Update. If the provider is serving: Then: The provider should: The information in this communication applies.

Transcription

1 Update CONTRACTUAL OCTOBER 24, 2017 UPDATE PAGES Individual Medicare Advantage and IFP Claims Changes Effective January 1, 2018 After Health Net of California, Inc., Health Net Community Solutions, Inc. and Health Net Life Insurance Company (Health Net) were acquired by Centene Corporation, existing systems and operations were reviewed and the strongest elements of each organization were identified. As part of that ongoing work, Health Net is migrating certain functions from existing systems to new systems beginning in 2018, starting with individual Medicare Advantage (MA) and Individual Family Plan (IFP) products. Upon the successful transition of these functions, Health Net will eventually transition to new systems for its other lines of business. Refer to the table below. If the information does not apply, disregard this communication as there is no provider impact at this time. If the provider is serving: Then: The provider should: Individual MA HMO and Special Needs Plan (SNP) (does not apply to employer group MA HMO) IFP CommunityCare HMO IFP PureCare HSP PPO Individual and Family IFP PureCare One EPO The information in this communication applies. Review the information provided in this communication in its entirety to become familiar with the upcoming changes. THIS UPDATE APPLIES TO CALIFORNIA PROVIDERS: Physicians Participating Physician Groups Hospitals Ancillary Providers LINES OF BUSINESS: HMO/POS/HSP PPO EPO Centene Corporation Employee Self-Insured PPO Plan Medicare Advantage (HMO) Medi-Cal Kern Los Angeles Molina Riverside Sacramento San Bernardino San Diego San Joaquin Stanislaus Tulare Employer group MA HMO Employer group HMO, PPO, EPO Point of Service (POS) Medi-Cal (including CalViva Health) The information in this communication does NOT apply. Continue to work with Health Net as you do today and disregard the information provided in this communication as it does NOT apply at this time. PROVIDER SERVICES provider_services@healthnet.com HMO/POS/HSP, PPO & EPO Medicare Programs Covered California Cal MediConnect Centene Corporation Employee Self-Insured PPO Plan NATIONAL PROVIDER COMMUNICATIONS provider.communications@ healthnet.com fax Health Net of California, Inc., Health Net Community Solutions, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All other identified trademarks/service marks remain the property of their respective companies. All rights reserved. OTH016081EH00 (10/17)

2 OVERVIEW Effective January 1, 2018, there are several changes that impact Health Net providers serving individual MA and IFP members. The following topics are outlined and addressed in this provider update: address and provider portal registration Electronic claims submissions Payer ID information Online claims submissions and inquiries Changes to claim and code review software Claims payment information New remittance advice and explanation of payment change to claims letters Reminders: paper claims address changes, paper claim forms and EFT/ERA Providers associated with a participating physician group (PPG) can continue to follow the PPG s guidelines as appropriate. ADDRESS AND PROVIDER PORTAL REGISTRATION The following includes detailed information about the need for providers to update their address on provider.healthnet.com and registering for a provider account on provider.healthnetcalifornia.com. REMINDER TO UPDATE ADDRESS (STEP 1) AND PROVIDER PORTAL REGISTRATION (STEP 2) First Update Your Address by December 1, 2017, on provider.healthnet.com As a reminder, per provider update , Action Required: Update Your Address on provider.healthnet.com, distributed September 12, 2017, certain functions from the current provider portal at provider.healthnet.com are being enhanced for efficiency. In preparation for these upcoming enhancements all participating providers and delegated administrators must update their information on Health Net s provider portal at provider.healthnet.com with a unique individual address for themselves and a unique individual address for each person on their account who uses the provider portal. Log in to provider.healthnet.com to access My Account (located at the top of the home page) > Profile > to edit or provide your individual address. Delegated administrators also need to log in to provider.healthnet.com to access My Account or the Delegated Administrators banner > Manage Users to update the address for each person currently using Health Net s provider portal. Then Access the New Provider Portal on provider.healthnetcalifornia.com Beginning December 1, 2017, providers serving individual MA and IFP members must register to obtain access to Health Net s new portal at provider.healthnetcalifornia.com. Detailed information and instructions regarding how to register to obtain access to the new provider.healthnetcalifornia.com site will be provided via a separate provider update at a later date. ELECTRONIC CLAIMS SUBMISSIONS Health Net continues to encourage electronic submission of claims via the 837 institutional and professional formats for faster processing. Institutional claims should be limited to 97 service lines or less. Claims should be split by the submitter to avoid rejections. Effective January 1, 2018, for questions on electronic claims or electronic remittance advice for individual MA and IFP member claims with dates of service (DOS) on or after January 1, 2018, contact: Centene EDI Department , extension Or by at: EDIBA@centene.com Employer group MA HMO, HMO, PPO, and EPO; POS, Medi-Cal (including CalViva Health) and/or Cal MediConnect providers are not impacted by these changes and can continue to contact the Health Net EDI department by telephone at or by at edl.support@healthnet.com. Page 2 of 5 October 24, 2017 Health Net Update

