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3011 W Grand Blvd, Ste 1600Detroit, MI 48202March 5, 2019PROVIDER BULLETINTO: All Total Health Care Participating ProvidersRE: TEMPORARY SUSPENSION OF REFERRALSAs you are aware, THC implemented a new Provider Portal as of 2/26/2019. We continue to experience difficulty with some functionality related to processing of referrals and approval of log-ins. Accordingly, in an effort to prioritize patient care and alleviate any burdens for our providers, EFFECTIVE IMMEDIATELY, TOTAL HEALTH CARE IS SUSPENDING THE NEED FOR REFERRALS FOR ALL SERVICES, REGARDLESS OF PLACE OF SERVICE, THROUGH MARCH 31, 2019. This includes all services noted on the attachment. Services that require clinical review and prior approval are not affected by this notice. Services that require Prior Approval continue to require prior approval. You may fax those requests to 313-748-1312 as always.Please share this notice with all concerned.We are diligently working on improving the functionality of the portal, as well as working to approve log-ins to the portal. Please be advised that THC will approve administrators only based on tax ID and Type II NPI. All subsequent users must be set up and approved by the administrator.Thank you for your patience and understanding while we work to improve our services.Best regards,Noel Upfall, DOAssociate Medical Director These services will temporarily not require a referralthrough March 31, 2019(Please note that claims may initially deny but THC will automatically reprocess to pay without the referral). PCP Initiated Referral Must process through the Provider Portal Services must be provided in networkAll procedures/surgeries in an ASC (Ambulatory Surgical Center) or Outpatient Hospital :Excluding procedures noted as requiring prior authorizationThe following procedures when performed in POS 22 or Outpatient: Biofeedback Therapy Cardiac Catheterization Cardioversion Tilt-table, TEE Cardiac Rehabilitation Hyperbaric Oxygen Therapy Endoscopy procedures in an outpatient setting:GI Tract – excluding colonoscopy, sigmoidoscopy, proctoscopy Capsule endoscopyEGDERCPGastroscopyLaryngoscopyRespiratory Tract:BronchoscopyLaparoscopyArthroscopyFemale Reproductive System:HysteroscopyNasal/sinus endoscopy – Prior authorization required High-tech radiology exams:CT ScansMRIs, MRAsPET ScansNuclear StudiesCardiac Stress TestMUGAHIDA ScanInfertility Testing Podiatry Visits and TreatmentPhotochemotherapy – UV Light TreatmentPT/OT/ST- initial evaluation onlySleep StudiesWound care/ debridement Chiropractic Visits and Treatment Echocardiography (except 99307, 99308 with do not require a referral)Evoked Potentials ................
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