MINUTES - MMBA SouthEast Chapter Meeting March 19, 2014

MINUTES - MMBA SouthEast Chapter Meeting
March 19, 2014
SPEAKERS: Insurance Representatives:
Sue Brinich, BCBSM, [email protected] (also present, Candice
McCoy, [email protected])
Tammy Smith, Aetna/Cofinity, [email protected]
Tekendria Batts, DMC Care, [email protected] (also present Tammy
Calhoun, [email protected])
Pamela Long, Health Alliance Plan
Lisa Harris, Humana, [email protected] (also present Brian Ward,
[email protected])
Tina Villareal, Michigan Medicaid, [email protected]
Marilyn Morgan, Molina Healthcare,
[email protected]
Shawntell Ferguson, United Healthcare, [email protected]
CCI Edits, Marion Salwin, CPC, CPC-I, Director, PHysician &
Regulatory Compliance, Trinity Health
Sue Brinich reminded us that BCBSM and BCN reps are combining and will be able to service both
insurances. She introduced her "BCN Buddy", Candice McCoy. Remember new 1500 forms are
required on April 1, 2014, which will allow for up to 12 diagnoses codes. Status forms will be eliminated
so providers will need to submit a 'corrected claim' on the new 1500 form, completing boxes 19 and 22
and referencing the original ICN. Review November, December, January and March issues of The
Record, where changes are discussed, as well as the provider manuals on WebDenis.
Remember
there are new reporting requirements for NDC codes - if you're not submitting correctly, you're being paid
at the lowest fee schedule.
If you discover this has happened to you, please call in or submit a
corrected claim. If you were a PPO or HMO provider in 2013, you are a a par provider for the new
coverages through Health Care Reform in 2014. Remember to verify benefits at every encounter patients have a 30-day grace period if they purchase coverage on their own, 90 days if they're on a
subsidized plan. If you're not checking, you could be rendering care for free! As of now, there are no
plans for BCBSM to reimburse a provider for completion of a patient's qualifying health form. WebDenis
is updated nightly, so deductible amounts are correct. ICD-10 testing options were discussed.
Tammy Smith reminded us that Aetna has a website, www.aetnaeducation.com, where providers can
access webinars on various topics of interest. Expedited Medicare pre-cert line is (860) 754-5468.
Aetna/Cofinity will be ready for ICD-10, and they are currently taking both old and new 1500 forms. A
member asked if Cofinity will work with their TPA to make sure they are ready also - and if not, make sure
the TPAs will be paying interest!! Tammy will get back with MMBA as to whether or not Cofinity will allow
a preventive medicine and E/M code on the same day, and as to whether Cofinity will pay for telehealth
codes.
Tekendria Batts reminded us that many of the DMC members have high deductible plans now, which has
not been the case in the past. Make sure you obtain the fee schedule from the website and charge the
appropriate deductible amounts.
DMC was one of the 4 plans that covered ABW patients. Since
ABW will be terminating 3/31/14, make sure you get all outstanding claims submitted, because there will
be a run-off period. (Those patients will be moved to the Healthy Michigan program.) DMC is
completingi testing and will be reading for ICD-10. We were reminded that Vanguard had purchased the
DMC, but then Tennant Health purchased Vanguard . . . .due to the new ownership, claims WILL be
changed to calendar year versus fiscal year in the future. DMC has re-branded Pro Care, now calling it
Harbor Health Plan. The plans include the Medicaid HMO (formerly ProCare Health Plan) and a new
MICHILD plan. New website is www.harborhealthplan.com, but visitor to www.procarehealthplan.com
will be directed to the new site seamlessly.
Pamela Long reports that HAP has made strides to stabilize inventory since the July 2013 conversion to a
new processing system. There are still issues with providers who dropped out of the new system
because NPIs didn't match TINs. Another concern is unresolved claim adjustments from prior to the
conversion date. Increased resources have been devoted to that issue and the goal is to receive and
respond within 30 days. Some Cigna claims were being erroneously processed as out-of-network but
that was fixed on 11/15/13. If you are still having problems, contact CIA. Some audience members
indicated they were told by HAP reps to submit Cigna claims with the HAP id, instead of the Cigna
contract number, and that seems to work to get the claims through the door.
