ADDENDUM B. COVERED PROVIDERS* (Revised 04/02/18) *Provider list to be updated quarterly.

Transcription

1 POLICY TITLE: Centura Health Financial Assistance Policy DEPARTMENT: Revenue Management ORIGINATION DATE: 07/01/2016 CATEGORY: Billing EFFECTIVE DATE: July 1, 2016 ADDENDUM B COVERED PROVIDERS* (Revised 04/02/18) *Provider list to be updated quarterly. The following professional charges are covered by the Centura FAP. 84TH AVENUE NEIGHBORHOOD HEALTH CENTER ACADEMY WOMEN'S HEALTHCARE ASSOCIATES ASPEN RIDGE ENT AT ST ANTHONY AVISTA ADVENTIST HOSPITAL PALLIATIVE CARE AVISTA CYPRESS ONCOLOGY PARKER AVISTA MILE HIGH ONCOLOGY AVISTA CYPRESS ONCOLOGY DENVER BILLINGS NEPHROLOGY CLINIC CARDIAC THORACIC SURGERY ASSOC ST ANTHONY CASTLE ROCK ADVENTIST HOSPITAL PALLIATIVE CARE CENTRE FOR BEHAVIORAL HEALTH CENTURA CENTER FOR REHABILITATION PUEBLO CENTURA COMPREHENSIVE CARE AHS CENTURA COMPREHENSIVE CARE CHIC CENTURA GASTROENTEROLOGY CENTURA HEALTH ARVADA EMERGENCY AND URGENT CARE CENTURA HEALTH AVON EMERGENCY AND URGENT CARE CENTURA HEALTH GOLDEN EMERGENCY AND URGENT CARE CENTURA HEALTH INDIAN PEAKS EMERGENCY AND URGENT CARE CENTURA HEALTH LAKEWOOD EMERGENCY AND URGENT CARE Category Statewide Financial Assistance Policy Page 1 of 12

2 CENTURA HEALTH MERIDIAN EMERGENCY AND URGENT CARE CENTURA HEALTH ORTHOTICS AND PROSTHETICS CENTURA HEALTH PHYSICIAN GROUP CENTER FOR BREAST CARE HIGHLANDS CENTURA HEALTH URGENT CARE BROADMOOR CENTURA HEALTH URGENT CARE CANON CITY CENTURA HEALTH URGENT CARE TRI-LAKES CENTURA NEUROSCIENCE CONCUSSION FRISCO CENTURA ORTHOPEDICS CHPG - AUDUBON CENTURA ORTHOPEDICS CHPG - BRIARGATE CENTURA ORTHOPEDICS CHPG - BROADMOOR CENTURA ORTHOPEDICS CHPG - LONE TREE CENTURA ORTHOPEDICS CHPG - MEADOWS CENTURA ORTHOPEDICS MERIDIAN CENTURA ORTHOPEDICS PSA - AUDUBON CENTURA ORTHOPEDICS PSA - BRIARGATE CENTURA ORTHOPEDICS PSA - BROADMOOR CENTURA ORTHOPEDICS PSA - HUGO CENTURA ORTHOPEDICS PSA - LAMAR CENTURA ORTHOPEDICS PSA - LONE TREE CENTURA ORTHOPEDICS PSA - MEADOWS CENTURA ORTHOPEDICS PSA - POWERS CENTURA ORTHOPEDICS PSA - SALIDA CENTURA ORTHOPEDICS TRI-LAKES CENTURA PEDIATRICS ST THOMAS MORE CENTURA PHYSICAL THERAPY AT GOLDEN CENTURA SPINE CARE CENTURA SPORTS MEDICINE ST. ANTHONY CHPG PHYS MED & REHAB PORTER IP CHPG ADVENTIST HOSPITALISTS AVISTA CHPG AVISTA FAMILY MEDICINE CHPG BREAST CARE LONGMONT Category Statewide Financial Assistance Policy Page 2 of 12

