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Tracking Urgent Care Visit Volume Urgent Care Visit Continue to Decrease Mid-Spring As of May 16,2025, seasonal flu activity is low and declining. This season has been classified by the CDC as a “high-severity season overall for all age groups and is the first high severity season since 2017-2018.” CDC estimates that there have been at least 47 million illnesses, 610,000 hospitalizations, and 27,000 deaths from flu so far this season. Nationally,…
…23, 2019. How does an urgent care center know if the patient is covered by Tricare Prime? U.S. Military healthcare cards do not specify Tricare Prime coverage, so urgent care center staff must verify eligibility for the patient through the military’s website or by calling the Department of Veterans Affairs. Are there any restrictions in the program? Tricare Prime beneficiaries can visit urgent care twice in a fiscal year without pre-approval or re…
…nder the U.S. Department of Defense and is divided into regions, including TRICARE East and TRICARE West, with different contractors handling claims and services for each. Effective May 1, 2025, the payer listed as TRICARE East Region DOS before Jan. 1, 2025 (CPIDs 1253, 4585, Payer ID: TREST) will no longer be available through Optum for claims processing due to the termination of their contract with WPS. To ensure timely processing, all claims w…
…he patient is the subscriber or a dependent. Note: For Medicare, Medicaid, Tricare, and Aetna, you must set the patient as the subscriber. Refer to the full setup guide: Experity PM RTE Setup 2. Finding the RTE Payer ID in Waystar To find the correct payer ID: Log into your Waystar portal. Go to Eligibility > Payer List. Search for the insurance company by name. Copy the RTE Payer ID and use it in Experity. Refer to the detailed instructions: Ways…
…dated for contracting and credentialling with Medicare, some Medicaid, and Tricare, according to Phyllis Dobberstein, RCM Compliance Manager for Experity. Tricare and Medicaid typically require some level of enrollment. Private payers including Blue are subject to timely filing and thus typically aren’t held. Regardless, even if retro claims are paid, it still leads to a delay in cash flow while expenses are accruing. Even with an interim policy i…
…ices when preparing your proposal. Typically, BCBS, Medicare, Medicaid and Tricare will not consider renegotiating; additionally, Managed Medicare and Managed Medicaid plans rarely reimburse over 100% of the current state fee schedule. Updated Documentation Often the payers will require updated documents to maintain your participation. Keeping updated files for your providers and your entity will set you up for success as you receive payer recrede…