CMS, North Carolina Medicaid, United Community Plan of PA updates

There’s a lot happening in payer land right now. These are a few of the things that have crossed my desk.

1. Of course as soon as I published the post on Medicare DDE being shutdown this week, CMS postponed the date. The announcement is very vague about when it will be shut down but the rumor is that it won’t go away until 2015.

2. CMS has a release scheduled for this weekend that will add psych and historical hospice data to the Medicare eligibility response. They’ve attempted to add this several times but have had to roll it back each time. I’m keeping my fingers crossed that it will stick this time.

*Update 12:45 4/3/2014 – CMS just announced that this was postponed until 4/12.*

HETS Eligibility Release Notes

3. North Carolina Medicaid made changes to the eligibility response on 3/22 to be CORE complaint. One of the changes was that they stopped telling you if the recipient was actually eligible. They were bombarded with complaints and made another change on 3/29 to “fix” it. I suspect there will be other changes coming up soon.

Updates to Recipient Eligibility Inquiry and Claim Status for CAQH CORE Announcement

4. H.R 4302 was signed by President Obama Tuesday. This bill will delay the implementation of ICD 10 until 2015 as well as delay the Sustainable Growth Rate fee structure for Medicare payments.

5. UHC migrated the United Community Plan members from the old Americhoice PA system to the United Healthcare system effective 3/1/2014. For dates of service after 3/1, you will need to use United Healthcare Online to check eligibility (or your EDI vendor) but you will need to use the United Healthcare Community plan portal for dates prior to 3/1. Also the new claims payer ID will be 87726 for dates after 3/1.