3 CHPG BREAST IMAGING ST ANTHONY CHPG CARDIAC & THORACIC SURGERY PENROSE CHPG CARDIAC & THORACIC SURGERY PUEBLO CHPG CARDIOLOGY MERCY CHPG CARDIOLOGY MERCY CHPG CENTER FOR BREAST CARE CHURCH RANCH CHPG CENTER FOR BREAST CARE SUMMIT CHPG CHURCH RANCH GENERAL SURGERY CHPG CHURCH RANCH PRIMARY CARE CHPG COLORADO HEAD & NECK SPECIALISTS CHPG COLORADO JOINT REPLACEMENT CHPG COLORECTAL PARKER CHPG CRIPPLE CREEK & VICTOR MOUNTAIN HEALTH CENTER CHPG CRITICAL MEDICINE FOUR CORNERS CHPG CTR FOR BREAST CARE AVISTA ADVENTIST HOSPITAL CHPG CTR FOR BREAST CARE ST ANTHONY HOSPITAL CHPG EKG INTERPRETATIONS ST THOMAS MORE CHPG ENDOCRINOLOGY LONGMONT CHPG ENDOCRINOLOGY ST ANTHONY CHPG ENDOCRINOLOGY SUMMIT CHPG ENDOCRINOLOGY THREE SPRINGS CHPG ENT CASTLE ROCK CHPG ENT ORCHARD CHPG ENT PARKER CHPG ENT ST THOMAS MORE CHPG ENT SUMMIT CHPG FOUR CORNERS PULMONARY AND CC AT AZTEC CHPG GASTRO LONGMONT CHPG GASTROENTEROLOGY AVISTA CHPG GASTROENTEROLOGY CHURCH RANCH CHPG GASTROENTEROLOGY MERCY Category Statewide Financial Assistance Policy Page 3 of 12

4 CHPG GASTROENTEROLOGY PARKER CHPG GASTROENTEROLOGY PORTER CHPG GASTROENTEROLOGY ST MARY CORWIN CHPG GENERAL SURGERY LONGMONT CHPG GENERAL SURGERY MERCY CHPG GENERAL SURGERY ORCHARD CHPG GENERAL SURGERY ST ANTHONY CHPG GENERAL SURGERY ST ANTHONY KS CHPG GENERAL SURGERY ST. THOMAS MORE CHPG GOLDEN PRIMARY CARE CHPG GRACE FAMILY CHPG GRACE FAMILY PRACTICE CHPG HEART AND VASCULAR HEALTH GRANBY CHPG HEART AND VASCULAR HEALTH KREMMING CHPG HEART AND VASCULAR HEALTH SUMMIT CHPG HEART AND VASCULAR HEALTH SUMMIT LEAD CHPG HIGH COUNTRY PRIMARY CARE BRECKENRIDGE CHPG HIGH COUNTRY PRIMARY CARE FRISCO CHPG HIGH COUNTRY PRIMARY CARE SILVERTHORNE CHPG HIGH COUNTRY WOMEN S HEALTH GRANBY CHPG HIGH COUNTRY WOMENS HEALTH FRISCO CHPG HOME PALLIATIVE CARE MERCY CHPG HOME PALLIATIVE CARE ST ANTHONY CHPG HOSPITALISTS LITTLETON CHPG HOSPITALISTS MERCY CHPG HOSPITALISTS ORTHO COLO CHPG HOSPITALISTS PARKER CHPG HOSPITALISTS PORTER CHPG HOSPITALISTS ST ANTHONY CHPG HOSPITALISTS ST ANTHONY NORTH CHPG HOSPITALISTS ST MARY CORWIN Category Statewide Financial Assistance Policy Page 4 of 12

