Prime West Health System - Neighbor carying for Neighbor

Provider Updates

PrimeWest Health Provider Services Contact Center: 1-866-431-0802 (toll free)

Do you have a question, comment, or concern regarding PrimeWest Health? Our Provider Services Contact Center is here for you! Providers can call us with questions, claims inquiries, comments, concerns, or just to let us know how we are doing!

The Provider Services Contact Center is staffed by our most knowledgeable, friendly, and courteous representatives 8 a.m. - 5 p.m., Monday - Friday. We take pride in having the latest and most up-to-date information available for you. If there is ever a question we are unable to answer, we will research the issue and get back to you as quickly as possible.

Call us at 1-866-431-0802 (toll free) and make us your first point of contact!

UB-04 and CMS-1500 Paper Claim Form Submissions

Effective December 1, 2008, PrimeWest Health will no longer accept black and white paper claim forms. Providers will be required to submit all paper claims on the standard CMS-1500 or UB-04 red and white forms. Only original, typed claim forms will be accepted. PrimeWest Health does not accept handwritten claims or claims submitted by fax, photocopy, or screen prints. Providers must mail all paper claims on the standard
UB-04 or CMS-1500 red and white forms to:
     PrimeWest Health
     PO Box 369
     Alexandria, MN 56308

Please note: Providers will still be able to submit adjustment requests that include corrected claims on black and white forms. You may mail the Adjustment Request Form along with corrected claims to the address listed on the form or you may fax them to
1-320-335-5355. The Adjustment Request Form can be accessed on our website at Partners & Providers>Resources>Forms, Letters, and Miscellaneous Documents>Adjustment Request Form.

Standard CMS-1500 or UB-04 claim forms may be purchased at any medical office supply store.

Office Ally Update

If you or your facility has a Uniform Minnesota Provider Identifier (UMPI) number and you submit your claims electronically to PrimeWest Health through Office Ally, you may have noticed that Office Ally would not accept the alpha character in your UMPI number.

Office Ally has now updated their system to accept the alpha characters in UMPI numbers.

Your facility UMPI number should be entered in Box 33b of the claims form. If you have an individual UMPI number, that should be entered in Box 24J.

If you have questions about this update, please call the Provider Services Contact Center at 1-866-431-0802 (toll free).

Update for Pediatric Specialty Outpatient Visits
Effective July 7, 2008, PrimeWest Health members ages 21 and under who are referred to a non-contracted pediatric specialist no longer need to get a Service Authorization to see that specialist for an outpatient visit, with the exceptions noted below. This is a change from the previous policy, which required members to obtain a Service Authorization from PrimeWest Health in order to see a non-contracted provider for an outpatient visit.

Please note that certain procedures, such as Botox injections and circumcision, still require all members to obtain a Service Authorization, regardless of whether or not the provider is contracted. Please refer to Chapter 5 of the PrimeWest Health Administrative Manual for information about which procedures require Service Authorizations.

As a reminder, all inpatient stays still require a Service Authorization. In addition, preventive and Child and Teen Checkup (C&TC) services are still expected to be provided by a contracted, primary care provider.

Message to PrimeWest Health Chemical Dependency (CD) Providers

Effective July 1, 2008, CD providers will be required to bill according to the revised CD structure grid to reflect the specific type of care provided. This differs from DHS FFS CCDTF billing requirements that (currently) do not require the breakout of various types of room and board based on facility type. CD services rendered before July 1, 2008 using the previous CD structure will still be considered for payment.

PrimeWest Health understands this is an imposition to you and we apologize. PrimeWest Health is now required to submit quarterly reports to DHS that identify the CD room and board services authorized in combination with CD treatment pursuant to the Rule 25 assessment criteria. The report needs to include only those CD room and board services for which the MCO issued payment and submitted an encounter claim to the State.

Please contact PrimeWest Health’s Provider Services Contact Center at 1-866-431-0802 (toll free) if you have questions and or concerns.

2008-09 e-Health Grant Program Announced

The Minnesota Department of Health's Office of Rural Health and Primary Care is soliciting proposals for grants to support the adoption and use of interoperable electronic health records by health care providers in rural and medically underserved areas of the state that frequently cannot fully afford the investment in health information technology.

Total funding of $3.5 million is available for: 1) Readiness Assessment and Planning Grants up to $50,000 or 2) Implementation Grants up to $750,000. Eligible applicants are community e-health collaboratives, community clinics and regional or community-based health information exchange organizations. A one-to-three match is required.

Applications are due September 5, 2008. For application materials, go to:
the Minnesota Department of Health website:

For more information contact Anne Schloegel at (651) 201-3850 or anne.schloegel@state.mn.us

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Below you cas see PrimeWest Pointers available for download as PDF files:

PrimePointers September/October 2008 (PDF)

PrimePointers July/August 2008 (PDF)

PrimePointers May/June 2008 (PDF)

PrimePointers March/April 2008 (PDF)

PrimePointers January 2008 (PDF)

PrimePointers November 2007 (PDF)

PrimePointers September 2007 (PDF - 216kB)

PrimePointers July 2007 (PDF - 376kB)

PrimePointers May 2007 (PDF - 596kB)