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09/26/2008

OPTUM HEALTH (ACN) SEEKING TO ENTER OHIO WORKERS’ COMP MARKET

Panel Docs Must Opt Out by October 1 or will be Included

You may recently have received a letter from OptumHealth (formerly ACN) regarding a network for Chiropractic benefits called Align Networks, Inc (Align). Align specialized in management of workers' compensation injuries.

Align network will provide the following:
• Direct patient referrals resulting in increased referral volume of injured workers
• Payment directly from Align within contracted timeframes
• No membership or access fees
• No case rates or capitation; visit authorization is obtained on a case-by-case basis based on clinical need.

The Reimbursement Structure for the Ohio Chiropractic Network is as follows:

The provider can bill at 100% of established charges. However, Reimbursement will be at whichever is the lesser reimbursement amount of the following:
• 80% of any applicable state, federal or governing agency mandated fee schedule
• The established global or daily fee cap of $65.00
• 80% of UCR as determined by the Payor
• 80% of billed charges

If you are currently a participating provider with OptumHealth (formerly ACN), you are automatically enrolled in this workers' compensation system effective October 1, 2008.

If you wish to opt out of this program, you must notify OptumHealth (formerly ACN) in writing before October 1, 2008.

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