is yes!
Beginning October 21, 2013, Cigna will begin rejecting electronic claims received without
a National Provider Identifier (NPI) number. Cigna and other insurance carriers use the NPI
number to process electronic claims so that transactions are handled efficiently and
payments are issued quickly and accurately. Be sure to include your NPI when submitting
claims to Cigna and on electronic transactions that you or your electronic data interchange
(EDI) vendor may submit. Claims without an NPI number will reject or deny resulting in
lost reimbursement for your practice.
If you aren’t sure if your electronic claims are going with the NPI number correctly, contact
your EDI vendor directly. Your vendor can provide information including verifying that the
NPI number is in the correct place on the claim to ensure accurate submissions and
reporting of transactional data.
As a reminder, your Taxpayer Identification Number (Employee Identification
Number or Social Security number) should also be included on electronic claims.
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ProHealth Provider Relations
(317) 621-7581
Department Staff
Judy Bourquin, Director
jbourquin@eCommunity.com
Provider Relations Coordinators:
Carol Boyd, cboyd@ecommunity.com
Hollie Putzback, hputzback@eCommunity.com
Provider Relations Assistant:
Dawn Widgery, dwidgery@ecommunity.com
Manager of Medicaid Services:
Salena Woodson, swoodson2@eCommunity.com
Medicare Program Manager:
Lori White, lwhite4@ecommunity.com
Credentialing and Contracting:
Jenny Bouck, jbouck@ecommunity.com
Kim Tibbets, ktibbets@eCommunity.com
Carmela Williams, cwilliams4@ecommunity.com
Recredentialing:
Sue Bolner, sbolner@eCommunity.com
Behavioral Care Services Credentialing:
Denise Smith, dasmith6@ecommunity.com
Enrollment and Credentialing Manager:
Carol Tucker, ctucker@ecommunity.com
Enrollment Team (TPPECC):
Katrice Gray, kvgray@ecommunity.com
Jenni Martin, jmartin3@ecommunity.com
Kara Welch, kwelch2@ecommunity.com
Jenna White, jwhite2@ecommunity.com
Liz Williams, nwilliams5@ecommunity.com
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