Management is aware of
the increased phone hold times since the new system was implemented and is trying to rectify the
situation. HAP will be offering limited ICD10 training claims for their providers. Check the upcoming
Newsletter on their website for info on that as well as copies of the insurance cards for Affordable Care
Act enrollees.
Lisa Harris discussed Humana's Medicare Risk Adjustment and the importance of documenting all
conditions and coding to the highest specificity. Humana will be ready as a payer for ICD-10 on
Octobero 1, and is finalizing their strategies to train staff, who will be required to take a proficiency exam.
There are currently no plans to eliminate foreign provider service phone representatives. There are
currently reps in Louisville and San Antonio, and it's the luck of the draw when you call the 800 number as
to where your call will be routed.
Tina Villareal reminded us that Michigan Medicaid has ICD-10 training on their website. Tina discussed
recent policy change MSA 13-17, which indicated any claim with an attending, referring or ordering NPI
which is not Medicaid enrolled, will be rejected. Informational edits were sent during 2013, and the
policy took effect 10/1/13. The NPI has to be enrolled on Champs, but does not have to be a
participating provider.
This could be a problem with the snowbirds making their way back to Michigan
in the next few weeks - if a Florida doctor referred a patient, and he's not on Champs, the claim will be
rejected. Tina suggests you review your claim to determine if it actually needs a referring/ordering NPI!.
Another policy change is that Plan First! is being eliminated June 30, 2013, because it's participants are
likely eligible for Healthy Michigan. ABW patients will also be moved to Healthy Michigan effective
4/1/14. Existing patients will be automatically transferred in to the Plan - if they're in a managed care
plan now, they will transfer to that MCs Healthy Michigan plan. New enrollees will be fee-for-service
Medicaid through the first calendar month of enrollment and then will be switched to a Healthy Michigan
plan. (Healthy Michigan offers family planning, dental, vision, chiropractic and podiatric benefits!) For
more info, visit Michigan.gov/healthymichiganplan
Marilynn Morgan from Molina Healthcare shared directions for submitting authorizations online, as well as
the 2014 prior authorization/pre-service review guide. Incentive pay for PCPs and FQHCs was discussed.
Marilynn also had a handout regarding the Molina Healthy Michigan product. Physicians will NOT be
responsible for collection copays from Healthy Michigan patients. The patients will have copays, but the
health plan is responsible for collection! She reiterated that Molina ABW patients will automatically
transition to the plan on April 1, and states the patients have already been notified by mail of the change.
ICD-10 testing was discussed. Marilynn will forward a power point presentation on testing to MMBA for
inclusion on our web site. We were reminded that the Molina Claims Adjustment form is on their website.
Shawntell Ferguson shared that if a claim rejects, you must first use a reconsideration form. If that
doesn't work, you can call for an appeal. If you are not getting satisfaction, then contact your provider
representative.
Shawntell clarified the 1/1/2014 change to the national platform for all Community
claims. Providers will need to access the United website for 2014 claims; 2013 claims can still be
access on the old, 'Oscar'/Great Lakes website. (They will be holding a Webinar town hall meeting in
May to discuss the changes. Invitations will be sent via e-mail, somake sure you find out who your rep is
and contact them!
Operators on the 800 line are supposed to be able to provider your Community and
Commercial reps for you - the audience has been experiencing difficulty with it, however.) United has
been closed to new providers until their new national contract is approved by the state. Once they
receive approval, they will begin enrolling the providers who have been on hold until the transition has
been completed.
Marion gave a wonderful CCI presentation - hopefully the audience now better understands what their -25
and -59 modifiers mean!
NEXT MEETING: June 18, 2014