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August 2019 News Flash

August 30, 2019

In this issue

  1. Clinic Innovation Recognition!
  2. Save the Date: Symposium & Awards Dinner, 11.21.19
  3. Reminder! Incentive Opportunity
  4. Learning Hub
  5. Disclosure of Ownership and Cultural Competency Requirement
  6. Organization Determinations
  7. Let Your Voice Be Heard! Provider Satisfaction Survey
  8. NewsFlash and Email Communications
  9. Moving or Retiring? Let us Know!

Clinic Innovation Recognition!

Change MakersIs your clinic working to change the way it delivers patient-centered care?

Or towards a successful team-based care approach?

If so, then Fulcrum Health would like to recognize you for your efforts at our upcoming symposium !

Person shape walking with arrowApply here today!

As a provider, you can apply for one or both awards with the award recipients recognized at our November 21st symposium at US Bank Stadium .

Our selection committee will review the applications using specific criteria and notify the winners in mid-September. Deadline for submission is September 3, 2019.

Save the Date: Symposium & Awards Dinner, 11.21.19

Save the Date

Fulcrum Health is excited to present our Symposium and Awards Dinner on November 21, 2019 at US Bank Stadium!

In addition to the informative speaker line-up, there is an optional 45 minute stadium tour which may include the field, Vikings locker room, Vikings interview room and other highlights like the Press Box, a suite, club spaces, and the operable doors.

Attendee registration is now open! Register here today to reserve your spot.

3 Continuing Education credits may be available at no additional cost.

For more information, please visit our event website at

Reminder! Incentive Opportunity

Money BagWe are now offering an incentive for eligible clinics in the A and CCoE assigned tiers based on clinical outcome submissions. In addition to the financial incentive, submitting your clinical outcomes shows how you compare to your peers and generates shared learning from colleagues. More information on the incentive and the eligibility guidelines are available in the Learning Hub under the Incentive tab.

Learning Hub

Connect Learning HubAs of 6/1/2019, the Learning Hub has been updated based on provider feedback and additional resources. If you have not been to Fulcrum’s Learning Hub to see the latest enhancements or are a first time visitor, please click here .

In Fulcrum’s Learning Hub you will find QConnect login access, informative videos, sign-up availability for a telephonic training session with a QConnect Specialist, and important education materials.

This resource will continue to be updated based on enhancements and new educational learnings so please check the site regularly.

As a reminder, for B and C tier assigned providers, the use of Fulcrum Health’s utilization management program, QConnect, is required to obtain authorization to prevent interruption to claims payments.


Disclosure of Ownership and Cultural Competency Requirement

Red FlagIn accordance with regulatory requirements of the Minnesota Department of Human Services (DHS) and the Centers for Medicare & Medicaid Services (CMS) regulations, all payors, including Fulcrum Health, Inc. (Fulcrum) must collect and maintain information regarding disclosure of ownership and management information and cultural competency from all providers in its network on an annual basis.

Fulcrum is requesting that each clinic complete the online form by November 29, 2019. Click here to access the online form.

This online form is located on a secure, encrypted webpage.

Organization Determinations

Magnifying glass over paperThis article focuses on organization determinations – what they are and when to get one. As a reminder, Advance Beneficiary Notices (ABN) (Form CMS-R-131), are not used in the administration of Medicare Part C services. ABNs are used only for Medicare Part A and B (original Medicare).

Please review the organizational determination process to ensure the patient has exhausted their insurance benefits and use the Fulcrum financial disclosure forms to provide cost information on non-covered services to your patients.

An organization determination, as defined by the Centers for Medicare and Medicaid Services (CMS), is:

Any decision made by a Medicare health plan regarding:

  1. Receipt of, or payment for, a managed care item or service;
  2. The amount a health plan requires an enrollee to pay for an item or service; or
  3. A limit on the quantity of items or services.

An organization determination, sometimes referred to as a coverage decision, is a decision a health plan or delegated entity makes about a patient’s benefits and coverage and whether the requested service(s) should be paid. Organization determinations are typically requested by a provider, but a patient is also able to request a coverage decision before receiving certain medical services. A patient may choose to request a determination for a coverage decision beforehand when either the doctor or patient are unsure whether the health plan will cover a medical service. After notification of the denial, a written consent, in the form of a Financial Disclosure Form (FDF), signed by the member agreeing to receive and be financially liable for the denied services prior to the services being rendered is required .

The only way to justify billing the member is if the FDF is filled out. These forms can be found here . After these steps are complete, the provider may treat the member. If this is not done in the manner prescribed, the provider risks being financially liable.

Upon receipt of your request for an organizational determination, the health plan has 14 calendar days for the physician or other health care professional to make a final decision. Once the decision has been made you and the patient will receive a letter indicating the outcome of the review. If the review was denied, you will be presented with appeal rights in the letter along with an explanation of the process you must complete to appeal the decision.

For further information on Organization Determinations, please visit the Learning Hub . Instructions on entering Organization Determinations in the QConnect provider portal can be found on page 16 of the Training Manual located on the Resources tab.

For information on how a Medicare health plan processes organization determination, please visit:

If you have any questions on this matter, please call Fulcrum Provider Services at 877-886-4941. If you know or suspect fraud, waste, or abuse is occurring in your place of business please report it immediately to Fulcrum’s compliance hotline at 1-866-714-0526. Tips can be left on this voicemail 24/7 by anyone (provider, office support staff, patients, etc.).


Let Your Voice Be Heard! Provider Satisfaction Survey

Large green arrows in boxesWe value your opinion. The feedback we gather from this annual survey helps identify areas of interest and of concern to the ChiroCare by Fulcrum Health network. We also use your responses to assist in the development of new programs, supporting materials, and educational opportunities.

ChiroCare network providers should have received Fulcrum’s provider satisfaction in the mail. If you have not received or would like to request an emailed version, please email .

Please complete the survey and return it in the self-addressed, postage-paid envelope, no later than Friday, October 4, 2019.

If you have any questions, feel free to contact us at or (763) 204-8570 and we’ll be happy to assist you. ​Thank you for taking the time to share your feedback and ideas with us!

NewsFlash and Email Communications

If you no longer wish to receive NewsFlashes or other important electronic emails, please and state that you no longer wish to receive the publication, and include your name, provider group name, and Tax ID #.

Please note that per Fulcrum’s contractual agreements, this publication needs to be received by at least one individual within your clinic.If someone in your organization would like to be added to the NewsFlash distribution list, please click here . Typically, you will only receive 1-2 emails per month.

Moving or Retiring? Let us Know!

Address Book IconIt is vital that you report any practice changes to ensure that we have your current address, phone, fax, and email address. Any changes or corrections to your TIN/name combination should be communicated immediately. TheProvider Update tool within ChiroCare Connect offers a quick and electronic means to report changes. Simply select the “Billing Information Update” option within the Provider Update tool.

Please contact our Provider Services team at 877-886-4941 with any questions about submission of updates.

We appreciate your continued partnership!