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WCH Bulletin February 2012 VOLUME 3 ISSUE 2

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Welcome to the February issue of WCH bulletin. is 5010 H C

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Grow Your Practice with a Compelling Website & Effective Internet Marketing

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New WCH Blog on page 6

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WCH Service Bureau is a proud member of the following professional organizations:


INSIDE THIS ISSUE: WCH BUZZ WCH is 5010 compliant, what about other hundredths of billing companies and clearinghouses?.......................................................................................................................3 WCH Webinar service. ...................................................................................................3 Let WCH helps you to create your own practice website............................................................4 WCH Credentialing department can help with updating providers credentialing file.........................5 Providers must agree to EFT for Medicare payment.........................................................................5 New WCH Blog....................................................................................................................................6

HEALTHCARE UPDATES 27,4% Cut has been postponed by Medicare for 10 months. .......................................7 Starting Fall 2012, New Federal Rules Require Enrollment Revalidation for All NY Medicaid Providers .................................................................................................................7 NY Medicaid major changes in Transportation service and Coverage!..............................................7 Oxford Medicare plans . .....................................................................................................8 Medicare Will Pay for Obesity Screening, Intervention..................................................................8 Only One Electronic Remittance Advice Recipient per NPI/Legacy ID Beginning Sunday, April 1st.....9 Immediate Recoupment for Fee for Service Claims Overpayments..................................................9 Interaction of the MPPR on Imaging Procedures and the OPPS Cap on the Technical Component.....10 New Waived Tests ........................................................................................................10-11 Updating Beneficiary Information with the Coordination of Benefits Contractor............................12 Medicare advantage premiums down 7 percent on average, enrollment up 10 percent.............13 QUESTIONS AND ANSWERS . ........................................................................................14 CONTACT US ..........................................................................................................15 FEEDBACK.............................................................................................................16


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WCH BULLETIN

WCH 5010 is compliant, what about other hundreds of billing companies and clearing houses?

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WCH has noticed that many physician practices that are not handled by WCH are not getting paid for their claims. The biggest problem is, that billing companies and clearing houses that these offices are using, are not 5010 compliant. We can assure you that your claims are in good hands, WCH is 5010 compliant. As reported earlier, we become compliant before January 1st deadline. is 5010 H We have updated software and passed necessary test as a C vendor with insurance companies, we are officially registered with Medicare program as 5010 compliant vendor, as well as with other insurance companies. If you know any medical providers, which are experiencing problems with receiving payment or submitting claims to insurance companies, please give them WCH contacts and we will help them. Once again, we want to make sure that you know, that WCH is 5010 compliant and your claims are in good hands!

WCH Webinar service. What is a Webinar? Webinar – is a service for web-conference, online-meeting, seminars and presentations via Internet in real-time mode. WCH offers Webinar service, which helps you in communications with your colleagues and customers, where ever you are. Participants can access to the service in the web-browser without long and tiring downloading of software. Service has very convenient, simple and intuitive measuring interface. Service provides possibility of recording webinar for the future downloading and later viewing by webinar users. Have the opportunity to communicate with webinar speaker, participants can answer and ask questions by the text chat or voice communications. Webinar can be used for distance education and trainings, seminars and on-line meetings, presentations for customers, attraction of new clients, demonstration of new products, negotiation and teamwork. Webinar is the perfect tool for corporate education. Distance education and trainings via webinar allow not spending time and money on business trips, tickets and hotels, and it also gives you opportunity to receive new knowledge without discontinuing work.

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WCH BULLETIN

Let WCH helps you to create your own practice website. You may ask: Why should I create a website for my practice? In our present days the internet is one of the most underutilized operational resources and sometimes many patients complain that it's difficult to find information about doctors online. All people wish they could view more information about their doctor online. A website is a perfect way to connect you and your patients, a simple, visually attractive, and easily accessed site for your practice, should help your patients and prospective clients find crucial information. Share useful data including your location and contact info, the services you offer, which insurance plans you accept, and a list of frequently asked questions. The creation of a business website will allow you to present your practice in its best light. Thanks to your website you'll be able to attract new patients, find business partners. A website is a simple way to connect you and your patients.

