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AAHAM April 24, 2014. Member Identification Card 2.

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Presentation on theme: "AAHAM April 24, 2014. Member Identification Card 2."— Presentation transcript:

1 AAHAM April 24, 2014

2 Member Identification Card 2

3 Member Access Member access to any PCP/Specialist in network –No referral necessary –Don’t have to see PCP on card –Member can call Member Services to update their card 866-935-6760 No copays –Arbor Health Plan does not charge copays for any service 3

4 Additional member benefits Arbor Health Plan provides additional benefits to members: Adult Preventive Visits 24/7/365 Nurse Call Line Rapid Response and Outreach Team Diaper Reward Program Parenting and Lamaze Classes Breast Pump Purchases – effective November, 2013 YMCA 90 Day Membership (select locations) Community Baby Shower 4

5 Prenatal Care MCOs responsible for newborns effective 2/1/14. –Once DHHS is notified of birth, newborn is retroactively enrolled in Managed Care the first of the month of the notification Obstetrical Needs Assessment Form (ONAF) –Receive $100 for completing form –Receive additional $300 if certain criteria are met –Available on our website OB Billing Guide –Prenatal care billed on separate lines for each DOS Progesterone (J1725 & J1725TH) covered. 5

6 Recent Changes/Updates Enhanced Obstetrical Needs Assessment Form (ONAF) Payments Effective 4/1/2014: Additional payment of $300 is automatically issued for meeting ALL following requirements: Completed ONAF submitted to Arbor within two weeks of Arbor member’s first visit First visit occurs in first trimester or within 42 days of member’s Arbor membership Infant is term and not an elective delivery prior to 39 weeks gestation Post-partum visit within 21 to 56 days after delivery 6

7 Recent Changes/Updates continued Early Periodic Screening, Diagnosis, & Treatment (EPSDT) –DX Code V20.0 – V20.3 are allowed for CPT’s 99381-99384 and 99391 - 99394. –DX Codes V70.0 – V70.3 and V72.31 are allowed when billing CPT’s 99381-99384 and 99391 – 99394 –Referral indicator codes MUST be included on claims using CPT well- child preventive codes 99381-99395 with the required EP modifier. (Electronic 837P or CMS 1500 box 24H). 7

8 Recent Changes/Updates continued Enhanced PCP payments currently being made Fee schedule updates will match Nebraska Medicaid effective dates. –Individual provider and facility rate updates will still be delayed 30 days PT/OT/ST no longer require authorization effective 1/1/14. –Held to visit count limitation observed by Nebraska Medicaid Quad screen (81511) added as a covered service. 8

9 Recent Changes/Updates continued New CMS 1500 Form must be submitted. –Complete transition to new form effective 4/1/14. ICD-10 has been delayed until 10/1/15. –Providers will be able to test ICD-10 claims with us, when the time comes. 9

10 Reminders Timely filing is 365 days from DOS Appeals/Resubmissions/Corrections within 90 days of original remit –DO NOT send claims or corrections to Omaha office COB claims must be submitted within 365 days of DOS or 60 days from primary EOB generation, whichever is longer. When submitting with an invoice, item must be easily identifiable by code on the invoice. Routine and medical vision claims submitted to Avesis (anesthesia and facility fees for vision services submitted to Arbor). 10

11 Credentialing Provider must be enrolled with Nebraska Medicaid at practice location –Enrollment Center – 877-255-3092 – Credential via: –CAQH –Arbor Health Plan’s Full Credentialing Application Providers credentialed with Blue Cross Blue Shield of Nebraska are granted automatic approval Contact your Account Executive with questions 11

12 NaviNet NaviNet Web Portal: Phone: 888.482.8057 –View Member Eligibility –Member Rosters –View Third Party Liability Information (TPL) –Claims Status & Updates –View/Print Remittance Advices –Prior Authorization Requests –Gaps in Care Report 12

13 Provider Updates Arbor Website Provider Handbook – available online Annual Provider Newsletter Arbor Webkey Mouse List-serve in development –Watch website for updates 13

14 Electronic Data Interchange (EDI) To transmit claims electronically, contact your EDI software vendor and provide Arbor Health Plan payer ID # 52312 Arrange electronic claims submission through your EDI vendor or through Emdeon at 877-363-3666 Electronic Funds Transfer (EFT) 866-506-2830 –Simplifies the payment process by providing fast, easy and secure payments –Reducing paper –Eliminating checks lost in the mail –Not requiring a change to your preferred banking partner –Enroll through our EFT partner, Emdeon Business Services or sign up via our fast and easy links on Electronic Remittance Advice (ERA) 877-363-3666 14

15 Provider Network Management Adam Steffen, Director Provider Network Management – Jessica Wykert, PNM, Account Executive – Western Nebraska – Cathy Bojanski, PNM Account Executive – Northeast Nebraska – Kami Hudson, PNM Account Executive – Southeast Nebraska – 15


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