FHCA 2014 Annual Conference & Trade Show

Transcription

1 FHCA 2014 Annual Conference & Trade Show CE Session #49 Medicaid Managed Care Billing: Purely A Provider s Perspective Thursday, July 10 4:00 to 6:00 p.m. Crystal N/J2 Finance/Development Upon completion of this presentation, the learner will be able to: review SMMC LTC billing requirements for all claim types including Medicare crossover claims; discuss uniform billing requirements and explore plan-specific requirements; and review Plan billing processes and review and discuss best practices. Seminar Description: This session will review the billing requirements and processes of the Long Term Care component of the Statewide Medicaid Managed Care Program. The session will review the billing requirements that are uniform for each of the SMMC LTC Plans, as well as any Plan-specific unique requirements. The session will cover billing for all Medicaid bill types including SNF, ICF and Medicare Part A and Part B coinsurance crossover claims. Presenter Bio(s): Darlene Burt has been in the long term care industry for 21 years, managing billing teams of 30 plus employees. Additionally, Darlene consults for several large SNF and ALF corporations as changes occur in the industry. She currently serves as the Director of Reimbursement and one of four partners of Remington Financial Solutions, Inc., providing SNF and ALF billing services to a number of Facilities throughout Florida. Lynette Davis has worked in the healthcare field for 35 years. She has shared her talent with physician offices, hospitals, skilled nursing facilities and for the last 15 years with Opis Management Resources where she is presently the Director of Business Office Systems. Lynette and her family live near Orlando. Tony Marshall serves as Senior Director of Reimbursement for Florida Health Care Association. On behalf of FHCA, he serves as a liaison to the Florida Legislature, Agency for Health Care Administration, Department of Elder Affairs, Centers for Medicare & Medicaid Services, American Health Care Association, FHCA Reimbursement Committee and other relevant state and federal entities regarding issues of reimbursement and healthcare finance policy.

2 Florida Health Care Association 2014 Annual Conference Medicaid Managed Care Billing A Provider Perspective Thursday, July 10, 2014 Darlene Burt, Remington Financial Solutions Director of Reimbursement Lynette Davis, Opis Management Resources Director of Business Office Systems Tony Marshall, FHCA Senior Director of Reimbursement Presentation Objective Provide an overview of the Statewide Medicaid Managed Care (SMMC) Long Term Care (LTC) Program payment requirements Review and discuss SMMC LTC billing requirements for all claim types Review and discuss uniform billing requirements and explore plan-specific requirements and processes Discuss best practices 1

3 Payment and Rate Setting Rates and Supplemental Payments Payment rates to providers (5) Rate setting periods (Annual beginning September 1, 2015) Bed hold and therapeutic leave days Supplemental payments Medically complex services Payment and Rate Setting Retroactive Rate Adjustment Retroactive rate adjustment Interim rate adjustments Change of ownership Emergency payments 2

4 Payment and Rate Setting Prompt Payment/Timeliness Claims submission Weekly or monthly billing Timely filing limits (Rule vs. Statute vs. Contract) Prompt payment (5) 10 business days after receipt for electronic nursing home and hospice claims containing sufficient information for processing days after receipt for nonelectronically submitted claims Claims denial/appeal Payment and Rate Setting Prompt Payment/Timeliness Uniform claims processing/eft HIPAA compliant, nationally recognized billing software Electronic funds transfer Plan portal vs. clearinghouse 3

5 Eligibility Verification Eligibility and Benefit Information Online, real time verification through the secure Web Portal (FLMMIS web portal) Calling (800) for self-service automated voice response system (AVRS) to verify eligibility and other automated options Batch transactions supporting standard X12 270/271 eligibility verification through the secure Web Portal A Point-of-Sale (POS) device/connection through an approved Florida Medicaid MEVS vendor Eligibility Verification Benefit Plan Eligibility Verification (FLMMIS web portal) Benefit Plan is a term used by Medicaid to define the scope of benefits an individual is eligible to receive Not all Medicaid recipients receive the same level of benefits Some benefit plans have full benefits; others have limited benefits An individual may be in multiple benefit plans during the same period The Long Term Care benefit plan requires full Medicaid eligibility Recipients must be eligible for one of the LTC program codes in order to be eligible for LTC services 4

