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FACILITATORS:Mr. Wesley AshmoreMs. Peggy CarstensMs. Karen NorthcuttFOR BLUE CROSS:Ms. Brandy KirkMs. Amy Ellison MR. ASHMORE: Everyone, if we could take our seats, we're going to go ahead and begin. Ms. Kathryn Miller has another position within Blue Cross, so I want to welcome a new face today to our RIC/RAC group, which is Ms. Brandy Kirk. MS. KIRK: Hey, thank you guys for having me.Blue AdvantageFollow-Up Questions1.Follow up to Question #3 from the March 19, 2018 meeting concerning sepsis denials. We are experiencing retrospective denials for the diagnosis of sepsis when accounts are reviewed for both coding and clinical validation. Documentation supports the diagnosis of sepsis; however, reviewers are using SOFA criteria score of 2 or more. A sepsis protocol was implemented several years ago in compliance with CMS quality indicators and requires patient screening by specified criteria with implementation of specific therapeutic measures if appropriate. The physician must document the diagnosis of sepsis in the medical record before this diagnosis is coded; sepsis is not coded based upon positive screening. The rationale documented in the review results letter states “According to up-to-date criteria, in order to validate the diagnosis of sepsis, evidence of organ dysfunction caused by a dysregulated response to infection as measured by a SOFA score of 2 or greater must be demonstrated.” Of course, this reduces reimbursement. The references do not actually validate Cotiviti’s rationale. [an example was provided]Response: Sepsis 3- Singer, M etal. The Third International Consensus Definitions for Sepsis and Septic Shock. JAMA. 2016; 315(8):801-810.In the Sepsis-3 paper the definition of sepsis was revised in response to improved insights into its pathology, management and epidemiology. In previous definitions of sepsis, there was an overemphasis on inflammation (i.e., SIRS criteria) and a flawed assumption that sepsis goes through a continuum of severe sepsis to septic shock. It has been determined that SIRS criteria are too sensitive and insufficiently specific to be helpful in the identification of sepsis and that the term “Severe Sepsis” is superfluous-that is, all sepsis is severe.Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Organ dysfunction is demonstrated by a SOFA score of 2 or more. The SOFA score is determined using the SOFA scale, appearing in Table 1 of the Sepsis-3 paper: Sepsis-3 also introduces a new screening tool to help identify potentially septic patients- the qSOFA score. As a screening test the qSOFA score is used to begin a plan of care to treat possible sepsis until testing has helped determine a true diagnosis. The qSOFA score includes a respiratory rate of 22bpm or higher, altered mental status, and a systolic blood pressure of 100mmhg or less-any two of these is suggestive of possibly septic patient who should thus undergo evaluation with the full SOFA evaluation to determine if sepsis is present or not.The most current research reveals that sepsis leads to early activation of both pro-and anti-inflammatory responses along with changes in non-immunologic pathways including those affecting cardiovascular, neuronal, autonomic, hormonal, bioenergetics, metabolic, and coagulation. Organ dysfunction is not necessarily associated with extreme cell death.Septic Shock is defined as extreme circulatory, cellular, and metabolic abnormalities linked to serious infection, Septic shock is identified by, in addition to the presence of a related serious infection, a vasopressor requirement to maintain a mean arterial pressure of 65mmHgs or higher and a serum lactate level greater than 2mmol/L with no hypovolemia.Discussion at meetingMS. KIRK: Yes. Blue Cross Blue Shield of Alabama is using the sepsis three criteria. MS. KIRK: Blue Cross Blue Shield of Alabama is using the sepsis three diagnosis, which does require meeting a sepsis score of two. We know that the SIRS criteria in the sepsis two definition has been used for about the past two decades, and it's just with further research and knowledge we have discussed that sepsis is no longer a continuum. It's just the organ dysfunction SIRS shows more infection where the SOFA shows organ dysfunction. So, when you are treating a patient, if a patient comes into the emergency department, then you would use the quick SOFA to determine your first plan of care. And then at that point, begin the process of the full SOFA. We of course want our physicians to use, you know, their best knowledge and documentation on this. I have already discussed this with a few hospitals. As for the DRG reviews, know that those are probably going to start to come as well in the commercial side. I know you've been dealing with the appeals with Cotiviti on the Blue Advantage side. With Cotiviti I know that there have been some struggles with submitting information and questions, did they get it. They are actually working themselves on a new portal to be able to upload information, and it's supposed to be very user friendly; even the red light/green light function as to things did not upload correctly or they did upload correctly. There is no date set yet as to when that's