fhca 2014 annual conference & trade show · will cover billing for all medicaid bill types...

FHCA 2014 Annual Conference & Trade Show

CE Session #49 – Medicaid Managed Care Billing: Purely A Provider’s Perspective Thursday, July 10 – 4:00 to 6:00 p.m.

Crystal N/J2 – Finance/Development

Upon completion of this presentation, the learner will be able to:

review SMMC LTC billing requirements for all claim types including Medicare crossover claims;

discuss uniform billing requirements and explore plan-specific requirements; and

review Plan billing processes and review and discuss best practices.

Seminar Description: This session will review the billing requirements and processes of the Long Term Care component of the Statewide Medicaid Managed Care Program. The session will review the billing requirements that are uniform for each of the SMMC LTC Plans, as well as any Plan-specific unique requirements. The session will cover billing for all Medicaid bill types including SNF, ICF and Medicare Part A and Part B coinsurance crossover claims. Presenter Bio(s): Darlene Burt has been in the long term care industry for 21 years, managing billing teams of 30 plus employees. Additionally, Darlene consults for several large SNF and ALF corporations as changes occur in the industry. She currently serves as the Director of Reimbursement and one of four partners of Remington Financial Solutions, Inc., providing SNF and ALF billing services to a number of Facilities throughout Florida. Lynette Davis has worked in the healthcare field for 35 years. She has shared her talent with physician offices, hospitals, skilled nursing facilities and for the last 15 years with Opis Management Resources where she is presently the Director of Business Office Systems. Lynette and her family live near Orlando. Tony Marshall serves as Senior Director of Reimbursement for Florida Health Care Association. On behalf of FHCA, he serves as a liaison to the Florida Legislature, Agency for Health Care Administration, Department of Elder Affairs, Centers for Medicare & Medicaid Services, American Health Care Association, FHCA Reimbursement Committee and other relevant state and federal entities regarding issues of reimbursement and healthcare finance policy.

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Florida Health Care Association2014 Annual Conference

Medicaid Managed Care Billing – A Provider PerspectiveThursday, July 10, 2014

Darlene Burt, Remington Financial SolutionsDirector of Reimbursement

Lynette Davis, Opis Management ResourcesDirector of Business Office Systems

Tony Marshall, FHCASenior Director of Reimbursement

Presentation Objective

Provide an overview of the Statewide Medicaid Managed Care (SMMC) Long Term Care (LTC) Program payment requirements

Review and discuss SMMC LTC billing requirements for all claim types

Review and discuss uniform billing requirements and explore plan-specific requirements and processes

Discuss best practices

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Payment and Rate SettingRates and Supplemental Payments

Payment rates to providers - 409.982(5) Rate setting periods (Annual beginning

September 1, 2015) Bed hold and therapeutic leave days Supplemental payments

Medically complex services

Payment and Rate SettingRetroactive Rate Adjustment

Retroactive rate adjustment Interim rate adjustments Change of ownership

Emergency payments

3

Payment and Rate SettingPrompt Payment/Timeliness

Claims submission Weekly or monthly billing Timely filing limits (Rule vs. Statute vs. Contract)

Prompt payment 409.982(5) – 10 business days after receipt for

electronic nursing home and hospice claims containing sufficient information for processing

641.3155 – 40 days after receipt for nonelectronically submitted claims

Claims denial/appeal

Payment and Rate SettingPrompt Payment/Timeliness

Uniform claims processing/EFT HIPAA compliant, nationally recognized billing

software Electronic funds transfer Plan portal vs. clearinghouse

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Eligibility VerificationEligibility and Benefit Information

Online, real time verification through the secure Web Portal (FLMMIS web portal) http://www.mymedicaid-florida.com/

Calling (800) 239-7560 for self-service automated voice response system (AVRS) to verify eligibility and other automated options

Batch transactions supporting standard X12 270/271 eligibility verification through the secure Web Portal

A Point-of-Sale (POS) device/connection through an approved Florida Medicaid MEVS vendor

