Cdn.ymaws.com



Call SummaryPresenter: Christopher M Bowlby, United Healthcare (UHC) Provider Service Department ManagerCenter Attendance:Packard HealthThe Wellness Plan Health CenterIntercare Health CenterBaldwin Family Health CenterAlcona Health CenterGrace Health CenterWestern Wayne Health CenterCenters for Family HealthFamily Health Center of KalamazooOakland Integrated Health NetworkMuskegon Family CareIf you joined after roll call, please send an email to Charmaine to record your center’s attendance.Reimbursement StrategiesPPS Rate, Contract Rate, GCode Line, etc.UHC has adopted the reimbursement screen per MDHHSInitially, there were issues with the REV code, but has now been correctedPer diem rate covers the bulk of servicesThere are still carved out services that will receive the FFS rate (OB for example)Status of Outstanding ClaimsDenied or paid at $0Chris recommends the centers become engaged with LINK via UHCs website to assist with reviewing claims and status, reconsiderations, upload attachment when resubmitting for processingUHC website and tools also allow CHCs to verify benefits, COB’s, pre-check formularies, and verify center demographicsUHC also has its own YouTube channel for additional resourcesThere will be a Michigan specific video available soonChris also offered to connect centers with an advocate to assist in claims resolutionCenters are encouraged to connect with Chris on outstanding issues, please see contact information under the presenter bulletPolicy for submitting claims for reprocessing12 month timely filing allowance for reprocessing claimsAppeal timeframe will varyMedicaid is usually 6 months from denial dateCommercial is 365 days from denial dateFor reconsideration, this request can now all be processed onlineYou can request review through the reconsideration processRequest will receive full clinical reviewList of UHC Service LinksClaims and PaymentsEligibility and BenefitsLink Self-Service ToolsPrior Authorization and NotificationReferralsReports and Quality ProgramsCHAMPS DataProcess for resolving missing dataCHAMPS data will not be uploaded if Provider is not enrolled in CHAMPS (for new Providers)MDHHS has postponed in moving forward on this policy, State has a large backlog and will notify UHC once updatedPlease review MDHHS HYPERLINK "" Biller Beware announcement below as a resource for this discussion topicFebruary 23, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) requirement of Managed Care Organization (MCO) typical providers needing to be enrolled in CHAMPS by March 1, 2018, has been delayed. Additional communication will be issued when a date has been finalized. We continue to encourage all typical rendering, referring, ordering, prescribing and attending MCO providers to enroll in CHAMPS. As at a future date, MDHHS will prohibit MCOs from making payments to all typical non enrolled providers. Enrollment in CHAMPS neither requires nor mandates those providers who are part of a managed care network to accept Fee-for-Service Medicaid beneficiaries. Enrollment in CHAMPS is solely used for the purpose of screening providers participating in Medicaid. Policy UpdatesNone noted during the callCHC QuestionsClaim denied for primary Substance Abuse diagnosis as provided by a Primary Care Providerfor example, providing Vivitrol with opioid use as the primary dxUHC is currently working on this error, the problem is Substance Abuse is carved out for MHP, when the claims were received after moving to the UB Format, UHC was not preparedAs of 4/10, UHC reached out to MDHHS for clarification and awaiting a response; UHC will reprocess the claim if they are responsible or if not, will send a notice out on next steps to all CHCs; please remember to review the Provider Portal for updates and policiesDenials for Med/BH and/or not being paid for the BH portion; one center reports using the modifier but only being paid on the medial portionChris stated both should be paid and would like examples sent for reviewChris recommended attaching Modifier -25 on the claimResources: LINK Online Tool:Centers are encouraged to submit question via UHC’s Self-service portal, this will allow UHC to build an FAQ and trainings that are FQHC specificThere is an opportunity to enter CPT codes that will list all policy requirements and coverage details, to include PA You can status claims, request reconsideration, etc.; this system was put in place to reduce lengthy hold times. There is also an online helpdesk to route callers to the right person/departmentThere is also the EDI and clearinghouse options, you are able to use your internal system to communicate with UHC directly; you can learn more information by speaking with your UHC Advocate, Chris or send an inquiry to Charmaine to connect you with the right personVisit UHCs Provider Portal to receive network bulletins Bulletins are released the first week of every month that lists new policies and updates occurring in MI ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download