6 Eligibility Verification Managed Care Enrollment Provider must verify whether the recipient is enrolled in: the Managed Medical Assistance program the Long-term Care program, or both, or fee-for-service Provider must determine which Plan is responsible for which services (who do I bill and for what periods) Eligibility Verification New Aid Categories Aid Category Description MEDP SIXT Full Home and Community Based Services (HCBS) waiver services while HCBS Medicaid application is pending, if individual chooses to receive services while application is pending. These individuals can choose to receive services before being determined financially eligible for Medicaid by the Florida Department of Children and Families (DCF) This option is not available to individuals in nursing facilities Long-term Care plans are required to cover recipients who have lost Medicaid eligibility for sixty days from the date of ineligibility 5

7 Eligibility Verification Billing Reminder MEDP/SIXT If an institutional provider submits a feefor-service claim directly to the Medicaid fiscal agent for a recipient with MEDP or SIXT, the provider s claim will be denied with EOB code 4227 This Revenue Is Not Covered for This Member. Eligibility Verification Billing Reminder SIXT Although a recipient has an eligibility category in FMMIS of SIXT, he or she does not have full Medicaid eligibility at that time When an LTC enrollee loses Medicaid eligibility, LTC plans are required to continue providing covered LTC services, care coordination, and case management to the enrollee for 60 days following the enrollee s initial loss of eligibility Covered services for enrollees in SIXT are limited to their LTC services only; acute care medical, hospital, pharmacy, and behavioral health services are not covered in the SIXT period Claims submitted for non-ltc covered services for an enrollee with a SIXT span will be denied 6

8 Patient Responsibility Patient responsibility refers to the amount of an individuals income that the Department of Children and Families determines is the recipient s share in the cost of Medicaid long term care services Share of cost refers to the amount of medical expenses the individual must incur before DCF can determine the individual eligible for Medicaid Patient Responsibility cont. Collection of patient responsibility amounts Plan or provider Notification (Notice of Case Action) Verification (ACCESS Florida DCF Provider View ) Contact HP if you have questions about accessing DCF Provider View (800) Contact DCF if you have questions about data displayed in DCF Provider View DCF Customer Service Jacksonville: NFCC_Providers@dcf.state.fl.us Tampa: sr_call_center@dcf.state.fl.us Miami: SN_Providers_SCFCC@dcf.state.fl.us 7

9 Medicare Coinsurance Crossover Medicare crossover payments Part A coinsurance Part B coinsurance State payment process or Plan payment process Automatic crossover process or provider billing Medicare Crossover Claims: Plan Responsibilities The Managed Care Plan is responsible for Medicare co-insurance and deductibles for covered services. The Managed Care Plan must reimburse providers or enrollees for Medicare deductibles and coinsurance payments made by the providers or enrollees, according to guidelines referenced in the Florida Medicaid Provider General Handbook The Managed Care Plan must not deny Medicare crossover claims solely based on the period between the date of service and the date of clean claim submission, unless that period exceeds three years 8

10 Medicare Crossover Claims: Plan Responsibilities cont. Plans are responsible for processing and payment of all Medicare Part A and B coinsurance crossover claims for dates of service from the date of enrollment until the date of disenrollment from the plan Fee-For-Service Medicaid will continue to be responsible for processing and payment of Medicare Part A and B (level of care X) crossover coinsurance claims for dates of service from the date of eligibility until the date of enrollment with the LTC plan Medicare Crossover Claims: Plan Responsibilities cont. LTC plans are responsible for paying crossovers (if any) for the following services: nursing facility durable medical equipment home health, and therapies (occupational, physical, speech or respiratory) MMA plans are responsible for paying crossovers (if any) for all covered services If a recipient is also in an LTC plan, the LTC plan is responsible for crossovers for the services above 9

11 Medicare Crossover Claims: Plan Responsibilities cont. Medicare crossover claims will not be automatically submitted to the LTC or MMA plans Providers will bill the LTC plans for co-payments due for Medicaid covered LTC services for individuals who are dually eligible for Medicare and Medicaid after receiving the Medicare Explanation of Benefits (EOB) for the co-insurance payments Providers will need to submit the claim to the enrollees MMA plan in order to be reimbursed for any co-insurance or deductibles if no LTC Plan Providers will submit the claim to HP if no LTC Plan or if no LTC Plan (prior to enrollment in SMMC) Medicare Crossover Claims: Plan Responsibilities cont. When SMMC Plans calculate a zero dollar payment amount for a nursing facility Medicare Part A crossover claim, the claim must have a PAID status with an explanation of benefits (EOB) code that explains the calculated payment is zero because other insurance paid more than the Medicaid allowable 10