Eligibility VerificationBenefit Plan

Eligibility Verification (FLMMIS web portal) http://www.mymedicaid-florida.com/

“Benefit Plan” is a term used by Medicaid to define the scope of benefits an individual is eligible to receive

Not all Medicaid recipients receive the same level of benefits

Some benefit plans have full benefits; others have limited benefits

An individual may be in multiple benefit plans during the same period

The Long Term Care benefit plan requires full Medicaid eligibility

Recipients must be eligible for one of the LTC program codes in order to be eligible for LTC services

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Eligibility VerificationManaged Care Enrollment

Provider must verify whether the recipient is enrolled in: the Managed Medical Assistance program the Long-term Care program, or both, or fee-for-service

Provider must determine which Plan is responsible for which services (who do I bill and for what periods)

Eligibility VerificationNew Aid Categories

Aid Category Description

MEDP Full Home and Community Based Services (HCBS) waiver services while HCBS Medicaid application is pending, if individual chooses to receive services while application is pending. These individuals can choose to receive services before being determined financially eligible for Medicaid by the Florida Department of Children and Families (DCF)

This option is not available to individuals in nursing facilities

SIXT Long-term Care plans are required to cover recipients who have lost Medicaid eligibility for sixty days from the date of ineligibility

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Eligibility VerificationBilling Reminder MEDP/SIXT

If an institutional provider submits a fee-for-service claim directly to the Medicaid fiscal agent for a recipient with MEDP or SIXT, the provider’s claim will be denied with EOB code 4227 “This Revenue Is Not Covered for This Member.”

Eligibility VerificationBilling Reminder SIXT

Although a recipient has an eligibility category in FMMIS of SIXT, he or she does not have full Medicaid eligibility at that time

When an LTC enrollee loses Medicaid eligibility, LTC plans are required to continue providing covered LTC services, care coordination, and case management to the enrollee for 60 days following the enrollee’s initial loss of eligibility

Covered services for enrollees in SIXT are limited to their LTC services only; acute care medical, hospital, pharmacy, and behavioral health services are not covered in the SIXT period

Claims submitted for non-LTC covered services for an enrollee with a SIXT span will be denied

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Patient Responsibility

“Patient responsibility” refers to the amount of an individuals income that the Department of Children and Families determines is the recipient’s share in the cost of Medicaid long term care services

“Share of cost” refers to the amount of medical expenses the individual must incur before DCF can determine the individual eligible for Medicaid

Patient Responsibility cont. Collection of patient responsibility amounts

Plan or provider Notification (Notice of Case Action) Verification (ACCESS Florida “DCF Provider View”)

Contact HP if you have questions about accessing DCF Provider View (800) 289-7799

Contact DCF if you have questions about data displayed in DCF Provider View 866-762-2237 Email DCF Customer Service

Jacksonville: [email protected] Tampa: [email protected] Miami: [email protected]

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Medicare Coinsurance Crossover

Medicare crossover payments Part A coinsurance Part B coinsurance

State payment process or Plan payment process

Automatic crossover process or provider billing

Medicare Crossover Claims: Plan Responsibilities

The Managed Care Plan is responsible for Medicare co-insurance and deductibles for covered services.

The Managed Care Plan must reimburse providers or enrollees for Medicare deductibles and co-insurance payments made by the providers or enrollees, according to guidelines referenced in the Florida Medicaid Provider General Handbook

The Managed Care Plan must not deny Medicare crossover claims solely based on the period between the date of service and the date of clean claim submission, unless that period exceeds three years

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Medicare Crossover Claims: Plan Responsibilities cont.

