Q4 2023 PROVIDER NEWSLETTER

Date: 11/28/23

Welcome and Thank You

Ambetter of Tennessee values its relationships with network providers and we strive to make it easy to do business with us. This newsletter is one step in improving our outreach around Ambetter updates and key information to help you as a network provider.

We want to welcome you to our NEW Ambetter of Tennessee Provider Newsletter - Fall 2023 edition! Communication with our provider network is critical to success as our marketplace membership grows. Our Provider Newsletter is scheduled to go out via email each quarter with news and updates. Our goal is to make this newsletter a useful tool. We are always open to feedback and suggestions about what we include in future versions as well as where we can improve as a health plan.

Thank you for the great care you provide to your Ambetter patients! We appreciate your partnership. We will continue to improve our outreach and communication, making it easy to do business with us.

Policy Updates

Cotiviti COB Payment Update

Thank you for your continued partnership with Ambetter of Tennessee. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of an additional review that went into place as of 11/1/2023.

Description of Changes:

Ambetter claims will be reviewed for coordination of benefits by Cotiviti. Providers will begin seeing correspondence from Cotiviti when these claims are identified as being incorrectly paid for members with other primary coverage. Instructions for next steps and how to outreach for additional information will be included in the letters that Cotiviti will send to the providers.

Quality and Risk - Did You Know?

Did you know that providers can cash in on incentive bonuses by closing care gaps and submitting appointment agendas? You are already taking great care of our members! Please take advantage of these bonus dollars to expand your resources and provide an enhanced member experience. 

Learn more about our quality incentive (P4P) and risk adjustment (Continuity of Care) programs as well as numerous HEDIS pocket guides and tip sheets by clicking the links under “Quality Improvement/Risk Adjustment” on our Provider Resource webpage.

Did you attend Ambetter Health Day? 

Ambetter Health Days were held in Nashville (August) and Memphis (September). These events were opportunities for Ambetter of Tennessee to impact several priority metrics and elevate brand awareness, therefore positively increasing the overall retention and acquisition of members within Tennessee. We were able to showcase the resources and benefits of the health plan by educating members on services and providers, while also collaborating with several vendors and external partners to provide the best possible member experience overall.

 "The event was phenomenal. I was blown away with all that Ambetter offered me."- Ms. Alice F. 

Provider Engagement Resources

The 2023 Provider & Billing Manual is your comprehensive guide to doing business with Ambetter of Tennessee. The manual includes a wide array of important information relevant to providers including, but not limited to: Network information, Billing guidelines, Claims information, Regulatory information, Key contact list, Quality initiatives…and much more!

The Ambetter of Tennessee Provider Engagement staff conducts monthly Provider Orientations via Zoom to review topics such as the secure provider portal, prior authorizations, claims, billing, payments, grievances, appeals, and much more. The dates for the upcoming orientations can be found below. If you are interested in attending, please contact your designated Provider Engagement Administrator.

• December 20th, 2023 at 1pm CST
• January 17th, 2024 at 10am CST
• February 21st, 2024 at 1pm CST

REMINDERS

• Did you miss any recent Provider News Bulletins? Have you seen our quick reference guide?
• Open enrollment began November 1st…If members enroll by 12/15/23, they will have a 1/1/24 effective date. If members enroll by 1/15/24, they will have a 2/1/24 effective date.
  
• Schedule a 1:1 walk-through highlighting all features & functions found in our Secure Provider Portal.
  
• Remember to contact your Provider Engagement Administrator with any demographic updates.
  
• Providers can create an account or login to our portal.
  
• Our annual provider satisfaction survey will be launching soon.