Relevant News and Information for Network Providers                             Summer 2017
Is Texting In Violation of HIPAA? 
The Security Rule (45 CFR Part 160 and Part 164, Subparts A and C) requires Covered Entities (includes mental health practitioners) to evaluate the risks posted to any EPHI (electronic protected health information) that is transmitted or stored.  Is texting in violation of HIPAA?  The Privacy and Security Rules are complex; these rules do not mention texting as such, but they do include certain conditions that apply to electronic communications in the healthcare industry.

It is okay for a practitioner to send text messages to a patient, provided that the message complies with the “minimum necessary standard”. It is also okay to send messages by text when the mechanisms are in place to comply with the technical safeguards of the HIPAA Security Rule – such as an app for secure messaging.  As a reminder - PHI can be: electronic , written, spoken or heard.

PHI includes anything that can be used to identify a patient, as well as actual health information (e.g. diagnosis codes) and insurance and billing information. PHI includes but is not limited to a Patient’s:


  • name                    
  • address
  • employer
  • relatives’ names
  • date of birth
  • telephone number
  • email address
  • Social Security number
  • Medical record number
  • Member or account number
  • Fingerprints, photo
  • Characteristics (eg. job) – that could identify someone


If you are texting appointment reminders to clients you've opened the door for returned communication. Clients may assume you'll be available 24/7 for emergencies. Does your practice have communication guidelines established so that clients understand how and when to contact you in the event of an emergency.  Ensure your practice is in compliance with this HIPAA standard; protect your practice by using a secure messaging app.  For additional information go to www.HHS.gov search for Health Information Privacy.

EAS-C Training Course 
New Avenues is making final preparation for the EAS-C Employee Assistance Specialist-Clinical training.    

DATE: October 20, 2017
COST: $150.00
LOCATION: Oaklawn Children's Campus, Mishawaka IN 

Mark your calendars, registration emails will be sent in August.
When Is Prior Authorization Required?
In today's healthcare environment most plans do not require prior authorization for outpatient service. New Avenues currently manages 2 health plans that do require prior authorization in order for services to be covered at the highest maximum benefit available to the member.  As a contracted provider, it's your responsibility to obtain this prior authorization. Failure to do so may result in reduced or no benefit coverage . These 2 plans are Concord Schools and the  County of St. Joseph.   

How do you know when prior authorization is required?  Become familiar with our Insurance Reference Guide   The Pre-Cert Required column located on this guide indicates what services require prior authorization along with the telephone number to call and obtain prior authorization. If you are seeing a member through their EAP benefit and need to transition into insurance, you must submit the New Avenues (MBHN)  Initial Clinical Assessment to initiate the prior authorization for the member's insurance benefit. 

If you obtain retro-authorization for services rendered please re-submit the previously denied or reduced claim. All claims must be received within 90 days from the date of service rendered. 

Aetna Trinity PPO Arrangement with New Avenues 
In September 2016 New Avenues entered into a leasing arrangement with Aetna for the Trinity Healthcare group (Saint Joseph Regional Hospital).  N ew Avenues' name and logo are not printed on these id cards. If you are not an Aetna provider but you're a New Avenues provider, you are considered in-network under your New Avenues Provider Agreement for this employer group.

Revised ABA Request For Authorization Form
The ABA Requests for Authorization Form has been updated to reflect the change to TCodes implemented in January of this year. This link will take to your the new form.