going in. It's still being worked on, and they're trying to put the appeals process in it right now. So, there will be more to come on that. MR. ASHMORE: Do we have any additional questions from the floor? AUDIENCE: I'm actually going to just read this more so for the benefit of maybe you being able to take this back, and since we have a stenographer here. Our manager of CDI could not be here so she did submit some information as a response to your response that's listed in the documentation we have. So basically I'm just going to read this from her. She believes -- and she's got to confirm the source or the citation that this sepsis route actually was repealed by Jan Lovitz. She's confirming that. It is also not accepted by coding clinic or the sepsis core measure with CMS. The heart of this is early identification and treatment of sepsis to prevent sepsis shock and death. Treatment from sepsis starts when you have the clinical indicators or SIRS plus infection. Sepsis is simply a blood infection and is treated to prevent severe sepsis and septic shock. That is what the core measure is aimed at doing. Sepsis three basically says that sepsis is non-existent until it is severe sepsis or shock, which is not the case when treating a patient clinically. They are evaluating and treating to prevent mortality and sepsis as a valid clinical diagnosis, as the goal is to treat it. By only using sepsis three criteria, it is that Blue Cross is possibly trying to dictate the medical care of their members. They're taking away the clinical ability of the providers and showing that they are not willing to pay for the services rendered, which treats sepsis as best practice and thus should be rewarded for complete documentation and not penalized by the criteria of the paper. So we'll leave it at that, but we just wanted that information to go back, and then maybe we can get some further discussion at the next meeting. But if you could just take that back. MS. KIRK: Sure. And I, you know, would love to tell you again we are not here to dictate a way that a physician treats or documents. This has been discussed on the medical director level as well. McKesson accepted this back in 2016, and that's what InterQual follows as well as sepsis three, but I do hear what you're saying. Some of the physicians that I have spoken with have expressed so I'll be more than happy to take that back. So, thank you so much. AUDIENCE: So we have issues with the sepsis three criteria as well, and I know that's something y'all have to work out. I have a question about the coding validation. Sepsis three does not address positive blood cultures being an indicator of sepsis. So when you're doing the coding validation, or Cotiviti, or whoever is doing it -- if you deny sepsis, would you add bacteremia with positive blood culture, which would code to sepsis? MS. KIRK: I'm going to be honest. I cannot answer that question so I can take that back and find an answer for you. AUDIENCE: Please do. Because the DRG would work out to be the same. 2.Follow up to Question #4 from the March 19, 2018 meeting concerning Federal BC. Does Federal Blue Cross require outpatient claims to be submitted per date of service?Response: So, you'll be happy to know we've gotten this issue corrected. What happened is prior to the EAPG implementation, which is the new outpatient methodology that I'm sure you're all familiar with by now, prior to that going in place, we had only twenty-eight lines that were allowed on the claim before the claim had to be split. And with the Federal Employee Program, they were applying co-pays to multiple days. So, what was happening is they were rolling that up to one line level instead of having it on the individual levels. When EAPG's went in, they were supposed to remove that so it wasn't asking for the claim to be split or the rejections that you were seeing for that to happen. So now we can allow up to 999 lines, which I hope nobody submits a claim with 999 lines.Discussion at meetingMS. KIRK: Yes. I know this was a change when EAPG rolled in. There were some problems because we could only originally accept 28 lines, but now we can accept 999 lines. When it gets to the revenue line, each code needs to have a date of service. So for example, if you have a patient in observation for four days, every test and every day needs to be on a separate line, and each one of those tests and days need to be coded on that specific day. So October 1st, October 2nd, October 3rd, you're not able to run it as October 1st through October 3rd or 4th so just make sure that each line has an individual date on it. 3.Follow up to Question #5 from the March 19, 2018 meeting regarding pre-service determinations and ABNs. What is the update on the “work-in-progress” for allowing the patient to choose to go ahead with the services, but their determination was unfavorable, that they will be responsible for paying for the services?Response: This is continuing forward as a “work in progress” as BA Claims was working to?Rewrite the definition of the “GY” modifier to fit use by Blue Advantage. This rewrite was sent to both Legal and Compliance for review and comments. Our goal is to have this updated by Q4.Right now, Blue Advantage has only been working with the “GY” modifier.Discussion at meetingMS. KIRK: This is still a work-in-progress. There was rewrite of the definition. They are going to be using a GY modifier for you guys to use to put on a claim to show that predetermination may not have been approved. The member was aware, and then at that point, you know, they can sign to say you can bill the member for the service with that GY modifier. The goal is to have that in effect by fourth quarter. 