5 CHPG HOSPITALISTS ST THOMAS MORE CHPG INTERNAL MEDICINE AVISTA CHPG INTERNAL MEDICINE MERCY CHPG INTERNAL MEDICINE ORCHARD CHPG INTERNAL MEDICINE PARKER CHPG INTERNAL MEDICINE ST THOMAS MORE CHPG MEDICAL CONSULTANTS PORTER ADVVENTIST HOSPITAL CHPG MEDICAL ONCOLOGY AVISTA CHPG MEDICAL ONCOLOGY SUMMIT CHPG MERCY ORTHOPEDIC ASSOCIATES CHPG NEPHROLOGY CORTEZ CHPG NEPHROLOGY MERCY CHPG NEUROSCIENCE AND SPINE AAH CHPG NEUROSCIENCE AND SPINE - LAH CHPG NEUROSCIENCE AND SPINE - SAH CHPG NEUROSCIENCE AND SPINE - SAH CHPG NEUROSCIENCE AND SPINE - SAN ORCHARD CHPG NEUROSCIENCES AND SPINE CHURCH RANCH CHPG NEUROSURG AT LITTLETON HOSPITAL CHPG ORTHO AND SPORTS MED LT CHPG ORTHO AND SPORTS MEDICINE AT PORTER CHPG ORTHOPEDICS & SPORTS MEDICINE CASTLE ROCK MEADOWS CHPG ORTHOPEDICS & SPORTS MEDICINE HIGHLANDS CHPG ORTHOPEDICS ST MARY CORWIN CHPG ORTHOPEDICS ST THOMAS MORE CHPG PAIN SPECIALISTS AVISTA CHPG PAIN SPECIALISTS CHURCH RANCH CHPG PAIN SPECIALISTS ORCHARD CHPG PEDIATRICS FIRESTONE CHPG PEDIATRICS LONGMONT CHPG PEDIATRICS NORTH CARE Category Statewide Financial Assistance Policy Page 5 of 12

6 CHPG PENROSE NEUROSCIENCES CHPG PHYS MED & REHAB PORTER CHPG PRIMARY CARE BAYFIELD CHPG PRIMARY CARE BELMAR CHPG PRIMARY CARE BERTHOUD CHPG PRIMARY CARE BROADMOOR CHPG PRIMARY CARE CASTLE PINES CHPG PRIMARY CARE CHATFIELD CHPG PRIMARY CARE CHERRY CREEK CHPG PRIMARY CARE CLEMENT PARK CHPG PRIMARY CARE CORNERSTAR CHPG PRIMARY CARE DTC CHPG PRIMARY CARE FIRESTONE CHPG PRIMARY CARE HIGHLANDS CHPG PRIMARY CARE HIGHLANDS RANCH CHPG PRIMARY CARE HORSE GULCH CHPG PRIMARY CARE IDAHO SPRINGS CHPG PRIMARY CARE LONGMONT CHPG PRIMARY CARE MEADOWS CHPG PRIMARY CARE MERCY CHPG PRIMARY CARE MERIDIAN CHPG PRIMARY CARE NIWOT CHPG PRIMARY CARE NORTHGLENN CHPG PRIMARY CARE PENROSE CHPG PRIMARY CARE PORTER CHPG PRIMARY CARE POWERS CHPG PRIMARY CARE PUEBLO CHPG PRIMARY CARE PUEBLO WEST CHPG PRIMARY CARE SOUTHLANDS CHPG PRIMARY CARE SOUTHMOOR CHPG PRIMARY CARE SOUTHWEST LONGMONT Category Statewide Financial Assistance Policy Page 6 of 12

7 CHPG PRIMARY CARE ST THOMAS MORE CHPG PRIMARY CARE THORNTON CHPG PRIMARY CARE TIMBERVIEW CHPG PULMONARY & CC FOUR CORNERS CHPG PULMONARY & CC FOUR CORNERS CORTEZ CHPG SA BRECKENRIDGE CCEC CHPG SOUTH DENVER NEUROSURGERY CHPG SOUTHERN COLORADO GYN ONCOLOGY CHPG SOUTHWEST NEUROSCIENCE CHPG SOUTHWEST RHEUMATOLOGY CHPG SPORT & FAMILY MEDICINE PUEBLO CHPG SPORTS AND FAMILY MEDICINE ARVADA CHPG ST ANTHONY CENTER EVERGREEN CHPG ST ANTHONY INTERNAL MEDICINE CHPG TRAVEL & INFECTIOUS DISEASE LONGMONT CHPG TRI-LAKES NEIGHBORHOOD HEALTH CTR CHPG UROLOGY CASTLE ROCK CHPG UROLOGY MERCY CHPG VASCULAR SURGERY PENROSE CHPG VASCULAR SURGERY PUEBLO CHPG VASCULAR SURGERY PUEBLO/CANON CITY CHPG WOMEN'S HEALTH CASTLE ROCK CHPG WOMEN'S HEALTH CHATFIELD CHPG WOMEN'S HEALTH CHERRY CREEK CHPG WOMEN'S HEALTH CHURCH RANCH CHPG WOMENS HEALTH CORNERSTAR CHPG WOMEN'S HEALTH ERIE CHPG WOMEN'S HEALTH HIGHLANDS CHPG WOMEN'S HEALTH LITTLETON CHPG WOMEN'S HEALTH LONE TREE CHPG WOMEN'S HEALTH LOUISVILLE Category Statewide Financial Assistance Policy Page 7 of 12