3 Payer ID Information Refer to the table below for payer identification (ID) information as indicated by dates of services (DOS). Providers can also refer to the current member ID card for the correct payer ID information. Line of business Payer ID for dates of service on or before December 31, 2017 Payer ID for dates of service on or after January 1, 2018 INDIVIDUAL MA HMO, SPECIAL NEEDS PLAN (SNP) (DOES NOT APPLY TO EMPLOYER GROUP MA HMO) IFP EMPLOYER GROUP MA HMO, HMO, PPO, EPO, POINT OF SERVICE (POS), MEDI-CAL (INCLUDING CALVIVA HEALTH), CAL MEDICONNECT, CENTENE CORPORATION EMPLOYEE SELF-INSURED PPO PLAN ONLINE CLAIMS SUBMISSIONS AND INQUIRIES Effective January 1, 2018, Health Net providers serving individual MA and IFP members can obtain claims information directly through Health Net s new secure provider portal at provider.healthnetcalifornia.com. Providers must have secure access to the site by registering for a user name and password, and must select the Claims Role Access module. Providers can find comprehensive steps on how to submit or review a claim, create an institutional claim, correct or appeal a claim, create or view submitted batch claims, or to view payment history through the new secure provider website at provider.healthnetcalifornia.com > Instruction Manual (PDF) at the bottom of the page. On the Content page, refer to applicable claims topics as needed. Online Claims Inquiry Starting January, 1, 2018, the following is effective for claims inquiry for individual MA and IFP members. Claims with Dates of Service on or Before December 31, 2017 For claims with DOS on or before December 31, 2017, continue to access all claims information through the current Health Net provider portal at provider.healthnet.com. Claims with Dates of Service on or After January 1, 2018 For claims with DOS on or after January 1, 2018, log in to the new provider.healthnetcalifornia.com, select product type, on the Home screen > Claims. Enter member ID number or last name and date of birth (DOB) > Check Eligibility, select the individual > Blue Claim Number to open the claim. The claim details will appear and include covered services, denied services, payment details, including amount and payment date, along with check number. For questions or concerns regarding online claims submission requirements, providers can contact the Health Net Provider Services Department at the following telephone numbers PLAN AND PRODUCT PROVIDER SERVICES CONTACT INFORMATION Medicare Advantage Individual Family Plans (HMO, POS, HSP, PPO, and EPO) Employer group MA HMO, HMO, PPO, and EPO; POS, Medi-Cal (including CalViva Health) and/or Cal MediConnect providers can continue to access all claims information through the current Health Net provider portal at provider.healthnet.com. Page 3 of 5 October 24, 2017 Health Net Update

4 CHANGE TO CLAIM AND CODE REVIEW SOFTWARE Effective January 1, 2018, Health Net intends to change its claim and code editing software for individual MA and IFP. This will align Health Net to parent Centene s corporate correct coding editing standard, which follows National Correct Coding Initiative (NCCI) Centers for Medicare & Medicaid Services (CMS) editing used throughout the industry. Health Net s payment policies and rules used to adjudicate claims will continue to be consistent with Current Procedural Terminology (CPT), and standards accepted by nationally recognized medical societies and organizations (including, but not limited to, the American Medical Association (AMA)), federal regulatory bodies such as CMS, and major credentialing organizations. CLAIMS PAYMENT INFORMATION The following information provides details regarding changes to the claims payment schedule and claims payment information based on the claim s date of service. Payment Schedule Beginning January 1, 2018, individual MA and IFP claims with DOS on or after January 1, 2018, will be paid a minimum of weekly. Claims Submitted for Dates of Service on or Before December 31, 2017 Claims submitted for DOS on or before December 31, 2017, will be paid from existing accounts. Electronic fund transfers (EFTs) and electronic remittance advices (ERAs) will follow current processes. Claims Submitted for Dates of Service on or After January 1, 2018 New accounts have been established for individual MA and IFP lines of business for claims payments for DOS on or after January 1, Separate checks and EFTs for these lines of business will be issued from these new accounts. Providers who wish to receive payments via EFT on or after January 1, 2018, must register on Payspan to initiate electronic delivery services. If providers choose not to register via Payspan for individual MA and IFP claims payments, paper checks and remittance advices (RAs) will be mailed to the provider address on file. Refer to the Electronic Fund Transfer and Electronic Remittance Advice section below for information about enrolling with Payspan. Health Net anticipates at least an 18-month period of time where providers may receive payments via both methods outlined above depending on DOS and line of business. NEW REMITTANCE ADVICE AND EXPLANATION OF PAYMENT CHANGE TO CLAIMS LETTERS Effective January 1, 2018, for MA and IFP lines of business, claims payments and most denials will be communicated on a new Remittance Advice and Explanation of Payment (RA/EOP). Providers are encouraged to review their RA/EOPs as well as ERAs for any denials they wish to have reconsidered by Health Net as a corrected claim. To request reconsideration of a corrected claim, follow the instructions provided on the RA/EOP or ERA as applicable. Providers should continue to review all claims letters received. Additional communication regarding the new RA/EOPs will be distributed as needed at a later time. REMINDERS: PAPER CLAIMS ADDRESS CHANGES, PAPER CLAIM FORMS AND EFT/ERA The following are reminders that impact providers claims. Page 4 of 5 October 24, 2017 Health Net Update