4.Is physical therapy for pain management (non-pharmacological treatment for patients in lieu of opioids) a covered service? Response: I have reached out to the manager in Medical Policy regarding your question. It would depend on the individual contractual benefits as well as diagnoses and meeting certain criteria. We certainly ascribe to least invasive/conservative treatment before more invasive treatment. Opioids shouldn’t always necessarily be first line for “pain” without a thorough examination of the pain’s origin(s). Treatment of that origin could include physical therapy. In summary PT is certainly an object, but is subject to member eligibility, benefits, and meeting medical necessity criteria. It is definitely something to consider as a treatment option to help patients dealing with physical impairment due to disease, trauma, congenital anomalies or prior therapeutic interventions. For more details please refer to the physical therapy/OT medical policy# 132.Discussion at meetingMS. KIRK: Yes, it definitely is a possibility. And, you know, I think everybody is working very hard to combat the opioid issue in the U.S., so that would be great if a patient does qualify for physical therapy. But just remember that it is subject to the benefit and eligibility, so if that is a thought from your physician, just please have them verify with customer service that that patient, number one, does have the physical therapy or OT therapy that they need covered on their benefit. Remember as well that some of those policies may be limited. A patient may only have 30 visits per year, so just verify that. There is a policy, it's policy number 132, that I would like to direct you to with Blue Cross. Peggy had submitted some codes 97110 through 97112, 97140, and 97530, and those are addressed as well in that policy. 5.Medicare Contractor WPS states that it is appropriate to bill two (2) units of “per study dose” radiopharmaceuticals (such as A9500, Technetium Tc-99m, Sestamibi, diagnostic, per study dose, or A9502, Technetium Tc-99m, Tetrofosmin, diagnostic, per study dose) for the rest and stress portions of a myocardial perfusion imaging study. Do you agree two (2) units – one for the rest portion and one for the stress portion – are correct? Response: BA: Medicare MUEPer CMS 3 units are allowed.Discussion at meetingMS. KIRK: When I reviewed this, this is medical policy 211, it doesn't state a specific amount that you're able to put, but I did pull up the MUE and CMS has an MUE of three on it, so it appears that are allowed. So, if you feel that two is appropriate, it should meet the MUE. 6.Does Blue Advantage claims processing apply the Medicare or Medicaid NCCI edits?Response: BA follows MEDICAREDiscussion at meetingMS. KIRK: It's the Medicare NCCI edits. AUDIENCE: Did you say Medicare? MS. KIRK: Medicare for Blue Advantage, yes. MS. NORTHCUTT: Just for everybody's knowledge, it is Medicaid for regular Blue Cross. MS. KIRK: Yes. MS. NORTHCUTT: With Blue Advantage, it's Medicare NCCI, Medicaid for commercial. MS. KIRK: Yes. And the reason why that was explained to me that way is when it comes to commercial side -- and we're looking at children all across the board, so at that point, we would look at the Medicaid, and then for Blue Advantage just the Medicare. 7.Concerning the Reason for Visit field on outpatient claims:a.Does your claim processor read and adjudicate against the Reason for Visit field for outpatients (type of bill 12x or 13x), specifically to support the medical necessity of services?Response: BA: The claim processor reads and adjudicates against the reason for visit diagnosis code, specifically to support the medical necessity of service. While the processor does read the reason for visit field (i.e., type bills), the claim is not adjudicated to support the medical necessity of services, specifically based on the type bill on the claim. b.Can the admitting and Reason for Visit diagnoses on the claim be the same? Discussion at meetingMS. KIRK: The answer that I received is that our claims process and adjudicate on the primary diagnosis code, not the Reason for Visit. So primary diagnosis code. It was explained to me as well, yes, it is a possibility that they both could be the same. MR. ASHMORE: All right. Do we have any additional questions before we move to the Blue Cross side? AUDIENCE: Do you have any idea of when it would accept the admitting diagnoses or read and actually use the admitting diagnoses to justify a test? MS. KIRK: To my understanding, it's just going to use the primary. That is -- that's what it adjudicates off of, but when I read the question, could they be the same, in my mind, yes, it is possible. AUDIENCE: But you're only looking at form locater 67, and that's