Another important question: I'm part of a multiple Doctor practice. Why do I need my own internet presence? Many multi-doctor practices have own practice website, but WCH recommend every physician has a unique creative and innovative website to highlight their personal profile. Your own, individual website helps you build a personal strong brand. As a member of a large practice or hospital group, you are one of many physicians, perhaps even one of several specialties. Mutual website is generally concentrate on corporate branding and often limits individual physicians to a short biography and a picture. A personal website allows physicians to share more information with their patients and include regular additional comments on Facebook or Twitter.

“Creating any site begins from a dream. Creating a business website, usually begins from a dream about income.� (WCH Service Bureau, Inc) We offer the highest quality website design. Each of our designs is built-to-suit from scratch, without using any templates. You will be unique to your practice and specialty. WCH can help not only to create an effective website but will also make it rank high on search engines. Our talented creative team will help you to obtain the results you want. By working with national organizations and internet marketing companies we are able to optimize the informational link between physician and client. Social networks will allow you to post news about your practice, respond to questions, stay connected with patients, create a more personal relationship with patients on a regular basis, and generate referrals. Your Website, facebook, twitter, you-tube, linkedin will bring you new patients Every Day. WCH is able to work with any size practice or budget.

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WCH Credentialing department can help with updating providers credentialing file. Attorney General: Fined insurers must update provider directories Eight New York insurers have agreed to pay a $60,000 collective fine and will ensure their provider directories are accurate under a settlement agreement with the state attorney's general office. After conducting an investigation into the accuracy of insurers' online directories, New York Attorney General Eric Schneiderman found unreliable listings that wasted consumers' time and delayed access to care, reported WBNG.

In addition, the insurers pledged to keep their directories up-to-date by removing providers no longer participating in their health plans and correcting any errors concerning providers who are in their plans, according to the Greater Binghamton Business Journal.

Schneiderman also is requiring the eight insurers to prepare and file reports with his office describing their efforts to correct the directories, hire an auditor to ensure their compliance and track complaints regarding the directories' accuracy and document how they "Consumers are entitled to accurate resolved each complaint, the Long Island information from their health-care insurers, Business News reported. especially something as basic as whether or not their doctor is in their network," Schneiderman said. The insurers (Empire HealthChoice, Empire HealthChoice Assurance, Health Insurance Plan of Greater New York, HIP Insurance Company of New York, United HealthCare of New York, Oxford Health Plans of New York, United HealthCare Insurance Company of New York and Vytra Health Plans) must provide restitution for any customers who paid out-ofpocket expenses after seeing out-of-network providers who were incorrectly listed as being in-network.

Providers must agree to EFT for Medicare payment. Providers and suppliers have until March 31 to comply with the new Health Insurance Portability and Accountability Act (HIPAA) transaction standards for submitting claims electronically, and can even opt out and continue to submit paper-based claims if they so choose. If they want to get paid, however, they'll have to accept the wave of the future. We can help you to apply for Medicare EFT payment. WCH credentialing Department can help you to start receiving your Medicare payment directly to your bank account by applying for EFT. Who can apply for Medicare EFT? As part of CMS' revalidation efforts, all suppliers and providers who are not currently receiving EFT payments.

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What documentation WCH needs to apply for Medicare EFT? Those providers who are not currently receiving EFT payments are required to submit the following documentation to WCH: џ Signed CMS 588 EFT form; џ Voided check in the name of the Practice/Doctor; What will WCH do? WCH will prepare EFT form, attach all necessary documents and submit it for process to NGS Medicare; we will monitor the process of the request and provide you with the feedback of the ongoing status. Please keep in mind that the process can take up to 30 business days. Electronic Funds Transfer may give you the following benefits: џ Reduction to the amount of paper in the office џ Valuable time savings for staff and avoidance of hassle associated with going to the bank to deposit Medicare check џ Elimination of the risk of Medicare paper checks being lost or stolen in the mail џ Faster access to funds; many banks credit direct deposits faster than paper checks џ Easier reconciliation of payments with bank statements Feel free to contact our Credentialing Department specialist Julia Bondarenko at (646) 434-5569 or via e-mail: YuliyaB@wchsb.com Contact us and we can do it for you!

