Spring AAHAM Conference

Transcription

1 Spring AAHAM Conference April 18, 2018 Meagan Weese, MBA Manager of Provider Relations

2 Community Plan Updates 2

3 Community Plan Updates 2018 Provider Manual Updated Medical and Drug Policy: Makena and 17P - 17-Alpha-Hydroxyprogesterone Caproate (Makena and 17P) Community Plan Medical Benefit Drug Policy NDC Requirements for Medicare Crossover Claims 3

4 Reimbursement Policy Updates 4

5 Reimbursement Policy Update 5

6 Reimbursement Policy Updates 6

7 Reimbursement Policy Updates The following updates can be found on the website Reimbursement Change for Image Guidance Code Revision to Laboratory Services Reimbursement Policy Reimbursement Notice for Multiple Procedure Reduction Codes Important Reimbursement Change to Ambulance Reimbursement Policy New Observation Services Facility Policy - Effective May 1, 2018 (PDF KB) Policy Reminder: Reimbursement for Laboratory Claims Revenue Codes Requiring Procedure Codes Reimbursement Policy Clarification for Care Providers at Facilities and Hospitals Provider Expo

8 Network Bulletin Updates 8

9 April Network Bulletin LINK Self Service Updates and Enhancements EligibilityLink enhanced to include past and future coverage Prior Authorization and Notification App - New print button for printer friendly pages - Create and edit a list of 20 favorite procedure codes - View descriptions of each field - Easily access the medical records requirements - Copy and already entered service line to reduce duplicate data entry - Search for cancelled cases by reference number Goodbye Availity Hello Link - UnitedHealthcare information is no longer included on the Availity multipayer website. You can access the same information and more, at no cost, using LINK. 9

10 April Network Bulletin Update 10

11 April Network Bulletin Genetic and Molecular Testing Effective July 1, 2018, UnitedHealthcare will require prior authorization/notification for additional codes as part of the online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for our fully insured UnitedHealthcare commercial plan members. Complete list of new CPT Codes included in the prior authorization requirement can be found in the April Network Bulletin. The entire policy for Genetic and Molecular testing can be found at UHCProvider.com 11

12 Online Provider Resources 12

13 UHCProvider.com 13

14 UHC on Air 14

15 Provider Relations Update Mobile Service Centers - An opportunity to meet with Advocate and Claims processing teams at a site close to your office to resolve claims and ask questions. - Summer and Fall 2018 Provider Information Expo Fall 2018 New Provider Advocate Assignments New Advocate for Western Nebraska 15

16 Nebraska Provider Advocates Advocate Name Jenn Nelson P: Lori Busboom P: Janice Parolek P: Assigned Counties Systems: Bryan Health, Bryan Physician Network, Faith Regional Health Services (Hospital), Fremont Health, Madonna Rehab Hospital Counties: Adams, Boone, Clay, Dawson, Fillmore, Franklin, Furnas, Gage, Gosper, Harlan, Jefferson, Johnson, Kearney, Nemaha, Nuckolls, Otoe, Pawnee, Phelps, Richardson, Saline, Seward, Thayer, Webster, York Systems: SERPA, IHS: Heartland Health Center, Fred Leroy Health Wellness Center, Omaha & Lincoln, FQHC: Peoples Health Center (Bluestem) Counties: Buffalo, Butler, Custer, Greeley, Hall, Hamilton, Howard, Lancaster, Merrick, Nance, Polk, Saunders, Sherman, Washington, Valley Systems: IHS: Carl T Curtis Health Center, Santee Health Center, Winnebago Tribal Health, FQHC: Good Neighbor Community Health Center (Columbus and Fremont), Midtown Health Center Counties: Arapahoe, Blaine, Brown, Boyd, Burt, Cedar, Colfax, Cuming, Dakota, Dixon, Dodge, Garfield, Holt, Knox, Keya Paya, Loup, Rock, Madison, Pierce, Platte, Stanton, Thurston, Wayne, Wheeler Molly Holgate P: molly_holgate@uhc.com Systems: Nebraska Methodist Health System, Nebraska Medicine, FQHC: Charles Drew Health Center Counties: Cass, Douglas, Sarpy Julie Sheppeard P: julie_sheppeard@uhc.com Systems: UniNet, Boystown, Catholic Health Initiatives, Children s Hospital and Medical Center, FQHC: OneWorld Health Center Counties: Cass, Douglas, Sarpy Charlie Kennedy P: charlie_kennedy@uhc.com Systems: Great Plains Health, Regional West Counties: Arthur, Banner, Box Butte, Chase, Cherry, Cheyenne, Dawes, Deuel, Dundy, Frontier, Garden, Grant, Hayes, Hitchcock, Hooker, Keith, Kimball, Lincoln, Logan, McPherson, Morrill, Perkins, Red Willow, Scottsbluff, Sheridan, Sioux, Thomas 16

17 QUESTIONS???