NETWORK PROVIDER MANUAL

NETWORK PROVIDER
MANUAL
OneCall Care Management
Effective Date: 5/11/2015
T
F
1.800.733.2588
1.952.947.4915
6700 Washington Avenue South
Minneapolis, MN 55344
AmericanHearingBenefits.com
American Owned & Operated
TABLE OF CONTENTS
Participating Providers .............................................................................................................2
New Hearing Instrument(s) Ordering ........................................................................................3
Referrals ..................................................................................................................................3
Warranty ..................................................................................................................................4
New Hearing Instrument(s) Approval ........................................................................................4
Repairs, In Warranty ................................................................................................................5
Repairs, Out of Warranty ..........................................................................................................5
Loss and Damage ....................................................................................................................5
Earmolds ..................................................................................................................................5
Batteries ...................................................................................................................................6
Replacement RIC Receivers ....................................................................................................6
Follow Up Services ..................................................................................................................6
Returns & Exchanges...............................................................................................................7
Frequently Asked Questions ....................................................................................................7
PARTICIPATING PROVIDERS
In order for claims to be processed in a timely manner, please adhere to the guidelines within this
manual.
All credentialed hearing professionals in the AHB network can participate in this program.
If your facility is not currently enrolled with AHB, you will need to submit a completed AHB
credentialing form. For more information on how to become an AHB provider, please contact the
AHB credentialing team:
[email protected]
If you have questions regarding OneCall Care Management’s policies or procedures, please call our
designated provider line:
1.800.733.2588.
2
NEW HEARING INSTRUMENT(S)
Products from the following companies have been approved by OneCall Care Management
(OCCM) and TechHealth for AHB network use.
• Starkey®
• Audibel®
• NuEar™
REFERRALS
Patient referrals originate from OneCall Care Management. The following organizations are
the ones most commonly involved with One Call Care Management:
TOP 20 CARRIERS
Sedgwick
ESIS
Special Funds
Broadspire
Liberty Mutual
York Risk Services
PG&E
PMA Group
CCMSI
Zurich NA
Gallagher Bassett
Tristar Rem
Northeast Utilities
City of Tulsa
Care IQ/Corvel
County of San Diego
Corvel
City of Long Beach
City of Sacramento
SCIF
TOP 20 EMPLOYERS
Boeing
General Motors
Weyerhauser
Alcoa
General Electric
Pacific Gas & Electric
Georgia Pacific
GENESCO
BP
US Steel
Rio Tinto
Shell
International Paper
Qwest
Verizon
CenturyLink, Inc.
Boise Cascade Corporation
Delta
Lockheed Martin
City of Sacramento
3
WARRANTY
Each new hearing instrument carries a three-year warranty on repairs and loss and damage.
Remakes within the first year are covered under the new aid repair warranty. During the first
year of warranty, hearing aid checks, cleaning, programming and adjustments may NOT be
billed to OCCM or collected from the claimant.
NEW HEARING INSTRUMENT(S)
APPROVALS
 Patient referrals come from One Call Care Management.
 Occasionally, patients may contact providers first, in which case the provider will need to
contact One Call Care Management.
 After evaluating the patient, the provider completes and submits a referral form to One Call
Care Management for approval (see sample Hearing Aid Referral Request Form.)
Please send the following information with your new hearing aid order:
 Hearing Aid Order Form with PO number from OneCall Care Management
 Ear Impressions (when necessary)
You may submit your standard hearing aid order via email to: [email protected]. Custom
orders should be sent to Starkey, Attn: AHB.
After delivery please submit:
 Confirmation of Delivery document, signed by the provider and patient, must be submitted after
fitting. Please note, claim will not be billed until this document is received. Provider fees are
not paid until the claim has been paid.
4
REPAIRS
IN-WARRANTY REPAIRS
Hearing instruments covered under warranty will be sent directly to Starkey for repair. Please
send OCCM repairs to Starkey, Attn: AHB. Repairs are processed under your AHB account
with Starkey Hearing Technologies.
OUT-OF-WARRANTY REPAIRS
A PO number must be obtained from OCCM prior to out-of-warranty repair services. Please include this
number on your repair form.
Hearing instruments out of warranty will be sent directly to Starkey for repair. Please send
Attn: AHB. Repairs are processed under your AHB account with Starkey Hearing
Technologies.
OTHER
LOSS AND DAMAGE
A PO number must be obtained from OCCM prior to loss and damage fulfillment. Please include this number
on your order form.
Loss and damage orders for hearing instruments covered under warranty will be sent directly
to Starkey, Attn: AHB for coverage. The loss and damage warranty can be used once per
hearing instrument, and is processed on your AHB account. Providers will be paid a
reimbursement fee from OCCM. Providers cannot bill claimant for L&D fees or services.
EARMOLDS
A PO number must be obtained prior to ordering an earmold. Please include this number on your order form.
Earmold orders will be sent directly to Starkey, Attn: AHB. Earmolds are processed on the
provider’s AHB account number. No charge should be passed to the claimant.
5
BATTERIES
Each hearing aid will ship with 1 carton (40 cells) of batteries. Please give this carton to the
claimant. A post card will be sent directly to the claimant around their purchase anniversary
date instructing them how to obtain their additional batteries at no charge from AHB. Each
claimant is entitled to 3 cartons per aid.
REPLACEMENT RIC RECEIVER
A PO number must be obtained from OCCM prior to ordering a replacement receiver. Please include this
number on your order form.
Replacement RIC receiver orders will be sent directly to Starkey, Attn: AHB. Receivers are
processed on the provider’s AHB account number. No charges should be passed onto the
claimant.
FOLLOW UP SERVICES
HEARING AID CHECK
A PO must be obtained from OCCM prior to billing hearing aid checks.
The provider fee for a hearing aid check including cleaning, adjustment, tube replacement and
other related services shall be dispensed. Hearing aid checks can be billed after the first year
and every six month thereafter.
PROGRAMING
A PO must be obtained from OCCM prior to billing.
The provider fee for a programming after the first year shall be dispensed. Programming can
be billed after the first year and every six month thereafter.
6
RETURNS & EXCHANGES
RETURNS
Please send the hearing instrument to Starkey, Attn: AHB. Provider fees do not need to be
returned as long as the patient has been fit and has worn the hearing aids.
EXCHANGES
A PO must be obtained from OCCM prior to billing.
Exchanges must be approved by OCCM if changing technology as a new PO will be needed.
FREQUENTLY ASKED QUESTIONS
Q: If an injured worker loses their hearing instrument(s), will OCCM cover a replacement?
A: OCCM will NOT replace lost instrument(s). However, under the three-year manufacturer's
L&D warranty, one replacement is allowed. AHB network providers will be reimbursed for
their time and service to fit the new aids.
Q: How often will OCCM cover new hearing instrument(s) for its members?
A: OCCM considers the life expectancy of a hearing instrument to be five years, but will cover
replacement of new hearing instrument(s) whenever it is medically necessary. For
example, if the injured worker’s hearing has changed, their current aids are in disrepair, or
the current aids are of a low quality which do not work with the patient’s lifestyle. A letter of
justification must be sent to try for an approval before 5 years.
Q: What charges can be passed to the claimant?
A: None. You will be reimbursed from AHB for the services you render as indicated in this
manual.
7