going to be it, which would be the principal diagnoses? MS. KIRK: I'm not a biller or a coder.AUDIENCE: But it's a principal diagnosis? MS. KIRK: I was explained it was the primary diagnosis, correct. MR. ASHMORE: Any additional questions? AUDIENCE: So Medicare had this question earlier, and they said they would use the Reason for Visit codes to adjudicate. Is that something that Blue Advantage is going to look into to be consistent with how Medicare interprets the policy? MS. KIRK: I do not know an answer for that, but I can gladly take it back. Blue CrossFollow-up Questions8.Follow up to Question #9 from the March 19, 2018 meeting regarding drug screening. How are facilities supposed to know when a patient has exceeded the maximum number of drug screens? Since this is a benefit limitation, is the patient financially responsible if denied?Response: Please call Customer Service to verify the amount of Drug screens the member has had. Yes, member will be responsible for the charge if they are over the limits allowed per medical policy. The Drug screen medical policy is #566 and can be found on provider access.Make sure the member has a signed waiver stating they are aware if they are over the limit of drug screens allowed they will be responsible for the cost of the test.Discussion at meetingMS. KIRK: Please always make sure to call customer service to verify how many drug screens a member has had. That's the best way to find out and be sure. When it comes to member responsibility, yes, a member would be responsible if they had reached the maximum amount of drug screens allowed, but in saying that, please make sure that they do sign a waiver and that they are aware they would be responsible for the cost of that test9.Follow up to Additional Discussion from the March 19, 2018 meeting. Can you provide the preferred drug list for autoimmune biological drugs that do not require pre-certification?Response: All the autoimmune biologic drugs that would processed on the physician administered side require a PA. These include: Actemra? (tocilizumab)Cimzia? (certolizumab)Entyvio? (vedolizumab)Orencia? (abatacept)Simponi ARIA? (golimumab)Stelara? (ustekinumab)On that pharmacy benefit side, all the autoimmune biologics agents require a PA. These include Enbrel, Humira, Simponi, Cosentyx, ?Stelara, Actemtra, Cimzia, Kevzara, Kineret, Orencia, Xeljanz (including XR), Siliq, Taltz, and? Tremfya. New Questions10.Is physical therapy for pain management (non-pharmacological treatment for patients in lieu of opioids) a covered service? Response: I have reached out to the manager in Medical Policy regarding your question. It would depend on the individual contractual benefits as well as diagnoses and meeting certain criteria. We certainly ascribe to least invasive/conservative treatment before more invasive treatment. Opioids shouldn’t always necessarily be first line for “pain” without a thorough examination of the pain’s origin(s). Treatment of that origin could include physical therapy. In summary PT is certainly an object, but is subject to member eligibility, benefits, and meeting medical necessity criteria. It is definitely something to consider as a treatment option to help patients dealing with physical impairment due to disease, trauma, congenital anomalies or prior therapeutic interventions. For more details please refer to the physical therapy/OT medical policy# 132.Discussion at meetingMS. KIRK: Again, this is the same answer that was on the Blue Advantage side. Yes, if the doctor feels that it would help and the member does have a covered service, it does meet eligibility and benefits criteria, then by all means. But just again, please, verify that the member does have those benefits and remember that they could possibly be limited. 11.Medicare Contractor WPS states that it is appropriate to bill two (2) units of “per study dose” radiopharmaceuticals (such as A9500, Technetium Tc-99m, Sestamibi, diagnostic, per study dose, or A9502, Technetium Tc-99m, Tetrofosmin, diagnostic, per study dose) for the rest and stress portions of a myocardial perfusion imaging study. Do you agree two (2) units – one for the rest portion and one for the stress portion – are correct? Response: EAPG does not pay per unit. EAPG pays per visitDiscussion at meetingMS. KIRK: Now, on the commercial side, this would go for EAPG. EAPG does not use units. It pays per visit and not per unit. So as long as it still is meeting the MUE, then if you feel that two is appropriate, then of course that is fine but just remember EAPG pays per visit. 