Nebraska Winter practicematters. For More Information. Call our Provider Services Center at Visit UHCCommunityPlan.

Transcription

1 Nebraska Winter 2017 practicematters For More Information Call our Provider Services Center at Visit UHCCommunityPlan.com

2 In This Issue... Overcoming Barriers with 270/271 Eligibility and Benefits Transactions Understanding the Correct EPSDT Referral Indicator Codes Billing Process for Physical Therapy Services in Nursing Facilities PreCheck MyScript Community Volunteer Work at Together Inc. in Omaha Introducing UHCprovider.com Our New Care Provider Website p.1 We hope you enjoy the winter edition of Practice Matters. In this issue, you can read about the updated billing processes for physical therapy services, referral indicator codes, our local volunteer work and more. Happy winter! Practice Matters: NE Winter 2017 Provider Services Center:

3 Overcoming Barriers with 270/271 Eligibility and Benefits Transactions If you ve tried to get member eligibility and benefits information from your 270/271 Health Care Eligibility and Benefit Inquiry and Response transactions, you may have come across some error messages and other barriers to finding the right information. Our current search logic allows you to enter different criteria related to the member or patient for the eligibility and benefits inquiry transaction (270). If the information given in the request doesn t match the data in our system, you will receive an AAA code telling you what information didn t match in the eligibility and benefits transaction response (271). To help you resolve these errors, we ve created a quick overview below: Adhering to required MAPD benefits Limiting enrollment to Medicaid recipients (dually eligible Medicare and Medicaid) Providing Part D benefits Offering targeted clinical programs, benefits and services Resolving Error Messages The following suggestions can help you resolve errors for the most common 271 responses. Error message: You receive: AAA*Y**73*C~AAA*Y**71*C~ (Invalid or missing name and DOB.) Solution: verify name and date of birth in your records and include the member ID. Error message: You receive: AAA*Y**75: (Subscriber/insured not found.) Solution: The member has no active coverage or may not be a UnitedHealthcare member. Research their information. Error message: You receive: AAA*Y**71 (Subscriber/ insured birth date does not match patient database.) Solution: Check the date of birth formatting. It should be YYMMDD. After you research the member information and confirm your records are accurate, we recommend resubmitting a 270 transaction. For more information on 270/271 EDI transactions, go to UHCprovider.com > Menu > Resource Library > Electronic Data Interchange (EDI) > Electronic Transactions > EDI 270/271: Eligibility and Benefit Inquiry and Response. We re Here to Help If you have any questions about UnitedHealthcare Community Plan members, please contact EDI Support at or ac_edi_ops@uhc.com. If you have any questions about UnitedHealthcare Commercial, Medicare Advantage, Oxford or West members, please contact EDI Support at Understanding the Correct EPSDT Referral Indicator Codes At UnitedHealthcare Community Plan, we want to work with you to get your claims processed promptly and accurately. One way we can collaborate together for faster claim reimbursement is by helping ensure each claim contains the correct information. Using the right codes and modifiers can help you avoid claim denials while expediting payment of your claims. (continued on next page) 1