Plans are responsible for processing and payment of all Medicare Part A and B coinsurance crossover claims for dates of service from the date of enrollment until the date of disenrollment from the plan

Fee-For-Service Medicaid will continue to be responsible for processing and payment of Medicare Part A and B (level of care X) crossover coinsurance claims for dates of service from the date of eligibility until the date of enrollment with the LTC plan


LTC plans are responsible for paying crossovers (if any) for the following services: nursing facility durable medical equipment home health, and therapies (occupational, physical, speech or

respiratory) MMA plans are responsible for paying

crossovers (if any) for all covered services If a recipient is also in an LTC plan, the LTC

plan is responsible for crossovers for the services above

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Medicare crossover claims will not be automatically submitted to the LTC or MMA plans

Providers will bill the LTC plans for co-payments due for Medicaid covered LTC services for individuals who are dually eligible for Medicare and Medicaid after receiving the Medicare Explanation of Benefits (EOB) for the co-insurance payments

Providers will need to submit the claim to the enrollees’ MMA plan in order to be reimbursed for any co-insurance or deductibles if no LTC Plan

Providers will submit the claim to HP if no LTC Plan or if no LTC Plan (prior to enrollment in SMMC)


When SMMC Plans calculate a zero dollar payment amount for a nursing facility Medicare Part A crossover claim, the claim must have a “PAID” status with an explanation of benefits (EOB) code that explains the calculated payment is zero because other insurance paid more than the Medicaid allowable

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Medicare Crossover Claims: Recipient Responsibilities

Except for patient responsibility for long-term care services, the plan members should have no costs to pay or be reimbursed

COMPLETING THE UB-04 CMS 1450

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Field Description Fields Key Field Content or Usage Detail

1 Unlabeled Required Facility name, street address, city, state, zip and

telephone

2 Unlabeled Not Required

unless

different than

Field 1

Billing name (Pay‐To Name), address, city, state, zip

and telephone

REQUIRED if different than provider information in

FL 1 above

3a Patient Control

Number

Required Patient account/control number

3b Medical Record

Number

Not Required Facility medical or health record number

4 Type of Bill Required Enter appropriate type of bill as specified by the

NUBC UB04 Uniform Billing Manual

See Type of Bill Codes Table Below

5 Federal Tax ID

Number

Required Enter the 9 digit number assigned by the Federal

Government for tax reporting purposes

6 Statement Covers

Period

Required Enter the billing period for the this statement



8a Unlabeled Not Required

8b Patient Name Required Enter patient's last name, first name and middle

initial

9a‐e Patient Address Required

(except line e)

Enter the complete mailing address of the patient

a – Street Address

b – City

c – State

d – Zip Code

e – Not Required

10 Birthdate Required Enter DOB as (MMDDYYYY)

11 Sex Required Enter Sex as M or F only

12 Admission Date Required Enter date of admission as (MMDDYY)

13 Admission Hour Required Enter hour of admission using 2 digit 24 hour military time (example: for 1:00‐1:59 am use 01, for 11:00‐11:59 am use 11, for 1:00‐1:59 pm use 13, for 11:00‐11:59 pm use 23)

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14 Admission Type Not Required

15 Admission Source Required Enter 1 digit code indicating the source of admission

1 – Physician Referral

2 – Clinic Referral

4 – Transfer from Hospital

6 – Transfer from another health care facility

7 – Emergency Room

8 – Court Enforced

9 – Information not available

16 Discharge Hour Conditional Required on Admit thru Discharge claims and Final Interim claims

17 Discharge Status Required Enter appropriate discharge status as specified by the NUBC UB04 Uniform Billing Manual

See Discharge Status Codes Tables Below

18‐28 Condition Codes Conditional REQUIRED when applicable; Condition codes are used to identify conditions relating to the bill that may affect payer processing

For a list of codes and additional instructions refer to the NUBC UB04 Uniform Billing Manual