12.Can you please clarify the use of modifier 27 for two outpatient claims on the same date of service for the following types of services:Response: Modifier 27 allows processing for multiple E&M visits on the same date of service. For example, two ER visits on the same date of service.Physical therapy and a laboratory test on the same day? Would not be appropriateLaboratory tests ordered by two different physicians with two different diagnoses and collected in two separate encounters on the same day?If routine and medical should be split billed with correct diagnosis codes on correct claimsTwo separate ER visits on the same day? Yes appropriateDiscussion at meetingMS. KIRK: Remember, modifier 27 allows the processing of multiple ER visits on the same date of service. The physical therapy and laboratory tests on the same day would not be appropriate. The laboratory test ordered by two different physicians with two different diagnoses collected on two separate encounters on the same day, if it were routine and medical, then that should be split billed with the correct diagnosis codes on the correct claims. If it's not routine and medical, still file on the same claim, and if for some reason you do get a denial on that, just let me know, and we'll try to figure out what's going on there. But the ER visits, yes, that would be appropriate to use the modifier 27. MS. NORTHCUTT: So, do you recommend split billing for the medical visits on the same day? MS. KIRK: For the routine and medical, yes. Just another tidbit, and that's because this has come up. When you put in your modifiers, if it's the 27 on the two ER visits on the same day, if you could put that in the first slot. I know that multiple modifiers can be used, but you would put it in the first slot, and sometimes that helps out. 13.Some hospitals are using IV push meds instead of infusions due to the shortage of IV fluids. Since IV pushes are not separately reimbursed under EAPGs, this causes a financial hardship for the hospital. Would BC reconsider this payment policy in light of an increasingly inconsistent global supply of IV fluids? Response: We have been discussing this in EAPG committee. Explanation that was given is EAPG is paying appropriately for service provided. Hospitals are doing a great job working through issues and problem solving due to the IV fluid shortage, but EAPG pays by codes submitted. If an IV push code is submitted it pays appropriately for that service. If an infusion code is submitted it does the same. We are unable to change EAPG weights and reimbursement to cover cost of services not performed.Discussion at meetingMS. KIRK: This has been discussed in EAPG committee, and we have actually discussed this with a few facilities as well that has brought this to our attention. The facilities are doing a great job at combatting the issue with IV shortage. EAPG pays by the procedure that was done. So, whatever it codes at or whatever it is coded as is how EAPG is going to process. So, in saying that, you know, unfortunately we're not able to change the weights, so if you're coding it as an IV push, then it’s going to pay as an IV push. 14.BC is denying the home sleep study claims for place of service outpatient hospital. Although the sleep data collection occurs in the patient’s home, hospital personnel interaction for education, equipment procurement, and analysis is performed at the facility. The hospital staff is never at the patient’s home. Response: All home sleep studies should be billed on a 1500 with appropriate place of servicea.What is the appropriate place of service for these claims?If a sleep study was performed at home it should be coded as such on a 1500. If a sleep study was performed in outpatient setting at facility it should be coded as such on a UBb.If patient home, why is this different than other outpatient services such as holter monitors, 24-hour urine specimen collections, and Neulasta Onpro injections where place of service outpatient hospital is covered?These tests require assistance by a medical professional to perform. When a patient has a holter monitor placed it is placed and removed by a medical professional. With 24 hour urine the urine is only collected at home the lab is not being run in the home setting. Neulasta Onpro is applied on the body by a health care provider and not by the patient.Discussion at meetingMS. KIRK: All sleep studies do need to be -- let me start over. All home sleep studies do need to be billed on a 1500, so that way it can be represented as a home for the correct place of service. The reason why it is different than, for instance a holter monitor, if I were to have a holter monitor placed, I would go to my physician's office or wherever you may go. They would place it for me, and they would remove it for me. The Neulasta is also placed by a medical professional. The 24-hour urine, that is collected at home by the patient, but the lab is actually run in the hospital. So the home sleep study, when they receive that box, there's not a medical professional that, at home, would come over and apply the testing equipment to the patient. The patient does it themselves, so it's just been decided that it needs to represent the appropriate place of service, which is home. The only way to do that is on a 1500. MS. NORTHCUTT: So nobody in the hospital, right? So if we were given the kit or whatever in the hospital setting there would be nothing to bill? MS. KIRK: Right. And it is of course still possible to do sleep studies in the outpatient settings. AUDIENCE: We followed the process of billing on 1500 after receiving the denial on the UB, but we still received the denial after billing on the 1500 saying that we were only credentialed for facility and not for 1500 billing. So what do we do? MS. KIRK: That has actually come up as well. What you need to do is reach out to your accrediting body and get them