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19-791 Use the Correct Address to Get Paid Faster for Acupuncture Claims

Date: 12/30/19

Use the Correct Address to Get Paid Faster for Acupuncture Claims

Send claims to American Specialty Health

Please remember to send acupuncture claims to:

American Specialty Health Group, Inc.                                                                 

Claims Department                                                                                                   

PO Box 509001                                                                                                      

San Diego, CA 92150-9001

 

Physicians and independent physician associations (IPAs) must refer members to American Specialty Health, Inc. (ASH) for acupuncture benefits. If a member is currently obtaining these services through an out-of-network provider, refer them to Member Services at 1-877-658-0305 for continuity of care review.

See the table below for clearinghouse payer IDs used for ASH acupuncture claims.

Clearinghouse name	Payer ID	Clearinghouse name	Payer ID
Anvicare	ASH01	Medical Billing Pros	00001
ApexEDI	ASHN1 ASHN2 for MT	Nuesoft Technologies, Inc.	N/A
Availity	ASH01	Office Ally	ASHP1
Change Healthcare	43146	Prompt Solutions	ASH01
D&D Claims	ASHN	Signature Claims	ASH01
ECP	ASHP1	TransMedic	N/A
HEW (was ET&T)	ET393	TriZetto Provider Solutions (was Gateway EDI INC)	56240
InfinEDI	906N9	ZirMed, Inc.	Z1091
MDOnline	ASH01

When is prior authorization required?

Members may self-refer for acupuncture for certain conditions, illnesses or injuries only covered in conjunction with services from a medical doctor (for example, chronic pain or nausea related to chemotherapy). Authorization is not required for acupuncture services for up to two visits per month. Prior authorization is required if additional visits are needed during the same month.

Know the basics about the network and acupuncture benefits

In 2017, California Health & Wellness Plan (CHWP) expanded the network of acupuncture providers through ASH for its members.

Senate Bill (SB) 833 restored acupuncture on July 1, 2016, as a Medi-Cal benefit [California Code of Regulations (CCR), Title 22, Section 51308.5]. Acupuncture services are limited to treatment performed to prevent, modify or alleviate the perception of severe, persistent chronic pain resulting from a generally recognized medical condition. Acupuncture outpatient services are limited to two services in any calendar month (CCR, Title 22. Section 51304 [a]).

Additional information

Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. The provider operations manual is available in the Provider Resources section of the provider website at www.CAHealthWellness.com.

Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.