Optum Behavioral Health Covid-19 Changes
Optum Behavioral Health will be eliminating cost shares related to virtual visits for Covid 19. Please see the announcement they released yesterday:
RE: EDI 271 Update to COVID-19 Virtual Visits for Behavioral Health Members
ISSUE:
United Behavioral Health (dba Optum Behavioral Health) is eliminating the cost share for virtual visits related to COVID-19.
ACTION BY UNITEDHEALTHCARE:
Effective 4/3/2020, EDI 271 responses for this payer will indicate a $0 member cost share for copay, deductible and coinsurance.
Example:
EB*A*IND*A6***27**0****Y~
MSG*VIRTUAL VISITS/TELEMEDICINE
Aetna Eligibility Response Changes Regarding Covid-19
Aetna just sent out the following message:
Overview:
Eligibility and Benefits Inquiry (270/271):
We’ll make the following change:
- To
support our policies regarding member access to telemedicine and
diagnostic testing in response to the novel coronavirus (COVID-19), we’re
adding the following messages to our Eligibility and Benefits Inquiry
responses:
- Telemedicine
cost share
- Medicare Advantage Plans – While the COVID-19 public health emergency is in effect, there is no cost share for a Medicare member for covered Telemedicine services performed by a PARTICIPATING provider only. Cost share is required if a member sees a non-par provider.
- Commercial Plans – There is no cost share for a Commercial member for covered Telemedicine services regardless of provider’s participating status with the plan.
- Diagnostic
- All Plans – While the COVID-19 public health emergency is in effect, there is no cost share for the member for all COVID-19 and SARS-CoV-2 diagnostic testing performed in an approved laboratory location.
- Telemedicine
cost share
These messages will be available to providers on March 28, 2020. Providers will be able to see these messages when they submit an Eligibility and Benefits Inquiry transaction with any service type code.
COVID-19 Claim Submissions to UHC
UHC just sent out the following announcement:
UNITEDHEALTHCARE SYSTEM NOTIFICATION
DATE: 03/18/2020
RE: COVID-19 Claim Submissions
Effective today, UnitedHealthcare can accept EDI 837 claims with COVID-19 codes. It’s important our trading partners and health professionals are aware of appropriate coding for Novel Coronavirus (COVID-19) claims. Codes to use are as follows:
- HCPCS: U0001, U0002
- CPT: 87635
ACTION BY UNITEDHEALTHCARE:
A system update was put in place to add the COVID-19 codes, allowing us to accept claims electronically.
How Has Covid-19 Changed Your Workplace?
Happy Tuesday all. This week I’ve been thinking a lot about how every part of our lives had been changed by Covid-19. Everything from church, to work, to how we socialize with friends has been completely upended in a short period of time. These are crazy times.
My company recommended that we start working from home until further notice. This started me thinking about what other employers are doing so I figured I would ask. How has the Covid 19 pandemic changed your workplace? I know that many of you are on the front lines at doctor’s offices and hospitals. What has your facility or office changed to keep you safe and reduce the chances of exposure? Leave our responses in the comments.
CMS Release 3/14/2020
CMS will have their Q1 release on Saturday March 14th. This is a relatively small release but there is one change in particular that I wanted to bring to your attention. Currently CMS returns the next eligible date for the Pneumococcal Pneumonia Vaccination (PPV) and booster (90670 and 90732) if you specifically request them. On 3/14, CMS will be removing that information from their eligibility response temporarily. They’re planning to change the way they return that benefit and will add it back to the response at some point in April.
When it’s added back to the response next month, they will return the dates of the last 10 times these services were provided to the beneficiary. They will also be returning the NPI of the provider that rendered the service. They haven’t released the date it will be returned to the response but said it will be “early April”.
CMS will also be migrating to a more reliable and stable processing environment that should improve any slowness or downtime you currently experience.
They will also be changing the way they require clearinghouses to “enroll” NPIs to get access to the eligibility transactions. Unless you’re a large trading partner/clearinghouse that sends batches, this shouldn’t affect you.
Industry Updates for December 2019
Happy December everyone. Below are a few things that have crossed my desk recently that I found particularly interesting so I wanted to share. If you’ve run across any interesting articles lately, feel free to share them in the comments.