8 CHPG WOMEN'S HEALTH ORCHARD CHPG WOMENS HEALTH PARKER CHPG WOMEN'S HEALTH PINNACLE CHPG WOMEN'S HEALTH SOUTHLANDS CHPG WOMEN'S HEALTH ST THOMAS MORE CHPG WOMEN'S HEALTH THORNTON CHPG WOMEN'S SPECIALTY HEALTH ARVADA CHPG WOMEN'S SPECIALTY HEALTH CHURCH RANCH CHPG WOMEN'S SPECIALTY HEALTH LOUISVILLE CHPG WOMEN'S SPECIALTY HEALTH MERIDIAN CHPG WOMEN'S SPECIALTY HEALTH PORTER COLORADO SPRINGS SET COLORADO SPIRNGS CARDIOLOGY KANSAS COLORADO SPORT AND SPINE ASPEN CREEK COLORADO SPORT AND SPINE AT LANGSTAFF BROWN COLORADO SPORT AND SPINE AUDUBON HANDS COLORADO SPORT AND SPINE CHURCH RANCH COLORADO SPORT AND SPINE DRY CREEK COLORADO SPORT AND SPINE FRISCO COLORADO SPORT AND SPINE SISTERS GROVE PAVILION COLORADO SPORT AND SPINE TRI-LAKES COLORADO SPRINGS CARDIOLOGY COLORADO SPRINGS CARDIOLOGY BUENA VISTA COLORADO SPRINGS CARDIOLOGY CANON CITY COLORADO SPRINGS CARDIOLOGY DURANGO COLORADO SPRINGS CARDIOLOGY MONUMENT COLORADO SPRINGS CARDIOLOGY SALIDA COLORADO SPRINGS CARDIOLOGY SFMC COLORADO SPRINGS CARDIOLOGY WOODLAND PARK COPPER MOUNTAIN CLINIC CTSA CARDIAC TS DUR PIC SURGERY DURANGO Category Statewide Financial Assistance Policy Page 8 of 12

9 DENVER SET DIMENSIONS PAIN MANAGEMENT AT ST ANTHONY DIMENSIONS PAIN MANAGEMENT AT THE MEDICAL PAVILION DISTRICT 11 EMPLOYEE HEALTH DODGE CITY MEDICAL CENTER DODGE CITY MEDICAL CENTER DODGE CITY MEDICAL CENTER DODGE CITY MEDICAL CENTER DODGE CITY MEDICAL CENTER DODGE CITY MEDICAL CENTER ORTHOPEDICS DODGE CITY MEDICAL CENTER URGENT CARE DURANGO NEPHROLOGY ASSOCIATES GRAND MESA NEPHROLOGY IDFC ID & INTERNAL MED FOUR CORNERS KEYSTONE MEDICAL CLINIC LITTLETON PALLIATIVE CARE LONGMONT UNITED HOSPITAL MERCY INTEGRATED THERAPY CENTENNIAL MERCY INTEGRATED THERAPY DOWNTOWN MERCY INTEGRATED THERAPY HORSE GULCH MERCY INTEGRATED THERAPY THREE SPRINGS MERCY PALLIATIVE CARE MERCY REGIONAL MEDICAL CENTER DURANGO CANCER CENTER MERCY SOUTHWEST ONCOLOGY MERCY URGENT CARE AT DURANGO MOUNTAIN RESORT MONTANA NEPHROLOGY ASSOCIATES MONTEZUMA CLINIC ORTHO COLO PALLIATIVE CARE PAH PALLIATIVE CARE PARKER PALLIATIVE CARE PEN PALLIATIVE CARE Category Statewide Financial Assistance Policy Page 9 of 12