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HEALTHCARE UPDATES 27,4% Cut has been postponed by Medicare for 10 months. On Friday, February 17th the U.S. House of Representatives voted 293-132 to pass a compromise bill that would delay the implementation of 27% cut in Medicare pay rates for 10 months, starting March 1. We realized that this postponement is a temporary relief for doctors, but it is still a good in some days. WCH will continue to inform you about updates of expected cut closer to the summer 2012.

Starting Fall 2012, New Federal Rules Require Enrollment Revalidation for All NY Medicaid Providers. New federal rules and regulations require that all enrolled providers revalidate their enrollment at least every five years. Revalidation will include attestation of credentials as well as the agreement to abide by the rules and regulations of the Medicaid program. Certain provider types will be required to pay a fee for revalidation. A revalidation process will be initiated by the Department in the Fall of 2012. Revalidation will be rolled out by provider type. Correspondence will be sent to providers by Medicaid program, advising them of their need to revalidate their enrollment. Providers will then have 150 days from the receipt of the notice to complete the process. Failure to comply with the revalidation and attestation within the timeframe will result in provider disenrollment from the Medicaid program.

WCH Credentialing Department can help you with the process of revalidation. As soon as the revalidation will be mailed by NY Medicaid, please contact WCH for help! In the upcoming months, additional information regarding the revalidation schedule and instructions will be posted on www.eMedNY.org, and we will inform you of any upcoming updates. If you have any questions about NY Medicaid revalidation or other credentialing issues, please feel free to contact our Credentialing Department specialists at (718) 934-6714 x 1102 or via email: GeorgeO@wchsb.com.

NY Medicaid major changes in Transportation service and Coverage! The Medicaid Redesign Team (MRT) is committed to minimizing the barriers to accessing needed transportation, improving the quality of transportation services, ensuring consistent application of Medicaid rules and reducing costs. The MRT's investment in this initiative will result in the nation's largest Medicaid non-emergency transportation management program. For those Medicaid enrollees not covered by a managed care plan, orders for transportation will 3047 Avenue U, Brooklyn NY 11229

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WCH BULLETIN

be phased in by borough throughout 2012. Medical facilities or practitioners who request transportation will contact LogistiCare to schedule transportation according to the seasonal timeline below: Practitioner/Facility Location and Implementation Date. џ Brooklyn (Spring) џ Queens (Late Spring) џ Manhattan (Summer) џ Bronx (Summer) џ Staten Island (Fall) Additionally, on January 1, 2013, LogistiCarewill assume the management of transportation of enrollees covered by a managed care plan, resulting in a single process for medical practitioners and enrollees requesting transportation. Transportation Providers. Enrolled Medicaid transportation providers will continue to participate, and will be used for those facilities and practitioners who request their service. Further, reimbursement of rendered transports will continue to be made via eMedNY at the Department of Health established fees. WCH can help with enrollment, please contact our credentialing department. source Medicaid

Oxford Medicare plans. UHC is currently transferring all Oxford/AARP Secure Horizon patients to UHC. UHC is calling all enrolled providers and informing them about the change. Therefore many of you will be asked what does it mean for them. New cards will be issued and claims should be submitted with UHC payer ID 87726, not under Oxford. Please be aware of this transition.

Medicare Will Pay for Obesity Screening, Intervention. Medicare will cover obesity screening and behavioral therapy as part of its portfolio of preventive services. Medicare will pay for seniors to see their doctors for regular weight-loss counseling and it's hoped that the move will encourage private health insurers to do the same. Obese Medicare beneficiaries (BMI 30 or higher) will be able to see their primary care physician for one face-to-face visit for weight-loss counseling every week for the first month. After that, Medicare will pay for one face-to-face visit every other week for the next five months. If the patient loses at least 3 kg (6.6 lbs.) over the first six months, Medicare will pay for another six months of once-a-month face-to-face visits with the doctor. The benefit is available immediately without co-payments. source Medicare 3047 Avenue U, Brooklyn NY 11229

