All Providers
Release of Information on Members: PrimeWest Health delegates case management to our county partners. Your facility's contract with PrimeWest contains a section which states your facility "...shall cooperate with and actively participate with PrimeWest Health, County Case Managers, the beneficiary and/or beneficiary's family or representative in the development, monitoring, and follow through of care coordination plans for eligible beneficiaries..."
In addition, the PrimeWest Health member agreed to the following stipulations when they signed your notice of privacy practices: A clinic/hospital is permitted or required to use or disclose the member's protected health information without the member's authorization under the following circumstances: treatment, payment, health care operations.
County Case Managers would utilize the PrimeWest Health member's information for either treatment or health care operations. The Office of Civil Rights has information posted at the following website to assist covered entities with interpreting this particular Code of Federal Regulations (CFR) (45 CFR 164.506).
http://www.hhs.gov/ocr/hipaa/guidelines/sharingfortpo.pdf
Invalid Diagnosis Codes: Always verify diagnosis codes used on your claim forms. PrimeWest requires providers to code to the highest level of specificity. Most diagnosis codes require either a fourth or fifth digit to better detail the description of the diagnosis. You may receive a denial on your claim if an invalid diagnosis is used. (2/22/08)
Circumcision: PrimeWest Health will cover circumcision only if medically necessary. Circumcisions will require prior authorization. If the authorization is approved, circumcision is billed to PrimeWest Health. In accordance with PrimeWest Health's requirement to give providers 45 days notice, this becomes effective 3/16/08. (Posted 1/31/08)
Effective 1/1/08 Send paper claims and Claim Adjustment Requests to PrimeWest Health - PO Box 369 Alexandria, MN 56308.
Provider Appeals Address Change: Effective 7/30/07, please send Provider Appeals to: PrimeWest Health System - Attn: Provider Appeals- 2209 Jefferson St., Suite 101, Alexandria, MN 56308. Appeals sent to the old address in Minneapolis will be returned to you with instructions to send to the new address. (updated 7/12/07)
National Provider Identifier (NPI): NPIs are the new standard unique health identifier to use in submitting and processing health care claims and other transactions. PrimeWest has transitioned to an NPI-only identifier for all transactions effective 5/23/08. Failure to include an NPI may cause the claim to reject.
To submit your NPI (National Provider Identifier) to PrimeWest for our records, you can send it via email to sharon.larsen@primewest.org or fax it to 320-762-8750 Attn: Sharon Larsen or use this link to access the fillable form NPIform. (updated 10/23/07)
Provider Complaints & Grievance Forms due quarterly from all clinics: PrimeWest is required by the State of MN to conduct ongoing evaluation of enrollee complaints. As stated in Section 3.8 of our administration manual, clinics are required to notify PrimeWest of any complaint filed by a beneficiary with a clinic or clinic practitioners on not less than a quarterly basis. A Complaints and Grievance (CAG) form must be filed quarterly even if there are no grievance reports. This form is found here
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