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Site Updates 16

New Prefixes Added

I wanted to thank everyone that has sent me new prefixes to add to my list. Please keep them coming.  I did some digging and the Wellpoint plans have published the new prefixes for the health exchange plans. I added those yesterday along with a few more I’ve found. I still have another handful that I’ll add in a few days.

As I’m adding them, I’m changing the format of the tables to make them a little easier to deal with. Please note that the new tables can only display up to 100 lines at a time. If you don’t see the prefix you’re looking for, you may need to go to the next page.

 

Newly added:

(more…)

Site updates

Over the next few weeks you’ll notice format changes on the prefix pages. The way the tables are loaded currently, adding additional prefixes is somewhat of a nightmare. I’m going to be converting those pages into a different style of table so they’ll be easier to update. Also I’m looking for someone to help me update them monthly so you’ll see more frequent changes/additions.

If there are prefixes you would like to have added, please send them through Contact Us (it’s in the footer).

CHS, Oregon Medicaid, United Health Community Plan

A few interesting tid bits this week.

  • CHS  (Community Health System) announced they’re going to buy HMA (Health Management Associates) for $3.6 Billion.  CHS would have a total of 206 hospitals if this deal goes through.

 

  • Effective 8/1, Oregon Medicaid removed the managed care assignment information from the eligibility response. Members that are assigned to Heath Share in Oregon will need to contact them directly to verify if the member has Kaiser, CareOregon, etc.  From what I can tell, none of the eligibility vendors have HealthShare data yet so it will either be another phone call or you will have to log into their portal.

 

  • United Health Community Care electronic eligibility responses are returning bad ID numbers for members in Ohio and New Jersey.  UHC is investigating but they aren’t known for their speed. Make sure you double check the ID number against their new cards before you change anything in your registration system.

 

 

Medicare Eligibility Response Changes Effective 6/23

CMS will be making some changes to the Medicare realtime eligibility response next weekend. This does not effect DDE responses (HIQA, HIQH,etc).

1. The Medicare preventive data will be removed from the response. It will only be returned if a HCPCS code is specifically requested. So if you’re trying to find out if the beneficiary is eligible for a mammogram, you will need to request one of the mammography HCPCS codes. They will also be showing more detailed financial info on each service including whether or not the deductible and/or coinsurance is waived for that service. I’ve include the screening tests below with the appropriate codes.

  •  Annual Depression Screening includes code G0444.
  • Annual Wellness Visit (AWV) includes codes G0438 and G0439.
  • Cardiovascular Disease Screening (CARD) includes codes 80061, 82465, 83718, and 84478.
  • Colorectal Cancer Screening (COLO) includes codes G0104, G0105, G0106, G0120 and G0121.
  • Diabetes Screening Tests (DIAB) includes codes 82947, 82950, and 82951.
  • Fecal Occult Blood Test (FOBT) includes codes G0328 and 82270.
  • Glaucoma Screening (GLAU) includes codes G0117 and G0118.
  • Intensive Behavioral Counseling for Obesity includes code G0447.
  • Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD) includes code G0446.
  • Initial Preventive Physical Examination (IPPE) includes codes G0402, G0403, G0404, and G0405.
  • Pneumococcal Vaccine (PPV) includes codes 90669, 90670 and 90732.
  • Prostate Cancer Screening (PROS) includes codes G0102 and G0103.
  • Screening and High Intensive Behavioral Counseling (HIBC) to prevent STIs includes code G0445.
  • Screening Mammography (MAMM) includes codes G0202 and 77057.
  • Screening Pap Test (PAPT) includes codes Q0091, P3000, G0123, G0143, G0144, G0145, G0147, and G0148.
  • Screening Pelvic Exam (PCBE) includes code G0101.
  • Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) includes code G0389

 

2. The response will now show the individual hospice periods instead of lumping them into one large period. You will be able to see the beginning and ending date for each period.

North Carolina Medicaid NCTracks conversion

North Carolina Medicaid will be switching to their new claims system, NCtracks,  effective 7/1. There’s a pretty lengthy checklist of things that need to be completed by the conversion, which I have included below along with the registration application. I’m going to assume most of you have already done this so this really only applies to the procrastinators.

There are rumors floating around that the new fiscal agent, CSC, won’t be ready to provide realtime eligibility come 7/1. Also in order to get eligibility through your current vendor, you will need to log into the NC Tracks web portal and designate your vendors. You will have to do this for both your claims clearinghouse and your eligibility vendor. Unfortunately you can only choose one vendor until July.  For more information, there is a special website setup for NCTracks or you can sign up for their email list.

Provider Checklist for NCTracks Go-Live

The purpose of this checklist is to help DHHS providers understand the tasks they need to perform, and how and when to do them, to enable a smooth transition to the new NCTracks system.

 

  • Designate the Billing Agent for your provider organization. (Applies to providers who use a Billing Agent/Clearinghouse.)
  • Obtain an NCID for your Office Administrator (owner/managing employee)
  • Obtain an NCID for all other staff in your provider organization who will access the NCTracks system and who will be trained
  • Update your affiliation information. (Applies to individual providers who are in groups and/or affiliated with hospitals, etc.) Submit a Medicaid Provider Change Form on the current NCTracks site at www.nctracks.nc.gov
  • Designate the Office Administrator (OA) for your provider organization (using NCID)
  • Provide your bank account information for EFT payments
  • Make sure your OA email address is current in the system
  • Electronically sign the Trading Partner Agreement. (Applies to Billing Agents and providers who will submit ASC X12 batch transactions to NCTracks.)
  • Complete the recommended NCTracks on-line training. (Must have a NCID)
  • Verify the taxonomy codes and locations on your provider record.

 

https://www.nctracks.nc.gov/provider/providerEnrollment/assets/onlineHelp/cep_101_help.pdf

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