5 Paper Claims Submission Address Change Per provider update , Paper Claims Address Changes and Submission of Forms, distributed October 18, 2017, effective January 1, 2018, the addresses to submit paper claims are changing. The new paper claims submission addresses for paper claims are outlined in the table below by line of business. Line of business MEDICARE ADVANTAGE MEDI-CAL HMO/POS/HSP, PPO, CENTENE CORPORATION EMPLOYEE SELF-INSURED PPO PLAN, & EPO Paper claims address Health Net Medicare Claims PO Box 9030 Farmington, MO Health Net Medi-Cal Claims PO Box 9020 Farmington, MO Health Net Commercial Claims PO Box 9040 Farmington, MO Paper Claim Forms Per provider update , Paper Claims Address Changes and Submission of Forms, distributed on October 18, 2017, Health Net has implemented technology in our claims organization to improve the optical character recognition (OCR) of claim forms, to give better service, improve quality, and reduce costs. Paper claims received by the plan are scanned using OCR technology. This scanning technology allows for the data contents contained on the form to be read while the actual form fields, headings and lines remain invisible to the scanner. As a result of this technology, Health Net only accepts standard claim forms printed in Flint OCR Red, J6983 (or exact match) ink. For additional information on paper claims submissions, refer to the provider update mentioned above. Electronic Fund Transfer and Electronic Remittance Advice Per provider update , Action Required: Individual Medicare Advantage and IFP Providers Can Now Register for Payspan Health to Continue EFT and ERA, distributed October 16, 2017, effective January 1, 2018, existing EFT/ERA recipient providers serving individual MA and IFP members who wish to continue receiving EFT/ERA are required to register with Payspan to obtain access to EFT/ERA delivery services. Providers may also receive telephone and/or communications from Payspan regarding the option to register and to assist providers with the registration process. If providers choose not to register with Payspan for individual MA and IFP claims payments, paper checks and RAs will be mailed to the provider address on file. For additional information, refer to provider update , Action Required: Individual Medicare Advantage and IFP Providers Can Now Register for Payspan Health to Continue EFT and ERA, distributed October 16, 2017, and available on the provider portal at provider.healthnet.com in the Provider Library under Updates and Letters > Starting January 1, 2018, Health Net providers serving individual MA and IFP members can access the new Health Net Provider Library and provider operations manuals through the new provider.healthnetcalifornia.com, select product type, on the Home screen, under Welcome, select Resources > Contractual > Go to the Provider Library. For questions or concerns regarding claims submission requirements, providers can contact the Health Net Provider Services Department or by telephone as listed in the right-hand column on page 1. ADDITIONAL INFORMATION If providers are serving individual MA and IFP members, AND employer group MA HMO, HMO, PPO, and EPO; POS, Medi-Cal (including CalViva Health) and/or Cal MediConnect members, the following applies: For all claims matters applicable to individual MA and IFP members, follow processes outlined in this provider update. For all claims matters applicable to employer group MA HMO, HMO, PPO, and EPO; POS, Medi-Cal (including CalViva Health) and/or Cal MediConnect members, continue with existing claims processes and procedures currently in place. If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by at provider_services@healthnet.com within 60 days or by telephone as listed in the right-hand column on page 1. Page 5 of 5 October 24, 2017 Health Net Update