December 2011

Dear Integra Providers,

Happy Holidays and best wishes for a great New Year! With 2012 having just begun, we want to remind you that the 2012 Fee Schedule for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is now effective. You can find all your information on the code changes on our website. As a reminder, CMS announced an overall 2.4% rate increase for DMEPOS in 2012!

New Email Contacts

In order to help improve our response time to any provider questions, required assistance and claims needs, we have created new direct email addresses. Your use of these email addresses will help us to quickly, orderly and efficiently respond to any needs you might have: – for bill entry corrections, copies of Integra documents, copies of pre auths/denials, entries and software issues or questions – for any claim status, cost invoices and detailed LMN/clinicals – patient consents from providers to Integra – general questions or information requests

Billing Software Training Manual

We have recently introduced a customized, easy-to-use, Integra training manual that provides a step-by-step tutorial on how to use all the features of the billing software along with a short Q&A guide. If you should have any questions about using the billing software, features and capabilities or just need to train a new employee, please email us at and we will email a copy of the manual and answer any questions you might have.

Claim Reminders and Tips

In order to help reduce some common mistakes in submitting claims and avoid inaccurate reimbursements or denials from payors, please find some helpful reminders and tips.

Patient and Benefit Verification
The member’s policy/insurance must be verified on the initial visit and again for each date of service along with the benefits. This verification will identify those patients who might have lost coverage after the initial visit or who are not covered for certain DME or O&P benefits.

After authorization is given for service, it is important that all services are provided within the effective date span. Failure to submit within the given date span will result in a claim denial by the payor.

Paper Claims

GHI – claims with an ID that begin with “NA” must be sent by paper to American Plan Administrators (APA)

Multiplan – all claims must be sent to the claims submission address on each participant’s individual card


All DME procedures for all insurances require an NU or RR modifier.

All orthotics must include an RT or LT modifier for payors: BCBS, Fidelis, GHI, Health Plus, HIP and MetroPlus.

Prosthetic claims require a K functional modifier for payors: BCBS, Fidelis, GHI, HIP and Montifiore CMO.

In Closing

As always, we appreciate the trust you have placed in us and we will continue to work on improving our partnership with you. Over the coming year, we will roll out new features, capabilities and services to assist you and improve how we interact. We also want to hear from you and welcome any feedback on how we can further strengthen our relationship, improve our services or increase the value we are providing you. Please email us at

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