It has recently been brought to the attention of the State
Fiscal Agent (SFA) that for claims submitted to Oxford by providers, many
Individualized Family Service Plans (IFSPs) are being submitted but not
reaching the correct team at Oxford. This is causing Oxford to reject a large
number of claims for no IFSP on file.
To mitigate this issue, the SFA suggests that for claims
submitted to Oxford, providers mail the IFSP to the insurer with a copy of the
subrogation notice. A copy of the subrogation notice can be generated in
EIBilling.com. This package (IFSP and subrogation notice) should be mailed
directly to the address provided on the subrogation notice, which is
pre-populated when generated in EIBilling.com. The most recent IFSP should be
sent to Oxford upon six month and annual reviews, or whenever an IFSP is
amended to include new services or change the frequency or duration of existing
services.
Upon receipt of the IFSP with the copy of the subrogation
notice, Oxford’s team will record the IFSP and, if required, submit to Optum
Health. Oxford staff is currently undergoing internal training to ensure that
IFSPs are recorded properly, in order to limit the number of claims rejected
for no IFSP on file.
If you have any questions, please contact the PCG Customer
Service Center at (866) 315-3747.
Article ID: 187, Created On: 8/27/2014, Modified: 10/28/2015