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MN AAHAM Conference March 12, 2015 Elizabeth Nelson Cheryl Wilson.

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Presentation on theme: "MN AAHAM Conference March 12, 2015 Elizabeth Nelson Cheryl Wilson."— Presentation transcript:

1 MN AAHAM Conference March 12, 2015 Elizabeth Nelson Cheryl Wilson

2 Contents HealthPartners specific question Provider inquires Additional information Q & A 2

3 Provider Inquiries HealthPartners (HP) Question: Q: Is there a specific way HealthPartners would like to handle credits where they need to recoup or we need to refund HealthPartners? 3

4 HealthPartners Credit/Recoup Question A: HealthPartners preference is to use a Payment Adjustment Form (PAF) which can be submitted by the provider, in which case HP will adjust the claim and recoup monies from current or future payments. This type of recoupment is done electronically through our claims system through a void and replacement and not requiring a manual refund request. 4

5 Provider Inquiries HealthPartners (HP) Question Q: MN Care Tax is an issue when sending secondary’s. (This came up in the context of this discussion; why doesn’t HP have to give us an EOB with line by line COB that can be sent to patients secondary insurances? BCBS, Humana and Medica do all this all the time and in order for us to get our Secondary claim paid we have to manipulate the payment to cover each billed line. Doesn’t the AUC have regulations for EOB’s) 5

6 HealthPartners COB Question A: HealthPartners sends remits with line by line COB detail. HealthPartners Remits are electronic and can be accessed by utilizing HealthPartners Provider portal: – 6

7 Provider Inquiries All Payor Question Q: I have a question for all payers – Do any of the payers want/allow the Medicare condition codes when sending replacement or void claims? Example: DO – Change to service dates, D1 – Change to charges. A: Yes, HP does allow and would like the condition codes to be submitted when applicable. Condition codes D1 –D9 are only valid on “institutional claims”. 7

8 Provider Inquiries All Payor Question Q: I would like to ask a question to the Payers who have Medicare Advantage plans. If providers cannot use the Medicare ABN for notifying a patient prior to receiving a service that may not be covered, what is the correct notification to use to a patient with a MAP plan? Is it the patient’s responsibility to know what is covered and what is not covered? A: The Centers for Medicare and Medicaid (CMS) requires notification of non-coverage to Medicare Advantage and Medicare Cost plan members prior to the service(s) being rendered. In accordance with Chapter 4 of the Medicare Managed Care Manual and per language in HealthPartners contract agreements, providers are responsible for determining whether services are covered for HealthPartners Freedom (Cost) and Minnesota Senior Health Options (MSHO) members prior to rendering a service or referring to a non-contracted provider. Effective March 1, 2015, providers are required to follow the process outlined in the HealthPartners Administrative policy, Advance Notice of Non-coverage for Medicare Member (HealthPartners Fast Facts Article: February 2015 Special Edition) 8

9 Additional Information High Tech Diagnostic Imaging (HTDI) Decision Support (DS) In accordance with the HTDI policy, HealthPartners providers are required to have a DS solution in place. Providers may select the health plan sponsored DS solution – Medicalis, or may “Build Your Own” DS solution. The Diagnostic Imaging Provider Notification Program provides guidance on HTDI services such as CT, MRI, MRA, PET and Nuclear Cardiology as well as providing notification when DS is not required. Accurate communication of information between ordering and rendering providers is essential. By improving the quality of the order, better patient care will be achieved through use of treatments and imaging modalities that are consistent with evidence-based medicine and reduces unnecessary exposure to radiation. 9

10 Additional Information Epidural Steroid Injection (ESI) Decision Support (DS) Decision Support for Epidural Steroid Injections (ESI) for Low Back Pain Currently HealthPartners manages ESIs through preferred and non-preferred spine injection networks. Through feedback from members and designated Medical Spine Centers, we identified a need to reassess our current approach to this procedure As a result, HealthPartners will be implementing a decision support tool for low back ESIs with an anticipated launch date of July 1, 2015 This will provide a means to assess treatment options that support long-term functional improvement for the patient More information will be available in the May edition of HealthPartners Fast Facts newsletter 10

11 Additional Information Health Insurance Exchange Grace Period Information HealthPartners will begin reporting Health Insurance Exchange Grace Period information in the Eligibility Response (eligibility tool) as of March 26, 2015 Please review our Fast Facts news letter, March 2015 edition, article page 1 for further details – Link to view the: Health Care Eligibility Inquiry and Response ( 270/271) Best Practice – Link to view the: AUC Best Practices to Meet Requirements for Health Insurance Exchange Grace Period Notifications (per 45 CRF (d)(2) 11

12 Additional Information Contact information please visit: – Under “Help Center” on the left side of the page – Click on “More HealthPartners contacts” PDF Web support for the provider portal – Electronic Commerce Department – Monday - Friday 8:00 – 4:00 CST – or Fast Facts Newsletter – Please sign up for the delivery if you are still receiving the postal mailed paper copy – Please be sure to read each edition for updates and change notices Thank you! 12

13 Q & A Thank you! 13


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