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Employer Group Hot Topics & News Flash
 Current Issue

April 2010 Hot Topics

  • Tobacco cessation programs
  • CPAP/AutoPAP/BiPAP/Oral Appliances for Obstrutive Sleep Apnea (OSA) policy
  • Pharmacy and Therapeutics updates
  • Notification of changes to billing patterns
  • Gundersen Lutheran Health Plan Utilization Management Criteria
  • CMS Documentation Signature Requirements for Medical Records

 Past Issues

January/February 2010 Hot Topics

  • Complaint resolution by providers (Policy 11.218)
  • Access to specialty care and outreach referrals - HMO products (Policy 11.200)

November/December 2009 Hot Topics

  • 2010 State and Federal Mandates
  • Consumer Involved Medical Plan
  • Policy Updates
  • GLHP Criteria for DME

September/October 2009 Hot Topics

  • Claim submission for H1NI vaccine and administration
  • Surgical treatment of Obstructive Sleep Apnea
  • Communication among network providers
  • Medical policy: Pillar Palatal Implants

July/August 2009 Hot Topics

  • Member rights and responsibilities
  • Surgical treatment of hyperhidrosis
  • Gundersen Lutheran Health Plan policies & criteria for DME items/services
  • 2009 Criteria-Most requested DME reference sheet

May/June 2009 Hot Topics

  • Gundersen Lutheran Health Plan unveils new Web site
  • Drug prior authorization
  • Referral authorization and prior authorization forms

April 2009 Hot Topics

  • Assurant Health
  • Discrimination against members prohibited

March 2009 Hot Topics

  • CMS documentation signature requirements for medical records
  • Annual facility operations forms

February 2009 Hot Topics

  • Complaint resolution by providers
  • Access to specialty care and outreach referrals

February 2009 News Flash

  • Vagus nerve stimulation (VNS) device

January 2009 Hot Topics

  • New self-funded employer groups
  • Marketing
  • New provider to the network
  • Voluntary data sharing agreement
  • Effexor ER
  • Diabetic supply changes (reminder)

December 2008 Hot Topics

  • Durable medical equipment (DME)
  • Prior authorization pre-certification and prior authorization
  • Diabetic supply changes - effective January 1, 2009

November 2008 Hot Topics

  • NCQA accreditation
  • Notification of complaints or concerns
  • Reporting to state and federal authorities

October 2008 Hot Topics

  • Specialty providers
  • 2009 benefit changes for Gundersen Lutheran Health Plan fully insured line of business only

September 2008 Hot Topics

  • Provider directory
  • Practitioner credentialing and notification of practitioner/provider changes

August 2008 Hot Topics

  • BadgerCare Plus effective 9/1/08
  • Cass Street Pharmacy
  • NCQA accreditation

July 2008 Hot Topics

  • Services no longer requiring prior authorization
  • Commercial plans-formulary updates

June 2008 Hot Topics

  • Mailing address
  • BadgerCare Plus approval
  • Services no longer requiring prior authorization

May 2008 Hot Topics

  • Mailing address
  • Gundersen Lutheran Health Plan Medicaid addendums
  • Services no longer requiring prior authorization (PA)
  • Health plans taking steps to make out-of-pocket cost information more transparent

April 2008 Hot Topics

  • Provider Network Management contacts
  • Combined prior authorization grid for Commercial and Senior Preferred
  • Member rights and responsibilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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