10 PENROSE BEHAVIORAL HEALTH NORTH CARE PENROSE BEHAVIORAL HEALTH PUEBLO WEST PENROSE COMMUNITY URGENT CARE PENROSE INTENSIVE CARDIAC REHAB PENROSE MOUNTAIN URGENT CARE PIKES PEAK NEPHROLOGY PORTER ADVENTIST HOSPITAL 1S PSYCHIATRY PORTER ADVENTIST HOSPITAL 2S GERIATRIC PSYCH PORTER ADVENTIST HOSPITAL ADULT PARTIAL PORTER ADVENTIST HOSPITAL CARDIAC DIAGNOSTICS PORTER ADVENTIST HOSPITAL ECT PORTER ADVENTIST HOSPITAL PRE-ADMISSION TESTING PRECISION SPINE CENTER, A CENTURA HEALTH CLINIC PSF BEHAVIORAL HEALTH PSF BEHAVIORAL HEALTH BROADMOOR PSF BEHAVIORAL HEALTH PRIMARY CARE PSF BEHAVIORAL HEALTH REHAB PSF BEHAVIORAL HEALTH SISTERS GROVE PSF BEHAVIORAL HEALTH TRILAKES REGIONAL MEDICAL CLINIC-ASPEN CENTER SOUTHERN COLORADO FAMILY MEDICINE HIGH RISK OB SOUTHERN COLORADO FAMILY MEDICINE SOUTHERN SUBURBAN INTERNAL MEDICINE SAC NURSE FAMILY PARTNERSHIP SAH PALLIATIVE CARE SCH CONVENIENT CARE CLINIC SCH HEART CENTER SCH PALLIATIVE CARE SCHC PODIATRY SENIOR HEALTH WEST AT ST. ANTHONY HOSPITAL SFM PALLIATIVE CARE Category Statewide Financial Assistance Policy Page 10 of 12

11 SIENA MEDICAL CLINIC ORTHOPAEDIC SURGERY SIENA MEDICAL CLINIC PEDIATRICS SMC PHYSICIAN PARTNERS PAIN AND REHAB SOUTHERN COLORADO BREAST CARE SPECIALISTS SOUTHERN COLORADO MATERNAL FETAL MEDICINE SOUTHERN COLORADO NEPHROLOGY ST ANTHONY FAMILY MEDICINE CENTER ORCHARD ST ANTHONY HOSPITAL SENIOR HEALTH NORTH ST ANTHONY NORTH FAMILY MEDICINE 84TH ST CATHERINE EMERGENCY PHYSICIANS ST CATHERINE HOSPITAL RADIOLOGISTS ST MARY CORWIN PALLIATIVE CARE ST. ANTHONY HOSPITAL - BEHAVIORAL HEALTH ST. ANTHONY NORTH FAMILY MEDICINE 84TH ST. ANTHONY NORTH HEALTH CAMPUS PALLIATIVE CARE ST. CATHERINE'S HOSPITAL-SIENA MEDICAL CLINIC ST. FRANCIS MEDICAL CENTER 3W NICU ST. MARY'S NEPHROLOGY STM PALLIATIVE CARE SUMMIT PALLIATIVE CARE TRANSPLANT CENTER AT PORTER ADVENTIST HOSPITAL Category Statewide Financial Assistance Policy Page 11 of 12

12 ULYSSES FAMILY PHYSICIANS ULYSSES SURGICAL WOUND CARE CENTER AT ST CATHERINE HOSPITAL Category Statewide Financial Assistance Policy Page 12 of 12