Office Matters

Office Matters, the program held on November 1, 2016 for office managers and other staff of our participating providers, welcomed nearly 400 attendees who received important updates from Independent Health as we approach 2017.

Topics included an overview of Independent Health’s 2017 Medicare and commercial products and value-based care, an introduction of new provider engagement specialist and provider relations representative teams, and an overview of the growing trend toward value-based care, among other important updates. To view these presentations, please click here.


The following questions were submitted by attendees during Office Matters.

If you have an additional question, please submit it via email to Look for continued updates to these and other questions and important information in Scope, the monthly newsletter distributed via email to participating physicians, providers and their office staff. To subscribe to receive Scope, please click here.
Is there availability to submit provider inquiries electronically now?
Independent Health currently does not off the ability to submit provider inquiries electronically, but is working on this possibility with plans to establish this capability late in 2017.
Why is the nutrition benefit only available through Tops?
When we initially developed this program, Wegmans gave serious consideration to our invitation, but at the time decided it wasn’t viable to participate.
What is Independent Health doing with reimbursement in 2017?
Independent Health is evaluating potential fee changes for 2017. We base our fee schedule changes on the changes, additions and deletions to AMA CPT code set as well as changes to the related RVUs, as well as other changes in the health care market. Once again this year the major changes to fees will occur on April 1st and we will be posting those fees on Reveal before January 1st if not sooner. We will send out a communication when those fees are available. As always our goal is to set fees for our providers that are reasonable, fair and equitable.

At this time, Independent Health has no plans to shift plan-wide reimbursement to a value-based method for 2017.
Is the physical therapy fee schedule changing for 2017? And, if so, what is it?
Independent Health’s physical therapy fee schedule for 2017 is currently being evaluated, but has not been finalized at this time.

What is the Ambulatory surgery copay for ECT? At Hospice-based OP (AMBECT). Patients sometimes need to come 3x’s/week for a couple weeks.

This question has been forwarded to Independent Health’s appropriate subject matter experts, who will determine if and how this may be implemented in 2017.
It can be difficult for prescribers to identify which formulary a patient has (i.e., large/small group) and often patients are not sure either. What steps are being taken to make it clearer for prescribers?
Upon receiving this question at Office Matters, the Independent Health pharmacy team is following up on this possibility to determine how it can help physicians, providers and our members what formulary a patient has. In the meantime, a physician or provider practice may contact Provider Services from 8 am to 6 pm Monday through Friday by calling (716) 631-3282 or via email at
Regarding J codes denying for NDC for MediSource, does the prescription have to be ordered from Independent Health) NDC off of web site rep provided is incorrect (?)
Upon receiving this question at Office Matters, the appropriate Independent Health subject matter experts are determining if this process can be adjusted so it doesn’t result in a claim being rejected unnecessarily.
Can pharmacy offer an alternative when prior authorization is initiated to avoid denial of paperwork?
Independent Health is currently working on implementing an electronic prior authorization tool that will provide this information. Until that time, Independent Health will often contact the physician/provider office to gather additional information, if needed, to process this request.
For physical therapy, is it 60 days per condition or 60 visits?
Outpatient treatment is 60 visits per plan year for non-standard plans and 60 visits per condition per plan year for standard plans. Inpatient is 60 visits per plan year for both non-standard and standard plans. This applies to individual and small group commercial plans.
How will MACRA impact ancillary providers like speech and hearing centers? When?
For the first two performance years of the Quality Payment Program (QPP) under MACRA, eligible clinicians only include Physicians, Physician assistants, Nurse practitioners, clinical nurse specialists, and Certified Registered Nurse Anesthetists. The Secretary of Health and Human Services has the authority to expand this definition to other providers, including physical therapists, occupational therapists, speech language pathologists, clinical social workers and others, in the third year of the program. This will be done through future CMS rulemaking.
How does MACRA affect radiology and lab services without having a clinical provider?
MACRA impacts eligible clinicians such as radiologists and pathologists. For other specialties such as those that do not directly see patients, the Final Rule provides flexibilities to accommodate and take into account the differences in practice for these clinicians.
How does one know which track to choose? MIPS vs APM. Do you need to do anything to join either one?
Designation to each track of the Quality Payment Program is determined based on eligibility and participation to a certain degree in Advanced Alternative Payment Models. Current and future Alternative Payment Models will be (re)opened for application throughout the next several years for those entities and their participating clinicians to participate.

Below are two resources regarding MIPS and APM:
I have more than 400 patients in my practice. Who will you reach out to at my office to identify our provider rep.?
Any physician or provider practice may request answers to questions or other assistance by contacting Provider Services from 8 am to 6 pm Monday through Friday by calling (716) 631-3282 or via email at You may receive the information or support needed by phone at the time of the call or you will be contacted back during a follow up to determine how it may be helped.
Regarding the 14 day coverage for substance abuse: Is this for detox or rehab or combination of both? Will there be Utilization review during those 14 days?
The NYS Opioid Law excludes from pre-authorization substance use inpatient detoxification, rehabilitation, and residential services which are contracted with the plan AND are credentialed by the NYS Office of Alcoholism and Substance Abuse Services. The Plan may not conduct any concurrent or retrospective utilization management review until day 15.
Current members who have Network Advantage are automatically being opted other plans. What is Independent Health doing to reach out to these members?
Some Medicare members who qualify for a federal subsidy program called Extra Help/ Low Income Subsidy for Part D were automatically enrolled by Medicare in a Stand Alone Part D plan (prescription coverage only) because their Independent Health plan was discontinued.

Independent Health is contacting these members to clarify their options for 2017, which includes our four Medicare Advantage plans.

Please encourage patients with questions about their options to contact Independent Health:
  • Visit one of our Medicare Information Centers (locations posted at
  • Current Members may call: (716) 250-4401 or 1-800-665-1502 (TTY: 1-800-432-1110)
  • Prospective Members may call: (716) 635-4900 or 1-800-958-4405 (TTY: 1-888-357-9167)
  • Hours: October 1 – February 14: Monday – Sunday, 8 a.m. – 8 p.m.
Will medical nutrition therapy and Diabetes education remain a $0 copay service?
Will Independent Health cover telehealth benefits for medical nutritional therapy?
Is the hearing aid benefit applicable to all of the Medicare plans?
Yes, unless specifically declined by a custom Large Group Medicare Plan.
Are there non-Medicare plans that also have this benefit?