29 Accident State Not Required


31‐34 Occurrence

Codes

Not Required

35‐36 Occurrence Span

Code

Not Required


38 Unlabeled Not Required Responsible party name and address should always

be same as patient since Medicare, Medicaid, and

MLTC plans have no spouse or dependent coverage

39‐41 Value Codes Required Code: 09 Amount: $ coinsurance amount

Code: 31 Amount: monthly patient responsibility

Code: 80 Amount: number of days

See Value Codes Table Below

42 Revenue Code Required Enter the appropriate 4 digit revenue code

See Revenue Codes Tables Below

43 Description Required Enter the description for the covered service that

corresponds to the code entered in field 42

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Field Description Inpatient Field Content or Usage Detail

44 HCPCS/Rate/HIPPS

Code

Conditional Used for HCPCS/CPT codes, RUG codes, accommodation rates, and HIPPS rate codes

Medicaid per diem rate

RUG codes are REQUIRED on PART A Crossover claims when Medicare is primary. DO NOT recode to an all inclusive room and board revenue code

CPT/HCPCS are REQUIRED on all PART B Crossover claims

45 Service Date Conditional REQUIRED on the RUG code lines when

submitting PART A crossover claims if more than

1 RUG code is billed

46 Service Units Required Enter number of units/days/visits

47 Total Charges Required Enter total charges for each service line

48 Non‐Covered

Charges

Conditional If applicable ‐ list non‐covered charges on

applicable line items and the Total Non‐Covered

Charges in Field 48


Field Description Inpatient Field Content or Usage Detail

50a‐c Payer Name Required Enter appropriate payers

51 Health Plan ID

Number

Required Insured ID for payers

52a‐c REL INFO Required Release information is required for every payer

(must be Y)

53 ASG BEN Required Enter 'Y' or 'N' to indicate a signed form is on file

authorizing payment by the payer directly to the

provider for services

54 Prior payments Conditional REQUIRED for TPL Payment

REQUIRED for submission of PART A or PART B Crossover claims

55 EST Due AMT Not Required Recommend completion if TPL is applicable

56 NPI Required Enter providers 10 character NPI number

57 Other Provider ID Not Required

58 Insured's Name Required Enter the name of the person who carries the

insurance policy (should match Field 8b)

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59 Patient

Relationship

Not Required Usually "self" if patient only has Medicare or

Medicaid coverage, but could be Spouse or

Dependent if patient has primary coverage through

their spouse or a parent

60 Insured's Unique

ID

Required Enter the patients ID number exactly as listed on

their insurance card

61 Group Name Not Required

62 Insurance Group

Number

Not Required

63 Treatment

Authorization

Codes

Not Required You may submit authorization numbers in this field,

but it is not recommended

64 Document

Control Number

Conditional For corrected claims, submit the original claim ID in

this field

65 Employer Name Not Required


66 Diagnosis Code Required REQUIRED to indicate the version submitted

9 = ICD 9

0 = ICD 10

67a‐q Other Diagnosis

Codes

Conditional POA Indicators are REQUIRED on Part A and Part B Crossover claims if required by Medicare

POA = "Present on Admission"

Reportable values are "Y" for Yes and "N" for No

OPTIONAL for LTC Nursing Home Claims


69 Admitting

Diagnosis Code

Required Enter a valid ICD9 or ICD 10 diagnosis code

Make sure field 66 is completed

70 Patient Reason

Code

Not Required

71 PPS/DRG Code Not Required

72 External Cause

Code

Not Required


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74 Principal

Procedure

Code/Date

Conditional Submit on Crossover claims when required by Medicare


76 Attending

Physician

Conditional Attending provider NPI, ID, qualifiers, last and first name

REQUIRED on Crossover claims; OPTIONAL for MLTC long term care Nursing Home claims

77 Operating

Physician

Not Required

78‐79 Other Physician Not Required

80 Remarks Not Required REQUIRED for AEC crossover claims

81a Code to Code Required B3 ‐ Taxonomy number of billing provider

Required for validation of NPI submitted; must match taxonomy on file in the NPI Registry

81b‐c Not used Not Required

81d Level of Care Required Row D is REQUIRED for reporting Level of Care on all nursing home claims (Medicaid per diem rate) and Part A/B Crossover claims (average RUG rate)

See Level of Care Codes Table Below

Type of Bill CodesNursing Home & Part A Crossover

211Admit‐Through‐Discharge

Claim

One claim for the entire stay. Cannot span

months or calendar years.