UHC to Open Medicare Centers in Walgreens
Humana to Layoff 800 employees by the end of 2019
UHC Faces CMS Sanctions on Medicare Advantage Plan
http://www.startribune.com/unitedhealthcare-plan-faces-medicare-sanction/563068872/
Priority Health and Total Healthcare to Merge
Anthem Suing Federal government for $100 Million in ACA payments
North Carolina Suspends 2/1/2020 Managed Medicaid Implementation
CMS To Begin Revoking Access to CWF Eligibility
Good morning and happy November. As 2019 draws to a close, CMS as finally given a date for starting to get of HIQA, HIQH, ELGA and ELGH. They sent out the announcement below on 11/1. It sounds like they’re starting with clearinghouses first and will trickle down to everyone else later. I’ll pass on information on this as it becomes available.
” CMS will begin revoking access to Common Working File (CWF) eligibility transactions HIQA, HIQH, ELGA and ELGH effective February 1, 2020. Submitters that aggregate transactions for otherwise disparate providers (e.g., clearinghouses, billing services, software vendors, etc.) and have both HETS and CWF based eligibility access should use HETS exclusively.
CMS will remove HIQA/HIQH/ELGA/ELGH access for these submitters by revoking role-based access for specific CMS RACF IDs. CMS will revoke access starting with high-volume aggregators. Aggregators that use both HETS and CWF based eligibility should assume they must use HETS only no later than February 1, 2020.”
MBI Transition Period Coming to an End
As we wrap up Q3, I’m seeing an increase in questions about the MBI and using it on Medicare eligibility questions. I suspect this is because the transition period for using the HICN or the MBI is coming to an end. Beginning January 1st, 2020 you will no longer be able to use the HICN for eligibility or claims (with a few exceptions).
One of the complaints I’ve seen is that HETS is returning errors in some cases when eligibility is searched using the MBI that’s on the card. I’ve heard that it’s possible the beneficiary’s MBI may change from the one that was originally issued. I’m validating this with CMS and will get back to you on what I find out. The majority of the problems I’ve seen with the MBI have been user keying errors so please make sure you’re keying exactly what’s on the card. If you still haven’t gotten access to the Medicare MBI lookup tool, I highly suggest that you sign up before the end of the year. If you’ve been using it, please leave me a comment and let me know what your experience has been.
Below is a list of exceptions that CMS has published for still using the HICN. I wasn’t aware of most of these so I thought I would pass them along.
Medicare plan exceptions:
- Appeals – People filing appeals can use either the HICN or the MBI for their appeals and related forms.
- Adjustments – You can use the HICN indefinitely for some systems (Drug Data Processing, Risk Adjustment Processing, and Encounter Data) and for all records, not just adjustments.
- Reports – We’re using the HICN on these reports until further notice:
- Incoming to us (quality reporting, Disproportionate Share Hospital data requests, etc.).
- Outgoing from us (Provider Statistical & Reimbursement Report, Accountable Care Organization reports, etc.).
- Reports – We’re using the HICN on these reports until further notice:
- Retrospective reporting – Plans can use the HICN when submitting data for older contract years for applicable systems (e.g., Health Plan Management System).
Fee-for-Service claim exceptions:
- Appeals – You can use either the HICN or the MBI for claims, appeals and related forms.
- Audits – You can use either the HICN or the MBI for audit purposes.
- Claim status query – You can use either the HICN or the MBI to check the status of a claim (276 transactions) if the earliest date of service on the claim is before January 1, 2020. If you’re checking the status of a claim with a date of service on or after January 1, 2020, you have to use the MBI.
- Span-date claims – You can use the HICN for 11X-Inpatient Hospital, 32X-Home Health (home health claims & Request for Anticipated Payments (RAPs)), and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before the end of the transition period (12/31/2019). You can submit claims received between April 1, 2018 and December 31, 2019 using either the HICN or the MBI. If a patient starts getting services in an inpatient hospital, home health, or religious non-medical health care institution before December 31, 2019, but stops getting those services after December 31, 2019, you may submit a claim using either the HICN or the MBI, even if you submit it after December 31, 2019.