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Only One Electronic Remittance Advice Recipient per NPI/Legacy ID Beginning Sunday, April 1st. Prior to the implementation of HIGLAS (the Healthcare Integrated General Ledger Accounting System), Medicare's Multi-Carrier System (MCS) created just one check per sender, National Provider Identifier (NPI), or legacy ID. Each sender / NPI / legacy ID was able to have multiple receivers of the electronic remittance; MCS would use the sender ID submitting each claim to aid in determining to whom the remit should be sent. For each check that was created, MCS also created an electronic remittance advice (ERA), which accurately reported the payment amount for that ERA. When a Medicare administrative contractor (MAC) transitions to HIGLAS, only one check can be produced per NPI/legacy ID. The old MCS system logic, which took the sender information into account when generating the remit, was not

changed when MACs began their transition to HIGLAS; in some instances, the result was a remittance advice that did not contain all of the claims processed in a given cycle or a remittance advice containing payments that did not total to the EFT/check amount. In order to accurately produce electronic remittance advices to match the EFT/check amount, MCS will be changing their logic effective Sunday, April 1, 2012 – and will no longer consider the sender information when creating the ERA files. MACs will allow only one receiver of an electronic remittance per NPI/legacy ID regardless of whether the provider submits their inbound files under different sender IDs. Your respective MAC will be contacting you if you are set up on their files for multiple receivers of the ERA, in which case you will need to select one receiver for your electronic remittance CMS Learn Resource

Immediate Recoupment for Fee for Service Claims Overpayments. Medicare contractors begin recoupment of an overpayment on day 41 from the date of the initial demand letter. Effective July 1, 2012, however, providers can request recoupment to begin prior to day 41. Providers who elect this process may avoid the assessment of interest if the overpayment is paid back in full before day 31. Providers who voluntarily choose immediate recoupment must do so in writing (by mail, FAX, or email) to contractors. The letter should contain the following information: 1. Provider name and phone number 2. Provider Medicare number and/or National Provider Identifier (NPI) 3. Provider or CFO's signature 4. Demand letter number 5. Which option the provider is requesting 3047 Avenue U, Brooklyn NY 11229

Providers can elect a one-time immediate recoupment request for the current overpayment and all future overpayments or request immediate recoupment for a specific overpayment addressed in a demand letter. A request for immediate recoupment letter must be received by contractors no later than the 16th day from the date of the initial demand letter. In accordance with 42 CFR 405.378, simple interest at the rate of 10.50 percent (effective Jan. 19, 2012) will be charged on the unpaid balance of the overpayment beginning on the 31st day. Interest is calculated in 30-day periods and is assessed for each full 30-day period that payment is not made on time. In other words, if payment is received 31 days from the date of final determination, one 30day period of interest will be charged. CMS Learn Resource

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Interaction of the Multiple Procedure Payment Reduction (MPPR) on Imaging Procedures and the Outpatient Prospective Payment System (OPPS) Cap on the Technical Component Effective January 1, 2012, CMS is discontinuing the use of the “global cap” amount in calculating global payments of certain diagnostic imaging procedures. Medicare implemented the Multiple Procedure Payment Reduction (MPPR) rule on the TC of certain diagnostic imaging procedures effective January 1, 2006, and CR7703 is a reminder that effective January 1, 2012, the MPPR will also be applied to the Professional Component (PC) of such services. The MPPR rule applies to PC-only services, to TC-only services, and to PC and TC portions of global services. Full payment is made for the PC service with the highest payment under the Medicare Physician Fee Schedule (MPFS). Payment is made at 75 percent for subsequent PC services furnished by the same physician to the same patient in the same session on the same day. Full payment is made for the TC service with the highest payment under the MPFS. Payment is made at 50 percent for

subsequent TC services furnished by the same physician to the same patient in the same session on the same day. The individual PC and TC services with the highest payments under the MPFS of globally billed services must be determined in order to calculate the reduction. Currently, global services are compared against a “global cap” derived from adding the TC capped amount to the PC. However, with the implementation of the MPPR on the PC, this could result in a situation where, although the global payment amount is lower than the “global cap” amount, the TC is higher than the TC cap amount and is not appropriately being reduced. Therefore, CR7703 announces that CMS is discontinuing calculation and use of the “global cap” amount. CMS Learn Resource