212 Interim—First Claim First claim for a continued stay.

213 Interim—Continuing Claim Interim claim for a continued stay.

214 Interim—Last Claim Last claim for a continued stay.

215 Late Charges Only Claim DO NOT USE.

217 Replacement of Prior ClaimUse for corrected claims – enter original claim

number in UB Field 64

218 Void/Cancel of a Prior ClaimEliminates and cancels a previous claim. DO

NOT USE.

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Type of Bill CodesPart B Crossover

221Admit‐Through‐Discharge

Claim

One claim for the entire stay. Cannot span

months or calendar years.

222 Interim—First Claim First claim for a continued stay.

223 Interim—Continuing Claim Interim claim for a continued stay.

224 Interim—Last Claim Last claim for a continued stay.

225 Late Charges Only Claim DO NOT USE.

227 Replacement of Prior ClaimUse for corrected claims – enter original claim

number in UB Field 64

228 Void/Cancel of a Prior ClaimEliminates and cancels a previous claim. DO

NOT USE.

Patient Disposition Codes (Discharge Status)

Code Description

01 Discharged/Transferred To Home Or Self Care (Routine Discharge)

02 Discharged/Transferred To Another Short Term Hospital For Inpatient Care

03 Discharged/Transferred To Skilled Nursing Facility (SNF).

04 Discharged/Transferred To Intermediate Care Facility (ICF)

05 Discharged/Transferred To A Designated Cancer Center Or Children’s Hospital

06 Discharged/Transferred To Home Under Care Or Organized Home Health Service Organization

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Code Description

07 Left Against Medical Advice Or Discontinued Care

08 Reserved For National Assignment

10‐14 Reserved For National Assignment

15 Planned Acute Care Hospital Inpatient


20 Expired


Code Description

21 Discharged/Transferred To Court/Law Enforcement


30 Still Patient


43 Discharged/Transferred To Federal Assignment


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Code Description

50 Hospice – Home

51 Hospice – Medical Facility


61Discharged/Transferred Within This Institution To Hospital Based Medicare Approved Swing Bed

62Discharged/Transferred To Inpatient Rehabilitation Facility (IRF) Including District Part Units Of Hospital(Effective Retroactive To 1/1/2000)

63Discharged/Transferred To Medicare‐Certified Long Term Care Hospital (LTCH)


Code Description

64Discharged/Transferred To A Nursing Facility Under Medicaid But Not Certified Under Medicare

65Discharged/Transferred To A Psychiatric Hospital Or Psychiatric Distinct Part Unit Of A Hospital

66 Discharged/Transferred To A Critical Access Hospital (CAH)

67‐68 Reserved National Assignment

69 Discharged/Transferred To A Designated Disaster Alternate Care

70Discharged/Transferred To Another Type Of Health Care Institution Not Defined Elsewhere

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Code Description

81Discharged To Home Or Self Care With A Planned Acute Care Hospital Inpatient Readmission

82Discharged/Transferred To Short Term General Hospital For Inpatient Care With A Planned Acute Hospital Inpatient Readmission

83Discharged/Transferred To A Skilled Nursing Facility (SNF) With Medicare Certification With A Planned Acute Hospital Inpatient Readmission

84Discharged/Transferred To A Facility That Provides Custodial Or Supportive Care With A Planned Acute Hospital Inpatient Readmission

85Discharged/Transferred To A Designated Cancer Center Or Children's Hospital With A Planned Acute Hospital Inpatient Readmission


Code Description

86Discharged/Transferred To Home Under Care Of Organized Home Health Service Organization With A Planned Acute Hospital Inpatient Readmission

87Discharged/Transferred To Court/Law Enforcement With A Planned Acute Hospital Inpatient Readmission

