About a month ago, I published a letter written by the AAP that I encouraged dear readers to submit to their local MCOs and other payers in an effort to straighten out the upcoming imms admin debacle in advance. I know that some local AAP chapters have been very active with this endeavor but I suspect that others haven't. I'll bet, sadly, that Vermont has done nothing, for example (I'd appreciate being wrong on that count).
In North Carolina, the Pediatric Society has received not only a detailed response from their massive payor, NC BCBS, but they helped guide some of the answers! For those of you out there without response from payors yet, here's a) proof that it can be done b) proof that you can be involved and c) a template for your use.
As it relates to the definition of "qualified healthcare professional," I am going to work with my SOAPM and Verden friends to create a chart, by state, indicating what I can learn from locals there. More on that in a bit.
Meanwhile, enjoy the NC BCBS response to Imms Admin 2011. Kudus to the NC Pediatric Society and nice response from NC BCBS. Proof that at least one payor isn't all bad!