12 Medicare Crossover Claims: Recipient Responsibilities Except for patient responsibility for longterm care services, the plan members should have no costs to pay or be reimbursed COMPLETING THE UB-04 CMS

13 Field Description Fields Key Field Content or Usage Detail 1 Unlabeled Required Facility name, street address, city, state, zip and telephone 2 Unlabeled Not Required unless different than Field 1 3a 3b Patient Control Number Medical Record Number Required Not Required Billing name (Pay To Name), address, city, state, zip and telephone REQUIRED if different than provider information in FL 1 above Patient account/control number Facility medical or health record number 4 Type of Bill Required Enter appropriate type of bill as specified by the NUBC UB04 Uniform Billing Manual See Type of Bill Codes Table Below 5 Federal Tax ID Number 6 Statement Covers Period Required Required Enter the 9 digit number assigned by the Federal Government for tax reporting purposes Enter the billing period for the this statement Field Description Fields Key Field Content or Usage Detail 7 Unlabeled Not Required 8a Unlabeled Not Required 8b Patient Name Required Enter patient's last name, first name and middle initial 9a e Patient Address Required (except line e) Enter the complete mailing address of the patient a Street Address b City c State d Zip Code e Not Required 10 Birthdate Required Enter DOB as (MMDDYYYY) 11 Sex Required Enter Sex as M or F only 12 Admission Date Required Enter date of admission as (MMDDYY) 13 Admission Hour Required Enter hour of admission using 2 digit 24 hour military time (example: for 1:00 1:59 am use 01, for 11:00 11:59 am use 11, for 1:00 1:59 pm use 13, for 11:00 11:59 pm use 23) 12

14 Field Description Fields Key Field Content or Usage Detail 14 Admission Type Not Required 15 Admission Source Required Enter 1 digit code indicating the source of admission 1 Physician Referral 2 Clinic Referral 4 Transfer from Hospital 6 Transfer from another health care facility 7 Emergency Room 8 Court Enforced 9 Information not available 16 Discharge Hour Conditional Required on Admit thru Discharge claims and Final Interim claims 17 Discharge Status Required Enter appropriate discharge status as specified by the NUBC UB04 Uniform Billing Manual See Discharge Status Codes Tables Below Condition Codes Conditional REQUIRED when applicable; Condition codes are used to identify conditions relating to the bill that may affect payer processing For a list of codes and additional instructions refer to the NUBC UB04 Uniform Billing Manual Field Description Fields Key Field Content or Usage Detail 29 Accident State Not Required 30 Unlabeled Not Required Occurrence Not Required Codes Occurrence Span Not Required Code 37 Unlabeled Not Required 38 Unlabeled Not Required Responsible party name and address should always be same as patient since Medicare, Medicaid, and MLTC plans have no spouse or dependent coverage Value Codes Required Code: 09 Amount: $ coinsurance amount Code: 31 Amount: monthly patient responsibility Code: 80 Amount: number of days See Value Codes Table Below 42 Revenue Code Required Enter the appropriate 4 digit revenue code See Revenue Codes Tables Below 43 Description Required Enter the description for the covered service that corresponds to the code entered in field 42 13

15 Field Description Inpatient Field Content or Usage Detail 44 HCPCS/Rate/HIPPS Code Conditional Used for HCPCS/CPT codes, RUG codes, accommodation rates, and HIPPS rate codes Medicaid per diem rate RUG codes are REQUIRED on PART A Crossover claims when Medicare is primary. DO NOT recode to an all inclusive room and board revenue code CPT/HCPCS are REQUIRED on all PART B Crossover claims 45 Service Date Conditional REQUIRED on the RUG code lines when submitting PART A crossover claims if more than 1 RUG code is billed 46 Service Units Required Enter number of units/days/visits 47 Total Charges Required Enter total charges for each service line 48 Non Covered Charges Conditional 49 Unlabeled Not Required If applicable list non covered charges on applicable line items and the Total Non Covered Charges in Field 48 Field Description Inpatient Field Content or Usage Detail 50a c Payer Name Required Enter appropriate payers 51 Health Plan ID Number Required Insured ID for payers 52a c REL INFO Required Release information is required for every payer (must be Y) 53 ASG BEN Required Enter 'Y' or 'N' to indicate a signed form is on file authorizing payment by the payer directly to the provider for services 54 Prior payments Conditional REQUIRED for TPL Payment REQUIRED for submission of PART A or PART B Crossover claims 55 EST Due AMT Not Required Recommend completion if TPL is applicable 56 NPI Required Enter providers 10 character NPI number 57 Other Provider ID Not Required 58 Insured's Name Required Enter the name of the person who carries the insurance policy (should match Field 8b) 14