New Waived Tests Related CR Release Date: February 3, 2012 Effective Date: April 1, 2012 Implementation Date: April 2, 2012 CLIA regulations require a facility to be appropriately certified for each test that it performs. To ensure that Medicare and Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA certificate level. CR7694, from which this article is taken, announces the latest 11 tests approved by the FDA as waived tests under CLIA (effective April 2, 2012). The Current Procedural Terminology (CPT) codes for the following new tests must have the modifier QW, defined as CLIA waived test, to be recognized as a waived test. However, the tests displayed at the beginning of the following table (i.e., CPT codes: 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651) do not require a QW modifier to be recognized as a waived test.

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WCH BULLETIN TESTS GRANTED WAIVED STATUS UNDER CLIA

CPT Code 82274QW G0328QW 81003QW G0434QW 81003QW G0434QW G0434QW 80061QW, 82465QW, 82947QW, 82950QW, 83718QW, 84450QW, 84460QW, 84478QW 82055QW G0434QW 81003QW 82055QW 86386QW 86386QW

Description

Effective Date September 8, 2004

Hemosure One-Step Fecal Occult Blood Test

October 28, 2009

Acon Mission U120 Urine Analyzer

May 5, 2011

Premier Integrity Solutions P/Tox Drug Screen Cup {OTC}

June 2, 2011

BTNX Rapid Response U120 Urine Analyzer Instant Technologies, Inc. iCassette DX Drug Screen Test Express Diagnostic Int’l Inc DrugCheck Waive RT (Model 9308z)

July 7, 2011 July 19, 2011 August 16, 2011

Alere Cholestech LDX {Whole Blood}

September 13, 2011 September 12, 2011 September 26, 2011 October 4, 2011 January 1, 2012 January 1, 2012

Acon Laboratories Inc. Mission Saliva Alcohol Test Strip Amedica Biotech Instant Test Cup Immunostics Inc., Detector Uristrip+ Analyzer Teco Diagnostics Saliva Alcohol Test Alere NMP22 BladderChek Test (Prescription Home Use) Alere NMP22 BladderChek Test (Professional Use)

For 2012, the new CPT code 86386 was developed for the Nuclear Matrix Protein 22 (NMP22), qualitative test. Therefore, the CPT code assigned to the Matritech, Inc. NMP22 BladderCheck Test for Professional and Prescription Home Use is changed to 86386QW with an effective date of January 1, 2012. CMS Learn Resource

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WCH BULLETIN

Updating Beneficiary Information with the Coordination of Benefits Contractor. In compliance with Section 111 of the Medicare, Medicaid and State Children's Health Insurance Program (SCHIP) Extension Act of 2007 (known as Section 111 of the MMSEA), CMS has implemented a process through which private insurers (both Group Health Plans (GHP) and Non Group Health Plans (NGHP)) submit coverage information to the COBC when they also provide coverage to a Medicare beneficiary. A private GHP insurer reporting under Section 111 is known as a Responsible Reporting Entity (RRE), and the COBC receives Section 111 data input files from approximately 1,500 GHP insurers, and each file can include large numbers of individual coverage records. This information permits CMS to more accurately determine who (either the private insurer or Medicare) has primary, or secondary, claims coverage responsibility. Occasionally, information submitted to the COBC from any number of sources, including GHP RREs, service providers, and beneficiaries themselves can conflict with MSP information previously reported to the COBC. To reduce such conflicts in the future, CMS has developed and implemented a data management “Reporting Hierarchy” process, which the COBC administers (effective April 1, 2011). An explanation of the Hierarchy rules can be found at http://www.cms.gov/MandatoryInsRep/Dow nloads/GHpHierarchy.pdf on the CMS website. The COBC works closely with GHP RREs and other reporters in order to reduce “hierarchy” conflicts in future reporting. The following steps are in place to help providers update MSP records: COBC Initiatives џ Provider attempting update with the beneficiary in the office: The first time a call is made to update the