88Discharged/Transferred To A Federal Health Care Facility With A Planned Acute Hospital Inpatient Readmission

89Discharged/Transferred To A Hospital‐Based Medicare Approved Swing Bed With A Planned Acute Hospital Inpatient Readmission

90

Discharged/Transferred To An Inpatient Rehabilitation Facility (SNF) Including Rehabilitation Distinct PartUnits Of A Hospital With A Planned Acute Hospital Inpatient Readmission

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Code Description

91Discharged/Transferred To A Medicare Certified Long Term Care Hospital (LTCH) With A Planned AcuteHospital Inpatient Readmission

92Discharged/Transferred To A Nursing Facility Certified Under Medicaid But Not Certified Under MedicareWith A Planned Acute Hospital Inpatient Readmission

93Discharged/Transferred To A Psychiatric Hospital Or Psychiatric Distinct Part Unit Of A Hospital With APlanned Acute Hospital Inpatient Readmission

94Discharged/Transferred To A Critical Access Hospital (CAR) With A Planned Acute Hospital InpatientReadmission

95Discharged/Transferred To Another Type Of Health Care Institution Not Defined Elsewhere In This CodeList With A Planned Acute Hospital Inpatient Readmission

Value Codes

Code Description Comments

09 Coinsurance AmountReport the total coinsurance amount (coinsurance days X coinsurance rate)

31 Patient Responsibility

Report the monthly patient responsibility amountREQUIRED – If resident has no patient responsibility enter $0.00

80Covered Days (Required on paper crossover claims)

REQUIRED – value submitted should be equal to the number of days covered

81Non‐covered Days (Required on paper crossover claims when applicable)

REQUIRED if all days are not covered

82Coinsurance Days (reportable only on paper claims)

REQUIRED – Value should be equal to the coinsurance applied by Medicare and reflected on the Medicare EOB

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Revenue CodesRoom & Board

0101 Long Term Care Day

0185 Hospital Leave Days (Hospital bed‐hold days)

0182 Home Leave Days (Therapeutic bed‐hold days)

0120 Medicare Crossover Days (except AEC)

Revenue CodesPhysical Therapy

042X Physical Therapy UB04 Revenue Code

0420 General Classification UB04 Revenue Code

0421 Visit Charge UB04 Revenue Code

0422 Hourly Charge UB04 Revenue Code

0423 Group Rate UB04 Revenue Code

0424 Evaluation or Re‐evaluation UB04 Revenue Code

0429 Other Physical Therapy UB04 Revenue Code

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Revenue CodesOccupational Therapy

043X Occupational Therapy UB04 Revenue Code






0439 Other Occupational Therapy (may include restorative therapy) UB04 Revenue Code

Revenue CodesSpeech-Language Pathology

044X Speech Therapy






0449 Other Speech‐Language Pathology UB04 Revenue Code

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Level of Care Codes

1 Skilled

2 Intermediate I

3 Intermediate II

4 State Mental Health Hospital

6 through 9 ICF‐DD Levels of Care

U Skilled Fragile Children Under 21

X Medicare Part A Coinsurance Payment

COMPLETING THECMS-1500

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Field Description Field Content or Usage Detail

1 PAYER Check Plan Program Type (Medicaid)

1a INSURED’S I.D. NUMBER Patient's Medicaid No. or Plan ID No.

2 PATIENT’S NAME Patient's Name (Last Name, First Name, Middle Initial)

3 PATIENT’S BIRTH DATE/SEX Patient's Date of Birth (MMDDYY) & Gender (M or F)

4 INSURED’S NAME Insured's Name (Last Name, First Name, Middle Initial)

5PATIENT’S DEMOGRAPHIC

INFOPatient's Street Address, City, State, Zip, Telephone

6PATIENT RELATIONSHIP TO

INSUREDPatient's Relationship to Insured (Enter “Self”)

7INSURED’S DEMOGRAPHIC

INFOInsured's Street Address, City, State, Zip, Telephone

10IS PATIENT’S CONDITION

RELATED TO:

