Arizona Long Term Care Winter 2018 practicematters For More Information UHCCommunityPlan.com

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1 Arizona Long Term Care Winter 2018 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 Atypical Providers Should Include Medicaid ID Number on Claims Understanding Program Exclusions We hope you enjoy this edition of Practice Matters. In this issue, you can read about overcoming barriers with 270/271 eligibility and benefits transactions, how atypical care providers should include Medicaid ID numbers on claims, and more. p.1 Practice Matters: AZ - Winter 2018 Provider Services Center:

3 If you receive: AAA*Y**75: (Subscriber/insured not found) Then member has no active coverage or may not be a UnitedHealthcare member If you receive: AAA*Y**71 (Subscriber/insured birth date does not match patient database) Then check formatting of date of birth should be YYMMDD For more information on 270/271 EDI transactions, go to UHCprovider.com > Menu > Resource Library > Electronic Data Interchange (EDI) > EDI 270/271: Eligibility and Benefit Inquiry and Response. Overcoming Barriers with 270/271 Eligibility and Benefits Transactions UnitedHealthcare wants to help you overcome barriers to get member eligibility and benefits from your 270/271 Health Care Eligibility and Benefit Inquiry and Response transactions. 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). We ve outlined suggestions to resolve errors for the most common reasons we re unable to find a match. We recommend researching the information and resubmitting a 270 transaction to help ensure your records are accurate. Verify information is accurate from the member ID card, patient records or contacting the member when receiving the following 271 responses: If you receive: AAA*Y**73*C~AAA*Y**71*C~ (Invalid or missing name and DOB) Then verify name and date of birth in your records and include member ID If you have any questions, please contact EDI Support: UnitedHealthcare Community Plan EDI issue reporting form or ac_edi_ops@uhc.com or Atypical Providers Should Include Medicaid ID Number on Claims UnitedHealthcare Community Plan s Long Term Care plan requires providers who are referred to as atypical to include their six-digit Medicaid ID number on submitted claims. This requirement helps ensure your claims are processed faster and more accurately, and it follows Arizona HealthCare Cost Containment System (AHCCCS) guidelines that direct you to include your Medicaid ID, also referred to as your AHCCCS ID, on claim submissions. Atypical providers are defined as those generally rendering nontraditional services that are indirectly health care-related. Examples include taxi services to go to a health care appointment, or home or vehicle modification related to a member s health needs. (continued on next page) 1 Practice Matters: AZ TX - Winter Summer Customer Provider Services Center:

4 (continued from previous page) Here s how to include your Medicaid ID based on your claim submission method: Paper or online claims: Enter your Medicaid ID in Box 33b as the billing provider on the CMS 1500 form UHCprovider.com claim submission: Enter your AHCCCS ID in the billing Field 33 using the Medicaid ID box 837 electronic claim submission: Use the 2010AA billing provider loop Qualifier 0B must be entered in the REF01 billing loop segment Enter Medicaid ID in the REF02 billing loop segment If you have questions, please contact your Provider Advocate. Understanding Program Exclusions What are the different types of exclusions? Mandatory Exclusions [42 U.S.C. 1320a-7(a)]: Office of Inspector General (OIG) is required to exclude the individual or entity for a minimum of 5 years for conviction of certain offenses (e.g., program-related crimes, patient abuse, felony health care fraud, or felony convictions relating to controlled substances). Permissive Exclusions [42 U.S.C. 1320a-7(b)]: OIG may exclude individuals or entities under 16 different authorities (e.g., losing a state license to practice, failing to repay student loans, conviction of certain misdemeanors, or failing to provide quality care). Who can be excluded? Any individual or entity. What is the effect of a program exclusion? No payment may be made by any federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity. The prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, and any hospital or other provider or supplier where the excluded person provides services. The exclusion applies regardless of who submits the claims and also applies to all administrative and management services furnished by the excluded person. How long do exclusions last? Certain exclusions are imposed for a defined period, but others may be indefinite in length, such as those derived from licensing board actions. Reinstatement is NOT automatic. Any individual or entity wishing to again participate in the Medicare, Medicaid and all federal health care programs must apply for reinstatement and receive authorized notice from the OIG that reinstatement has been granted. How do you check to see if an individual or entity is excluded? List of Excluded Individuals and Entities (LEIE): oig.hhs.gov/fraud/exclusions.asp The database is downloadable or searchable online by name or business name. Remember to check former names and variations of names. 2 Practice Matters: AZ TX - Winter Summer Customer Provider Services Center:

5 Arizona Long Term Care practicematters Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network. Doc#: PCA _ UnitedHealth Group, Inc. All Rights Reserved. 1 East Washington Suite 900 Phoenix, AZ 85004