1. Billing Training
Updated March 2018

2. Great Plains Medicare Advantage Plan is a Medicare Advantage Plan offering a product designed to improve care for residents. The product offered by Great Plains Medicare Advantage Plan is:
Institutional/Institutional Equivalent Special Needs Plan
(ISNP)– designed for residents who functionally and medically meet a nursing facility level of care
We are a plan with strong local roots and a commitment to the residents, families, and communities we serve. 2

3. Capitation Rates – Per Member Per Month
Plan Per State
Part A SNF Cap
Part B Therapy Cap
Skill in Place Per Diem
GPMA - Nebraska $ $ $
GPMA - South Dakota
GPMA - North Dakota (Bismarck Area) $
GPMA - North Dakota (Grand Forks Area)
Capitation Checks cut last business day of the month and mailed directly to participating facilities. Member Count based on 15th of the month membership.

4. Supplemental Benefits
6 routine foot care visits per year
1 Routine Eye Exam and glaucoma test (annually) with Plan paying up to $275 annually for eyewear
Hearing Exams – 1 routine exam and hearing aid fitting annually. Hearing Aids up to $2,000 every 2 years
Dental -- Preventative services such as oral exam, cleaning and x-rays. Plan also pays up to $1,500 every 2 years
Non-Emergency Transportation – 24 one-way trips annually
Claims submitted by performing provider to the Plan using paper claims, Provider Portal via EZNet or EDI.

5. Non-Emergency Transportation
Plan covers 24 one-way non-emergency transports per year under following 3 categories:
Non-Emergency - No Wheelchair/Ambulatory (A0120): $
$2.00 per mile (A0380) (each way)
Non-Emergency - Wheelchair: (A0130) $ $2.00 per mile (A0380) (each way)
Non-Emergency - Stretcher: $ $2.00 per mile (A0380) (each way)
Claims submitted by performing provider to the Plan using paper claims, EZNet or EDI.

6. Cannot bill future dates of service
Great Plains Medicare Advantage Plan follows all Medicare guidelines in regard to timely filing requirement (12 months from date of service)
Cannot bill future dates of service
Bill Great Plains Medicare Advantage Plan as you would bill Medicare in 30 day increments
Acceptable claim forms:
CMS 1500 for Professional Claims
UB04 for Facility Claims
Claims can be submitted via paper, Provider Portal via EZNet or EDI
Paper Claims Mailing Address:
Great Plains Medicare Advantage Plan PO Box 908
Addison, TX 6

7. Provider Portal Access and Training
EZNet Functionality:
Member Eligibility Lookup
Authorization/Referral Submittal & Inquiry
Claims Submittal & Inquiry
User Guide & Training Video available on home page: com/EZ-NET60/ConfigFiles/EZ- NET%20User%20Guide.docx
Monthly provider trainings offered on the last Friday of each month at 12:30 PM EST

8. Reduce the cost of sharing information—
reduced faxes, voic , and telephone tag
Improve the accuracy of information
presentation—eliminate the incidence of human error
Provide secure, controlled access to information 24 hours a day, 7 days a week
Enhance communication between us and our network providers
Compatible with the popular Microsoft® Internet Explorer 9.0 and > 8

9. EZ-NET Benefits to Business Partners
Search for network providers
Submit authorizations requests and claims into the EZ-CAP system
Inquire on authorization status
Verify health plan eligibility
View member authorization history
Check status of claim/encounter information
PCPs can access and print assigned member lists
Look up procedure codes, diagnosis codes, and other general reference information
Provide a contact list of key office personnel for problem resolution

10. Payment Schedule
Claims can be submitted directly through our clearinghouse or through your current system. You can also receive payments electronically, but you need to sign up! Here is how:
EDI Customer Support: , Option 2
Website:
Obtain Companion Guide from the Great Plains Medicare Advantage website
EDI Routing
Great Plains Medicare Advantage ND – GPND1
Great Plains Medicare Advantage SD – GPSD1
Great Plains Medicare Advantage NE – GPNE1 10

11. Claims Require the Authorization
UM Department can be reached at:
Phone: (Option 3)
Fax:
For help, Great Plains Medicare Advantage Provider Services Representatives can be reached at:
Helpful provider information is always available on the Great Plains Medicare Advantage website: 11

12. Authorization Quick Guide
Optometry- No preauthorization required. No preauthorization required for glasses ($275 benefit every year) but encourage provider to verify benefits with provider services ( ) to ensure that benefit has not been used.
Audiologist- Requires preauthorization. Plan does cover hearing aids up to $2000 every 2 years.
Dental- Requires preauthorization. Plan does cover dentures up to
$1500 every 2 years.
Podiatry- No preauthorization is required as long as visit is done at facility. If member has to go to an office visit, referral from PCP/NP is required and Request for Authorization form needs to be submitted.
Psychiatrist-Requires PCP/NP referral and copy of order must be included with Request for Authorization form.
Psychologist/LCSW visits-Requires PCP/NP referral and copy of order must be included in the Request for Authorization form. 12

13. Authorization Quick Guide
Specialist- Requires PCP/NP referral and preauthorization. Please check provider directory for in network physicians or contact your Member Advocate for assistance. Examples include cardiologist, orthopedic, ENT, etc.
Wound Management/DME-Requires preauthorization and PCP/NP referral along with clinical documentation.
Labs-No preauthorization is required. If member has to go out of facility, PCP/NP referral is required along with Request for Authorization form. If services are emergent, no preauthorization is required.
X-rays-No preauthorization is required. If member has to go out of facility, PCP/NP referral is required along with Request for Authorization form. If services are emergent, no preauthorization is required.
Transportation-Requires preauthorization for Ambulance. This can be included on the same Request for Authorization form as the Hospitalization. The transport for the supplemental benefit for non- emergency transport does not require an authorization. 13

14. Thank You!

15. Billing Training
Updated: March 2018