record after April 4, 2011, it will be updated via the telephone call. For any subsequent calls made to update the record after April 4 2011, no update will be made on the call, but two options are available: 1) Proof of information can be faxed or mailed on the insurer or employer's company letterhead, and the update will be made in 1015 business days; or 2) You can contact the insurer or employer organization that last updated the record. џ Provider attempting update when the

beneficiary is not in the office: No update will be made from a telephone call. The provider has 3 options to have the record updated: 1) Have the Beneficiary contact COBC; 2) Contact the Beneficiary's insurer to resolve the issue; or 3) Fax or mail proof of information on the insurer or employer's company letterhead and the update will be made in 10-15 business days. џ Provider with new information: The COBC will take new information for a Beneficiary, but if the new information requires changes to an existing record, two options are available: 1) The Beneficiary will need to call to close out the record; or 2) Fax or mail proof of information on the insurer or employer's company letterhead and the update will be made in 10-15 business days. џ Provider update for deceased beneficiary: A SINGLE update can be made by ONE provider for a Deceased Beneficiary, once the date of death has been confirmed. Any subsequent updates would need to be handled by a family member with the appropriate documentation, including a death certificate. CMS Learn Resource

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Medicare advantage premiums down 7 percent on average, enrollment up 10 percent. Data released by the Department of Health and Human Services today show those premiums for Medicare Advantage plans decreased an average of seven percent for 2012 and that enrollment in the plans increased by 10 percent. The average decrease exceeds the four percent estimated drop in Medicare Advantage premiums made by HHS in September at the beginning of the open enrollment period. The average monthly premium for 2012 is $31.54 in 2012 down from an average of $33.97 in 2011. Since the enactment of the Patient Protection and Affordable Care Act in 2010, MA premiums have decreased by more than 16 percent on average and enrollment in the plans has increased by 17 percent. Total enrollment in MA plans now exceeds 12.8 million seniors. Further, in 2012 high-rated plans under the HHS rating system, for the first time, will qualify for bonus payments as an incentive to achieve a high quality score. Five-star rated Medicare Advantage and Medicare Part D prescription drug plans will have the added incentive of being able to market and enroll new members throughout the year instead of being restricted to the yearly open enrollment period. According to figures released by HHS, access to Medicare Advantage plans continues to remain nearly universal. On average, there are 26 different Medicare Advantage plans available in nearly every county in the country. In all, more than 99.7 percent of the senior population has access to a Medicare Advantage plan. source U.S. Department of Health and Human Services

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QUESTIONS AND ANSWERS 1. Q: What are the 4 New Jersey HMOs? A: The four (4) health plans are: 1. Amerigroup New Jersey, Inc. (Serving all counties except Salem) 2. Healthfirst Health Plan of New Jersey (in 10 counties: Bergen, Essex, Hudson, Mercer, Middlesex, Morris, Passaic, Somerset, Sussex and Union) 3. Horizon NJ Health (Serving all counties) 4. UnitedHealthcare Community Plan (Serving all counties)

2. Q: What services will now be carved into managed care? What services will now be corved by New Jersey HMO which for previously covered by NJ Medicaid program? A: On July 1, 2011, the following services will be covered by manage care: 1. Home Health for all members, including members who have been receiving this benefit with Medicaid fee-for-service; 2. Pharmacy for all members, including those members who have been receiving this benefit with Medicaid fee-for-service; 3. Personal Care Assistant (PCA) (Personal Preference, a self directed service, will remain under Medicaid fee-for-service); 4. Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST); and 5. Adult and Pediatric Medical Day Care Services. Dually eligible and waiver program clients will continue to receive these services under Medicaid fee-for-service until they enroll in a managed care plan on October 1, 2011.

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WCH Service Bureau, INC 3047 Avenue U, Brooklyn NY 11229 Phones: (718) 934-6714, (718) 934-6728, 888-WCHEXPERTS Fax: (718) 504-6072

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FEEDBACK Your feedback is very important to us! In our continued dedication to improve, we want your feedback, opinions, ideas, news and comments. Please send us your feedback today. Let us know what you want to see in upcoming issues or changes to the format that you would like to see. _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ ________________________________________________ Name_________________________________ E-Mail_________________________________

Thank you for your support!

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February 2012  

February 2012

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