to send you the certificate and send it to me, and I'll get it sent to credentialing to have the correct SPG code put in. AUDIENCE: Okay. 15.Concerning the Reason for Visit field on outpatient claims:a.Does your claim processor read and adjudicate against the Reason for Visit field for outpatients (type of bill 12x or 13x), specifically to support the medical necessity of services? b.Can the admitting and Reason for Visit diagnoses on the claim be the same? Discussion at meetingMS. KIRK: And this is the same answer as it was for Blue Advantage as well is our claims process and adjudicate on a primary diagnosis. And, yes, it is possible for them to be the same. 16.Per Evicore, Axumin as a PET agent for recurrent prostate ca indications is covered by Blue Cross as of 5/1/18 (see attachment), but we are being told by the BC rep that this is non-covered. Could you please clarify if Axumin is a covered PET agent?Response: Axumin, which is Fluciclovine f-18, diagnostic PET scan represented by code A9588. Effective 6/1/18 this code will no longer be considered investigational. The code will be included in the allowance of the PET scan. The PET scan itself would have to meet criteria for coverage. EviCore is handling our review of PET scans.Discussion at meetingMS. KIRK: Effective June the 1st, it will no longer be considered investigational. The code will be included in the allowance of a PET scan. The PET scan itself would have to meet criteria for coverage, and Evicore is handling all the PET scan reviews. Additional DiscussionMR. ASHMORE: And that was our final question for Blue Cross. Do we have any additional questions from the floor? AUDIENCE: I have a question about low dose CTs. We have quite a few pulmonologists and family doctors who order those, and Medicare and Medicaid both accept diagnoses of history of smoking and current smoker. But Blue Cross including Blue Advantage has told us that it has to be the history of smoking diagnosis. So that excludes all of our current smokers, if you follow coding guidelines, which doesn't meet Medicare's criteria. That's affecting our Blue Advantage claims and our commercial claims. MS. KIRK: I'll be more than happy to go back and research that. I don't have an answer for you right now. AUDIENCE: Thank you. And I'm with Marshall Medical Centers. We've put that out there to a couple of people at Blue Cross and have really not gotten anything back yet so I don't know if that's a problem that everybody is seeing or just us. MS. KIRK: Okay. That's honestly the first time I've heard it, but like I said, you're more than welcome to e-mail me personally as well. MR. ASHMORE: All right. Do we have any other questions? Without seeing any, thank you, Ms. Kirk, for being with us today. MS. KIRK: Thank you. Do you want to go over some hot topics while we have some time? MR. ASHMORE: Sure. MS. KIRK: I know there have been a few issues with the new Jiva and claims processing with predetermination, so I just wanted to give a few tidbits on that to hopefully be helpful. We found some facilities are entering the case type incorrectly, and I really think it's just an accident because the little drop downs are so close together. The issue that we're seeing is where they're entering the incorrect case type. So just make sure that you're entering it as a concurrent option. That's where we've seen some not processed correctly. Another would be just make sure it's the correct contract number and the correct date of birth. Also, when there's a predetermination or a precertification -- I should say precertification, I'm sorry, not predetermination. When there's a precertification already on file, and you're searching in Jiva, make sure that you open that case because a case should form. When a physician puts in for review, a case should open on its own in Jiva, and instead of opening a new case, just reopen or make the current case active that you see. Because sometimes that can cause an issue as well. There was an issue with acute coding or acute rehab coding, and this has been corrected so as long as a precertification is approved, the dates are matching, it should process without issue. If you are still noticing any issues, just let me know. Of course, again make sure your dates are correct and just make sure you address all dates of service. Some other just little hot topics, I know I mentioned when we were talking about the sepsis that the DRG reviews will begin, and I want to let you know that the letter that is going out, it used to be from Sante, we've had some questions because now it's Colaris Health. So if you see that, that's what it is. Another issue that has come up, the new multistate plans that require the primary care physician to be chosen by the member or else the patient does not have benefits, just please make sure you're verifying benefits and eligibility because if it is one of these cases where the member has not chosen a primary care physician, then the benefit will state no coverage. So just make sure that you're verifying those benefits. I think that's about it. Thank you, guys, so much for your time. MR. ASHMORE: Thank you for being here with us today. ................
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