Mark Yes or No for Employment, Auto Accident, or

Other Accident

11INSURED'S POLICY GROUP

OR FECA NUMBERInsured's Policy and Plan Information

12PATIENT'S OR AUTHORIZED

PERSON’S SIGNATURE Patient's Signature (Enter “Signature on file”)

13INSURED'S OR AUTHORIZED

PERSON'S SIGNATURE Patient Signature (Enter “Signature on file”)


21DIAGNOSIS OR NATURE OF

ILLNESS OR INJURY

Enter the diagnosis code included on the

authorization. If there is no code on the

authorization form use code 799.3 (Debility

Unspecified) * In most cases this will be the code

used

22MEDICAID RESUBMISSION

CODE

Required Only if resubmitting Enter Code 7（the

"Replace" billing code) to indicate that this is a

corrected or replacement claim

In the Original Ref. No. section enter the number of

the original claim you are replacing

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PRIOR AUTHORIZATION

NUMBER (All services must be

authorized)

Enter the authorization number listed on the

“service request form”

If you have not received a new authorization

number from the members new managed care plan

please contact them prior to billing to request a new

authorization be sent to you or billing instruction

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24a DATE(S) OF SERVICE

Enter the date of service for each procedure, service, or supply on an individual line.

Enter each Date of Service on a separate line (Exception: Providers on a capitated agreement may use a date range for a dates of service upon meeting their maximum allowable amount)

The form provides a maximum of six line entries; If it surpasses the amount of entries provided, complete a new CMS 1500 form for remaining entries

24b PLACE OF SERVICEEnter the two‐character place of service code. (As per CMS‐1500 Reference Guide). In most cases Code 13 will be used in this field.

24dPROCEDURES, SERVICES, OR

SUPPLIES

Enter CPT code/s per Plan requirements

In most cases no modifiers will be needed

24e DIAGNOSIS POINTER Enter A

24f $ CHARGES Enter the charge amount for the service


24g DAYS OR UNITS Enter the days or units provided for the procedure (all authorizations should indicate the proper unit increment)

24j RENDERING PROVIDER ID Enter NPI Number of the rendering provider

25 FEDERAL TAX ID NUMBER Enter the provider's federal tax ID number ‐ "EIN"

26 PATIENTS ACCOUNT NO.

Enter the patient's account number

This is the provider's internal account number for

the patient

27 ACCEPT ASSIGNMENT? ALWAYS check “Yes” to accept assignment

28 TOTAL CHARGE $ Enter the total charge for the services listed

29 AMOUNT PAIDEnter the total amount paid from all other insurance

sources

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31

SIGNATURE OF PHYSICIAN OR

SUPPLIER INCLUDING

DEGREES OR CREDENTIALS

Signature of the person completing the form

32SERVICE FACILITY LOCATION

INFORMATION

Enter the Servicing provider's name, address and

phone number. Include zip code + 4

32a.

Enter the NPI Number of the Servicing Provider

Location

In some cases this may differ from the Billing

Provider Locations

32b. Not applicable

33BILLING PROVIDER INFO &

PHONE #

Enter the billing provider's name, address and

phone number. Include zip code+ 4.

33a Enter the NPI. (Same from 24i)

33b Not applicable

American ElderCare

Customer Service 561‐499‐9656 ext. 1987

Paper ClaimsAddress

Red/White UB04 acceptedAmerican Eldercare, Inc.Attn: Claims Department14565 Sims RoadDelray Beach, FL 33484

Electronic [email protected]‐665‐4415 for access through web portal

Web Portal https://providerportal.americaneldercare.com/ProviderPortal/

Payment Methods Payment through Florida Medicaid

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Amerigroup Florida

Customer Service 800‐454‐3730

Paper ClaimsAddress

Red/White UB04 acceptedAmerigroupPO Box 61010Virginia Beach, VA 23466‐1010

Electronic Claims Electronic payer: 27514

Web Portal www.Availity.com

Payment Methods Initial payment= paper checkEFT‐ register at 800‐950‐7679 ext. 77429 or www.amerigroup.com