16 Field Description Fields Key Field Content or Usage Detail 59 Patient Relationship Not Required Usually "self" if patient only has Medicare or Medicaid coverage, but could be Spouse or Dependent if patient has primary coverage through their spouse or a parent 60 Insured's Unique ID Required Enter the patients ID number exactly as listed on their insurance card 61 Group Name Not Required 62 Insurance Group Number 63 Treatment Authorization Codes 64 Document Control Number Not Required Not Required Conditional You may submit authorization numbers in this field, but it is not recommended For corrected claims, submit the original claim ID in this field 65 Employer Name Not Required Field Description Fields Key Field Content or Usage Detail 66 Diagnosis Code Required REQUIRED to indicate the version submitted 9 = ICD 9 0 = ICD 10 67a q Other Diagnosis Codes Conditional POA Indicators are REQUIRED on Part A and Part B Crossover claims if required by Medicare POA = "Present on Admission" Reportable values are "Y" for Yes and "N" for No 68 Unlabeled Not Required 69 Admitting Required Diagnosis Code 70 Patient Reason Not Required Code 71 PPS/DRG Code Not Required 72 External Cause Not Required Code 73 Unlabeled Not Required OPTIONAL for LTC Nursing Home Claims Enter a valid ICD9 or ICD 10 diagnosis code Make sure field 66 is completed 15

17 Field Description Fields Key Field Content or Usage Detail 74 Principal Procedure Conditional Submit on Crossover claims when required by Medicare Code/Date 75 Unlabeled Not Required 76 Attending Physician Conditional Attending provider NPI, ID, qualifiers, last and first name REQUIRED on Crossover claims; OPTIONAL for MLTC long term care Nursing Home claims 77 Operating Not Required Physician Other Physician Not Required 80 Remarks Not Required REQUIRED for AEC crossover claims 81a Code to Code Required B3 Taxonomy number of billing provider Required for validation of NPI submitted; must match taxonomy on file in the NPI Registry 81b c Not used Not Required 81d Level of Care Required Row D is REQUIRED for reporting Level of Care on all nursing home claims (Medicaid per diem rate) and Part A/B Crossover claims (average RUG rate) See Level of Care Codes Table Below Type of Bill Codes Nursing Home & Part A Crossover 211 Admit Through Discharge Claim One claim for the entire stay. Cannot span months or calendar years. 212 Interim First Claim First claim for a continued stay. 213 Interim Continuing Claim Interim claim for a continued stay. 214 Interim Last Claim Last claim for a continued stay. 215 Late Charges Only Claim DO NOT USE. 217 Replacement of Prior Claim 218 Void/Cancel of a Prior Claim Use for corrected claims enter original claim number in UB Field 64 Eliminates and cancels a previous claim. DO NOT USE. 16

18 Type of Bill Codes Part B Crossover 221 Admit Through Discharge Claim One claim for the entire stay. Cannot span months or calendar years. 222 Interim First Claim First claim for a continued stay. 223 Interim Continuing Claim Interim claim for a continued stay. 224 Interim Last Claim Last claim for a continued stay. 225 Late Charges Only Claim DO NOT USE. 227 Replacement of Prior Claim 228 Void/Cancel of a Prior Claim Use for corrected claims enter original claim number in UB Field 64 Eliminates and cancels a previous claim. DO NOT USE. Patient Disposition Codes (Discharge Status) Code Description 01 Discharged/Transferred To Home Or Self Care (Routine Discharge) 02 Discharged/Transferred To Another Short Term Hospital For Inpatient Care 03 Discharged/Transferred To Skilled Nursing Facility (SNF). 04 Discharged/Transferred To Intermediate Care Facility (ICF) Discharged/Transferred To A Designated Cancer Center Or Children s Hospital Discharged/Transferred To Home Under Care Or Organized Home Health Service Organization 17