4 (continued from previous page) The Nebraska Department of Health & Human Services (DHHS) requires care providers to use specific Early Periodic Screening, Diagnosis and Treatment (EPSDT) codes when billing well-child preventive services for members younger than 21. To help you submit your claims with the right information, we ve provided a summary of their guidelines: CPT codes through should be submitted with an EP modifier. Include the appropriate referral indicator in box 24H as indicated on the CMS-1500 form. For electronic claims submission, include the modifier in the CRC segment in the 2300 loop of the 837 professional file. The required EP modifiers are: AV: Patient refused referral S2: Patient is currently under treatment for diagnostic or corrective health problem NU: No referral given ST: Referral to another provider for diagnostic or corrective treatment Claims submitted without the correct referral indicator codes will be denied, so please use this summary as a reference when submitting your claims. If you d like more information on the requirements for DHHS Health Check (EPSDT) Referral Indicator Codes, visit DHHS.ne.gov/medicaid/ Documents/ pdf. Old Submission Process When physical, occupational or speech therapists were employed by the nursing facility, they submitted therapy claims on a CMS-1500 claim form under their individual provider numbers. The nursing facility was not allowed to bill for those services. New Submission Process Now the nursing facility must bill UnitedHealthcare Community Plan of Nebraska on a UB-04 claim form under the facility provider number. This applies only for staff therapists employed by the facility. If you are a physical, occupational or speech therapist who contracts with the nursing facility, your billing process will stay the same. You will continue to bill UnitedHealthcare Community Plan of Nebraska on a CMS-1500 claim form under your individual provider number. We ll Reprocess Affected Claims If you are a physical, occupational or speech therapist who contracts with the nursing facility and previously billed UnitedHealth Care Community Plan of Nebraska on a UB-04 for outpatient therapy services, we will automatically reprocess claims submitted on a UB-04 before Oct. 9, There is no need for you to resubmit. If you d like updates on the status of this project, please visit UHCCommunityPlan.com > For Health Care Professionals > Nebraska > Bulletins > Open Issues log. Billing Process for Physical Therapy Services in Nursing Facilities Beginning Oct. 2, 2017, UnitedHealth Care Community Plan of Nebraska will change the claims submission process for billing therapy services in nursing facilities. The change will apply for dates of service on or after Jan. 1,

5 PreCheck MyScript PreCheck MyScript is a new app on Link your gateway to UnitedHealthcare s online tools. This new app helps make it easy to run a pharmacy trial claim and get realtime prescription coverage detail for your patients who are UnitedHealthcare benefit plan members. If a medication requires prior authorization, you can submit your request online within the app. With PreCheck MyScript, you can: Check prescription coverage and price for UnitedHealthcare members in real time Get information on lower-cost prescription alternatives, if available, to help save members money See which prescriptions currently require prior authorization, or are non-covered or non-preferred Request prior authorization and receive status and results How to access the app Sign in to Link by going to UHCprovider.com and clicking on the Link button in the top-right corner. Then select the Link Marketplace from your Link dashboard and search for the PreCheck MyScript app. Once you ve added it to your dashboard, you can start using the app for UnitedHealthcare benefit plan members. Community Volunteer Work at Together Inc. in Omaha A dozen employees from UnitedHealthcare Community Plan of Nebraska and Optum recently spent a September afternoon volunteering at Together Inc. Together Inc. collaborates with organizations to help prevent and end homelessness by providing safe, affordable housing, food and access to health care. Each year, they serve nearly 22,000 people in the Omaha area.. Our volunteers harvested produce from the community garden which they helped plant last spring and stocked the food pantry. They also toured the Together Inc. facility and learned about the organization s different programs and resources. This was UnitedHealthcare Community Plan of Nebraska s fifth volunteer event with Together Inc. in the past two years. Our UnitedHealthcare and Optum Volunteer Team 3

6 Introducing UHCprovider.com Our New Care Provider Website UHCprovider.com is your new home for the latest news, policy information and access to Link self-service tools. You told us you wanted provider content in one place, and we heard you. The new site is the first step in bringing provider content together for your convenience, and will begin by replacing UHCWest. com, UnitedHealthcareOnline.com and the healthcare professional content on UHCCommunityPlan.com over the coming months. UHCprovider.com was designed with your feedback in mind, but our job is just beginning. Tell us how we re doing by clicking the Feedback button on the right side of any page. Your suggestions will help us continue to improve so we can better meet your needs. You ll be able to access your state-specific content on UHCCommunityPlan.com until late spring Watch for additional information in the Spring 2018 edition of Practice Matters. UHCprovider.com is available now and includes several new features: 24/7 access to the Link self-service tool dashboard A predictive search function with filtering and sorting capabilities to help you find what you need faster and easier An easy-to-read design whether you re on a desktop computer, tablet or smart phone 4

7 Nebraska practicematters Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network. PCA _ UnitedHealth Group, Inc. All Rights Reserved.