For Providers
Christiana Care Quality Partners ACO
Christiana Care Quality Partners is applying to the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare Shared Savings Program (MSSP). Christiana Care Quality Partners ACO will be established as an Accountable Care Organization to facilitate coordination and cooperation among participants to enhance the overall value of care for Medicare fee-for-service beneficiaries. Our application will be submitted to CMS by July 31, and upon approval, we will launch this new Accountable Care Organization for the Medicare Shared Savings Program on January 1, 2016. This physician-led ACO will partner with primary care providers in our community to help us achieve our goal of delivering value-based care, offering incentives for lowering costs and increasing quality of care. Please click here to read more.
This ACO will benefit from the value of Christiana Care's Care Link – a robust information technology-enabled network of care coordination support services, including:
- Access to an interdisciplinary care coordination team including nurses, pharmacists, social workers, and health coaches supported by real-time integrated clinical information and data analytics, and
- Support for monitoring patients, identifying care needs, and reaching established quality metrics.
CMS regulations stipulate that physicians can participate in only one Medicare Shared Savings Program. Signing with one Medicare Shared Savings Program precludes you from signing with any other Medicare ACO.
If you have questions, contact Dan Elliott, M.D., Medical Director, of Quality Partners or Doug Azar, Executive Director, at 302-623-7959 or learn more at the Quality Partners website.
New Service Line Structure Supports The Christiana Care Way
Christiana Care Health System has reorganized its Quality and Safety work into a service line structure that will enable us to deliver on the promise of The Christiana Care Way — creating innovative, effective, affordable systems of care that our neighbors value.
This new structure positions us to advance a population health model of care: achieving excellence in patient outcomes, patient experience and high-value care. By simplifying our structure, we can reduce unnecessary variation in care, better coordinate care across the continuum, and continue to improve the quality, safety and value of the care we provide.
Nine service lines each are represented by an executive team comprised of physician, nursing and operations leaders across our organization. The service line executive teams will help to coordinate and integrate our many system change initiatives and Quality and Safety efforts, and collaborate closely with the Christiana Care Medical Group and Christiana Care Quality Partners.
The service line structure does not change the current organizational reporting relationships, and it does not replace the clinical departments. Department chairs continue to report directly to the chief medical officer. Christiana Care employees continue to report to and be evaluated by their current supervisor.
The service line structure is intended to be a flexible structure, acknowledging the complex relationships throughout Christiana Care Health System. Some programs cut across service lines. Our many vital essential services will continue to work across the service lines, and at the same time they will begin to work increasingly through the service line structure.
The physician leaders of the Service Lines are:
Acute Medicine: Virginia Collier, M.D., MACP
Behavioral Health: Linda Lang, M.D.
Cancer: Nicholas J. Petrelli, M.D.
Heart and Vascular: Timothy J. Gardner, M.D.
Musculoskeletal Health: Brian Galinat, M.D., MBA
Neurosciences: Kert Anzilotti, M.D., MBA
Primary Care and Community Medicine: Omar Khan, M.D., MHS, FAAFP
Surgical Services: Gerald Fulda, M.D. FACS, FCCM, FCCP
Women’s and Children’s: David A. Paul, M.D.
Look for more information about the Service Lines in the coming weeks.
Dan Elliott, M.D., Named Medical Director of Quality Partners
Dr. Dan Elliott became Medical Director of Quality Partners on March 1. Please click here to read more about Dan, or click here to email Dan.
New Outpatient Behavioral Health Service Available to Quality Partners Participating Providers
In January, Christiana Care began to integrate outpatient behavioral health services into primary care practices. A new transitional outpatient behavioral health service is now available for all Quality Partners participating providers. Click here for more information.
For Office Staff
Resubmitting Denied Claims
When appealing a denied claim, it is critical that you resubmit the claim using Geisinger’s CRFF form along with your supporting documentation. Simply re-submitting the claim again will result in another denial. Click here for the CRFF form and contact your provider relations representative if you have additional questions.
Precertification of Services
Please be advised that certain procedures and services require precertification. Bookmark this link for the most current list of all services and procedures that require precertification.
Submit Documentation When Using Modifiers 25 and 59
As a reminder, when submitting non-immunization claims with either modifier 25 or 59, please be sure to include supporting documentation. Please contact your provider relations representative with any questions about this process.
Notification of Providers Joining or Leaving Your Group
If your practice has providers that are joining or leaving the group, please remember to let your provider relations representative know as soon as possible. If you are unsure as to who is your representative, please call us at 302-623-7959.
Using NaviNet’s Secure Messaging Feature
Once you have added Geisinger to your NaviNet screen, you can take advantage of its secure messaging feature for answers to claims and other questions. You will receive a response to your inquiry within one business day. Click here to see where you can access this feature and for other tips on navigating NaviNet.
Going Electronic
Geisinger offers the ability to get submit claims, receive remittance advice, and receive payments electronically.
Note: due to setup timing issues, you may not able to immediately view submitted claims, EFTs, or remittance in NaviNet.
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