19 Patient Disposition Codes (Discharge Status) Code Description 07 Left Against Medical Advice Or Discontinued Care 08 Reserved For National Assignment Reserved For National Assignment 15 Planned Acute Care Hospital Inpatient Reserved For National Assignment 20 Expired Patient Disposition Codes (Discharge Status) Code Description 21 Discharged/Transferred To Court/Law Enforcement Reserved For National Assignment 30 Still Patient Reserved For National Assignment 43 Discharged/Transferred To Federal Assignment Reserved For National Assignment 18

20 Patient Disposition Codes (Discharge Status) Code Description 50 Hospice Home 51 Hospice Medical Facility Reserved For National Assignment Discharged/Transferred Within This Institution To Hospital Based Medicare Approved Swing Bed Discharged/Transferred To Inpatient Rehabilitation Facility (IRF) Including District Part Units Of Hospital (Effective Retroactive To 1/1/2000) Discharged/Transferred To Medicare Certified Long Term Care Hospital (LTCH) Patient Disposition Codes (Discharge Status) Code Description Discharged/Transferred To A Nursing Facility Under Medicaid But Not Certified Under Medicare Discharged/Transferred To A Psychiatric Hospital Or Psychiatric Distinct Part Unit Of A Hospital 66 Discharged/Transferred To A Critical Access Hospital (CAH) Reserved National Assignment 69 Discharged/Transferred To A Designated Disaster Alternate Care 70 Discharged/Transferred To Another Type Of Health Care Institution Not Defined Elsewhere 19

21 Patient Disposition Codes (Discharge Status) Code Description Discharged To Home Or Self Care With A Planned Acute Care Hospital Inpatient Readmission Discharged/Transferred To Short Term General Hospital For Inpatient Care With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Skilled Nursing Facility (SNF) With Medicare Certification With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Facility That Provides Custodial Or Supportive Care With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Designated Cancer Center Or Children's Hospital With A Planned Acute Hospital Inpatient Readmission Patient Disposition Codes (Discharge Status) Code Description Discharged/Transferred To Home Under Care Of Organized Home Health Service Organization With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To Court/Law Enforcement With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Federal Health Care Facility With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Hospital Based Medicare Approved Swing Bed With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To An Inpatient Rehabilitation Facility (SNF) Including Rehabilitation Distinct Part Units Of A Hospital With A Planned Acute Hospital Inpatient Readmission 20

22 Patient Disposition Codes (Discharge Status) Code Description Discharged/Transferred To A Medicare Certified Long Term Care Hospital (LTCH) With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Nursing Facility Certified Under Medicaid But Not Certified Under Medicare With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Psychiatric Hospital Or Psychiatric Distinct Part Unit Of A Hospital With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To A Critical Access Hospital (CAR) With A Planned Acute Hospital Inpatient Readmission Discharged/Transferred To Another Type Of Health Care Institution Not Defined Elsewhere In This Code List With A Planned Acute Hospital Inpatient Readmission Value Codes Code Description Comments 09 Coinsurance Amount 31 Patient Responsibility Covered Days (Required on paper crossover claims) Non covered Days (Required on paper crossover claims when applicable) Coinsurance Days (reportable only on paper claims) Report the total coinsurance amount (coinsurance days X coinsurance rate) Report the monthly patient responsibility amount REQUIRED If resident has no patient responsibility enter $0.00 REQUIRED value submitted should be equal to the number of days covered REQUIRED if all days are not covered REQUIRED Value should be equal to the coinsurance applied by Medicare and reflected on the Medicare EOB 21

23 Revenue Codes Room & Board 0101 Long Term Care Day 0185 Hospital Leave Days (Hospital bed hold days) 0182 Home Leave Days (Therapeutic bed hold days) 0120 Medicare Crossover Days (except AEC) Revenue Codes Physical Therapy 042X Physical Therapy UB04 Revenue Code 0420 General Classification UB04 Revenue Code 0421 Visit Charge UB04 Revenue Code 0422 Hourly Charge UB04 Revenue Code 0423 Group Rate UB04 Revenue Code 0424 Evaluation or Re evaluation UB04 Revenue Code 0429 Other Physical Therapy UB04 Revenue Code 22