- Incoming premium payments – People with Medicare who don’t get SSA or RRB benefits and submit premium payments should use the MBI on incoming premium remittances. But, we’ll accept the HICN on incoming premium remittances after the transition period. (Part A premiums, Part B premiums, Part D income related monthly adjustment amounts, etc.)
- We’re monitoring the use of HICNs and MBIs to see how many of you are using MBIs. We’re also actively monitoring the transition to MBIs to be sure Medicare operations aren’t interrupted.
Aetna Precert and Admission Notification Rejections
This morning Aetna sent out the announcement below regarding some issues they’re having with their EDI transactions for precert and notifications. If you get a rejection with one of the codes listed below, please call the precert number on the members ID card to complete your precert request.
Purpose:
We’d like to let you know we’re rejecting some Precertification Add and Notification transactions, but we’re not returning all the rejection reasons.
Overview:
We’re currently rejecting some Precertification Add and Notification transactions, but we’re not returning all the rejection reasons. Certain transactions are rejecting with the following two codes:
- A3: Not Certified
- 25: Services were not considered due to other errors in the request.
Our systems aren’t returning additional rejection reasons, so we’re unable to determine the exact reason for the rejected transactions. For some rejected transactions, we’ve determined there are duplicate requests.
This issue:
- Is affecting requests initiated on all vendor partner websites
- Isn’t limited to certain plan types
- Isn’t affecting all Precertification Add and Notification transaction requests
We’re researching this issue at a high priority, but we don’t have a resolution date yet. We’ll send an update once we have additional information.
Current Medicare HETS Eligibility Issues
Below is a list of outstanding issues that CMS is on working for the HETS eligibility response. If you’re using eligibility from a vendor (Experian, Change Healthcare, Availity, etc) this is the response you’re receiving. This is also the connection everyone will be required to use once CMS sunsets the CWF eligibility functions.
| Table 1. Open HETS Data Issues Current Data Issues | Percentage of Impacted Medicare Beneficiaries | Date that a Fix is Planned | Detailed Description of the Issue |
|---|---|---|---|
| HETS may be returning incorrect Hospice episode information or occurrence counts when the Medicare Beneficiary has a new Notice of Election (NOE) and had billed Hospice episodes four or more years ago. | 1% | October 2019 | HETS’ data source for Hospice information is the Common Working File (CWF). CMS has identified an issue where CWF is sending an incorrect Hospice information to other systems (including HETS) when the Medicare Beneficiary has a new Notice of Election (NOE) and previously billed hospice periods. CWF updates the file and corrects the Hospice history once a Hospice claim is processed for the new billing period. CWF will update their database and processes to resolve these discrepancies and prevent future occurrences. |
| After the Medicare Beneficiary received the first Pneumococcal Vaccine (PPV), CWF is not sending the eligibility information for the second PPV vaccine to HETS. | 33% | Q1 2020 | HETS’ data source for prior PPV usage is the Common Working File (CWF). HETS returns PPV vaccination data using CWF records for HCPCS 90670 and 90732. HETS correctly returns the PPV vaccination next eligible dates for both HCPCS if the Medicare Beneficiary has never been vaccinated. When the HETS 271 returns no next eligible date available for PPV, the Medicare Beneficiary may have actually only received one of the PPV vaccines and may still be eligible for the second vaccine after a year between deliveries. CMS encourages Providers to discuss the Pneumococcal vaccine and any previous receipt of that vaccine with your patients. |
| CMS has identified a more accurate source of data for End Stage Renal Disease (ESRD) Dialysis Start Date and ESRD Dialysis End Date. | 1% | August 2019 | HETS currently returns ESRD information on the 271 response when Service Type Code ‘CQ’ or ‘RN’ are included in the 270 request. CMS has identified an issue with the data source used for the End Stage Renal Disease (ESRD) Dialysis Start Date and ESRD Dialysis End Date. CMS is working to correct this issue quickly. In the interim, CMS encourages dialysis clinics to co-ordinate with each other to get correct Dialysis Start Dates for the coordination of the Medicare Beneficiary’s dialysis training. CMS will modify its data source to utilize the improved data. The format of the ESRD data in the 271 response will be exactly the same as is currently in use. |