Coventry Health Care


Paper ClaimsAddress

Red/White UB04 acceptedIndependent Living SystemsPO Box 21596Eagan, MN 55121email: [email protected]


Web Portal www.ilshealth.com/providerportalWeb portal is currently under construction – ETA 9/1/14

Payment Methods Paper checkEFT effective July 1, 2014, Contact William Lopez305‐262‐1292 ext. 7101, [email protected]

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Humana Medical Plan


Paper ClaimsAddress

Red/White UB04 acceptedIndependent Living SystemsPO Box 21596Eagan, MN 55121email: [email protected]


Web Portal www.ilshealth.com/providerportalWeb portal is currently under construction – ETA 9/1/14

Payment Methods Paper checkEFT effective July 1, 2014, Contact William Lopez305‐262‐1292 ext. 7101, [email protected]

Molina Complete Care

Customer Service

305‐702‐5197 (Carla)305‐908‐3509 (Luisa)305‐908‐3582 (Pam)305‐908‐3500 (Elva‐Supervisor)

Paper ClaimsAddress

Red/White UB04 accepted Molina HealthcarePO Box 22812Long Beach, CA 90801


Web Portal https://eportal.molinahealthcare.com/provider/login

Payment Methods Initial payment= paper checkEFT‐ register at providernet.alegeushttps://providernet.adminisource.com

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Sunshine Health PlanCustomer Service 877‐211‐1999

Paper ClaimsAddress

Red/White UB04 accepted Sunshine Health Tango PlanPO Box 3070Farmington, MO 63640‐3823Attn: Claims Department

Electronic Claims

Electronic payer: 68057Sunshine Health c/o Centene EDI Department800‐225‐2573 x [email protected]

Web Portal https://provider.sunshinestatehealth.com

Payment Methods Initial payment= paper checkEFT‐ Register at Payspanhttps://www.payspanhealth.com

United Healthcare


Paper ClaimsAddress

Red/White UB04 acceptedUnited Healthcare Community and StatePO Box 31362Salt Lake City, UT 54131‐0362

Electronic ClaimsElectronic payer: 87726Free claims submission option:http://www.officeally.com

Web Portal https://www.Unitedhealthcareonline.comeligibility, claims status, 1500 billing only

Payment Methods Enroll for EFT's at:https://www.Unitedhealthcareonline.com

31

Resources Florida Medicaid Provider Handbooks

http://portal.flmmis.com/FLPublic/Provider_ProviderSupport/Provider_ProviderSupport_ProviderHandbooks/tabId/42/Default.aspx

Provider General Handbook Nursing Facility Services Coverage and Limitations

Handbook Provider Reimbursement Handbook Hospice Services Coverage and Limitations

Handbook

Resources SMMC Homepage

ahca.myflorida.com/Medicaid/statewide_mc/index.shtml SMMC Event Calendar/Materials

ahca.myflorida.com/Medicaid/statewide_mc/index.shtml#NEWS

SMMC LTC Program Page ahca.myflorida.com/Medicaid/statewide_mc/index.shtml#LTCMC

SMMC LTC Program Snapshot ahca.myflorida.com/Medicaid/statewide_mc/pdf/LTC/SMMC_LTC_Snapshot_July_30_2013.pdf

AHCA YouTube Channel (Webinars) www.youtube.com/AHCAFlorida

32

Questions???

Questions???Questions???

Questions???

Contact Information

Darlene BurtDirector of ReimbursementRemington Financial Solutions(386) [email protected]

Lynette Davis, Director of Business Office SystemsOpis Management Resources(813) [email protected]

Tony MarshallSenior Director of ReimbursementFlorida Health Care Association(850) 224-3907(850) [email protected]

fhca 2014 annual conference & trade show · will cover billing for all medicaid bill types...

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