24 Revenue Codes Occupational Therapy 043X Occupational Therapy UB04 Revenue Code 0430 General Classification UB04 Revenue Code 0431 Visit Charge UB04 Revenue Code 0432 Hourly Charge UB04 Revenue Code 0433 Group Rate UB04 Revenue Code 0434 Evaluation or Re evaluation UB04 Revenue Code 0439 Other Occupational Therapy (may include restorative therapy) UB04 Revenue Code Revenue Codes Speech-Language Pathology 044X Speech Therapy 0440 General Classification UB04 Revenue Code 0441 Visit Charge UB04 Revenue Code 0442 Hourly Charge UB04 Revenue Code 0443 Group Rate UB04 Revenue Code 0444 Evaluation or Re evaluation UB04 Revenue Code 0449 Other Speech Language Pathology UB04 Revenue Code 23

25 Level of Care Codes 1 Skilled 2 Intermediate I 3 Intermediate II 4 State Mental Health Hospital 6 through 9 ICF DD Levels of Care U Skilled Fragile Children Under 21 X Medicare Part A Coinsurance Payment COMPLETING THE CMS

26 Field Description Field Content or Usage Detail 1 PAYER Check Plan Program Type (Medicaid) 1a INSURED S I.D. NUMBER Patient's Medicaid No. or Plan ID No. 2 PATIENT S NAME Patient's Name (Last Name, First Name, Middle Initial) 3 PATIENT S BIRTH DATE/SEX Patient's Date of Birth (MMDDYY) & Gender (M or F) 4 INSURED S NAME Insured's Name (Last Name, First Name, Middle Initial) PATIENT S DEMOGRAPHIC INFO PATIENT RELATIONSHIP TO INSURED INSURED S DEMOGRAPHIC INFO IS PATIENT S CONDITION RELATED TO: INSURED'S POLICY GROUP OR FECA NUMBER PATIENT'S OR AUTHORIZED PERSON S SIGNATURE INSURED'S OR AUTHORIZED PERSON'S SIGNATURE Patient's Street Address, City, State, Zip, Telephone Patient's Relationship to Insured (Enter Self ) Insured's Street Address, City, State, Zip, Telephone Mark Yes or No for Employment, Auto Accident, or Other Accident Insured's Policy and Plan Information Patient's Signature (Enter Signature on file ) Patient Signature (Enter Signature on file ) Field Description Field Content or Usage Detail 21 DIAGNOSIS OR NATURE OF ILLNESS OR INJURY Enter the diagnosis code included on the authorization. If there is no code on the authorization form use code (Debility Unspecified) * In most cases this will be the code used 22 MEDICAID RESUBMISSION CODE Required Only if resubmitting Enter Code 7(the "Replace" billing code) to indicate that this is a corrected or replacement claim In the Original Ref. No. section enter the number of the original claim you are replacing 23 PRIOR AUTHORIZATION NUMBER (All services must be authorized) Enter the authorization number listed on the service request form If you have not received a new authorization number from the members new managed care plan please contact them prior to billing to request a new authorization be sent to you or billing instruction 25

27 Field Description Field Content or Usage Detail 24a DATE(S) OF SERVICE Enter the date of service for each procedure, service, or supply on an individual line. Enter each Date of Service on a separate line (Exception: Providers on a capitated agreement may use a date range for a dates of service upon meeting their maximum allowable amount) The form provides a maximum of six line entries; If it surpasses the amount of entries provided, complete a new CMS 1500 form for remaining entries 24b PLACE OF SERVICE Enter the two character place of service code. (As per CMS 1500 Reference Guide). In most cases Code 13 will be used in this field. 24d PROCEDURES, SERVICES, OR SUPPLIES Enter CPT code/s per Plan requirements In most cases no modifiers will be needed 24e DIAGNOSIS POINTER Enter A 24f $ CHARGES Enter the charge amount for the service Field Description Field Content or Usage Detail 24g DAYS OR UNITS Enter the days or units provided for the procedure (all authorizations should indicate the proper unit increment) 24j RENDERING PROVIDER ID Enter NPI Number of the rendering provider 25 FEDERAL TAX ID NUMBER Enter the provider's federal tax ID number "EIN" 26 PATIENTS ACCOUNT NO. Enter the patient's account number This is the provider's internal account number for the patient 27 ACCEPT ASSIGNMENT? ALWAYS check Yes to accept assignment 28 TOTAL CHARGE $ Enter the total charge for the services listed 29 AMOUNT PAID Enter the total amount paid from all other insurance sources 26

28 Field Description Field Content or Usage Detail 31 SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS Signature of the person completing the form Enter the Servicing provider's name, address and phone number. Include zip code SERVICE FACILITY LOCATION INFORMATION 32a. Enter the NPI Number of the Servicing Provider Location In some cases this may differ from the Billing Provider Locations 33 BILLING PROVIDER INFO & PHONE # 32b. Not applicable Enter the billing provider's name, address and phone number. Include zip code a Enter the NPI. (Same from 24i) 33b Not applicable American ElderCare Customer Service ext Paper Claims Address Electronic Claims Web Portal Payment Methods Red/White UB04 accepted American Eldercare, Inc. Attn: Claims Department Sims Road Delray Beach, FL ebilling@americaneldercare.com for access through web portal erportal/ Payment through Florida Medicaid 27

29 Amerigroup Florida Customer Service Paper Claims Address Red/White UB04 accepted Amerigroup PO Box Virginia Beach, VA Electronic Claims Electronic payer: Web Portal Payment Methods Initial payment= paper check EFT register at ext or Coventry Health Care Customer Service Paper Claims Address Red/White UB04 accepted Independent Living Systems PO Box Eagan, MN Electronic Claims Electronic payer: Web Portal Payment Methods Web portal is currently under construction ETA 9/1/14 Paper check EFT effective July 1, 2014, Contact William Lopez ext. 7101, 28

30 Humana Medical Plan Customer Service Paper Claims Address Red/White UB04 accepted Independent Living Systems PO Box Eagan, MN Electronic Claims Electronic payer: Web Portal Payment Methods Web portal is currently under construction ETA 9/1/14 Paper check EFT effective July 1, 2014, Contact William Lopez ext. 7101, Molina Complete Care Customer Service Paper Claims Address (Carla) (Luisa) (Pam) (Elva Supervisor) Red/White UB04 accepted Molina Healthcare PO Box Long Beach, CA Electronic Claims Electronic payer: Web Portal Payment Methods Initial payment= paper check EFT register at providernet.alegeus 29

31 Sunshine Health Plan Customer Service Paper Claims Address Electronic Claims Web Portal Payment Methods Red/White UB04 accepted Sunshine Health Tango Plan PO Box 3070 Farmington, MO Attn: Claims Department Electronic payer: Sunshine Health c/o Centene EDI Department x ediba@centene.com Initial payment= paper check EFT Register at Payspan United Healthcare Customer Service Paper Claims Address Electronic Claims Web Portal Payment Methods Red/White UB04 accepted United Healthcare Community and State PO Box Salt Lake City, UT Electronic payer: Free claims submission option: eligibility, claims status, 1500 billing only Enroll for EFT's at: 30

32 Resources Florida Medicaid Provider Handbooks ovidersupport/provider_providersupport_provi derhandbooks/tabid/42/default.aspx Provider General Handbook Nursing Facility Services Coverage and Limitations Handbook Provider Reimbursement Handbook Hospice Services Coverage and Limitations Handbook Resources SMMC Homepage ahca.myflorida.com/medicaid/statewide_mc/index.shtml SMMC Event Calendar/Materials ahca.myflorida.com/medicaid/statewide_mc/index.shtml #NEWS SMMC LTC Program Page ahca.myflorida.com/medicaid/statewide_mc/index.shtml #LTCMC SMMC LTC Program Snapshot ahca.myflorida.com/medicaid/statewide_mc/pdf/ltc/s MMC_LTC_Snapshot_July_30_2013.pdf AHCA YouTube Channel (Webinars) 31

33 Questions??? Questions??? Questions??? Questions??? Contact Information Darlene Burt Director of Reimbursement Remington Financial Solutions (386) Lynette Davis, Director of Business Office Systems Opis Management Resources (813) Tony Marshall Senior Director of Reimbursement Florida Health Care Association (850) (850)