Billing Newsletter | August 2022

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*Updates found in green font. INSURANCE information C H I P C O - P A Y M E N T S Medical office visit co-payments are waived for all CHIP members for services provided from March 13, 2020 through <strong>August</strong> 31, <strong>2022</strong>. Copayments are not required for covered services delivered via Telemedicine or Telehealth to CHIP members. P A R T I C I P A T I O N R E M I N D E R S We are NOT in contract with out of state Medicare plans. We currently DO NOT participate with: Aetna Memorial Herman Palmetto (Railroad Medicare) Bright Healthcare Super Plan C R E D E N T I A L I N G U t i l i z e t h e M C O g r i d t o k n o w w h i c h p a y e r w e a r e P A R w i t h . I f y o u d o n o t s e e a p a y e r l i s t e d p l e a s e c a l l a n d v e r i f y b e n e f i t s f o r t h e s e r v i c i n g p r o v i d e r t o d e t e r m i n e i f t h e p a t i e n t h a s i n / o u t o f n e t w o r k b e n e f i t s . C R E D E N T I A L I N G F O R T H E N E W L Y O N B O A R D E D N E W W O R K F L O W T O E N T E R L O T N U M B E R W H E N R E C E I V I N G I M M U N I Z A T I O N I N V E N T O R Y As of 05/09/22, the workflow for adding a new immunization lot number into eCW has changed. It is now clinic responsibility. The clinic staff is in charge of maintaining the system up to date with the lot numbers and NDCs in stock at their corresponding clinic. This process needs to be performed every time the clinic receives new immunization stock. The manual on how to enter a new lot number into eCW is attached in the newsletter email and was also sent to CQI team. Please refer to CQI team for training about this matter. Newly onboarded MDs cannot see patients until they are confirmed to be credentialed. Otherwise Medicaid & Marketplace claims will deny and Commercial/Medicare MCOs will process claims as OON. New onboarded Midlevels cannot see the following plans until they are confirmed to be credentialed - Cook Children - Amerigroup - CHC We are only PAR with the Medicaid product for Cigna Healthsprings. So please make sure you verify benefits! We will notify you when our providers are PAR with the Medicare product. Before using BCBS HMO plan we need to check the member benefits with the individual providers NPI that Will be seeing the member, since we must be their PCP. None of our DFW locations should see patients who have TCHP, only Houston Providers are PAR with this plan.
I N S U R A N C E S U P D A T E S B C B S I N S U R A N C E R E C O R D It is very important to add correct BCBS insurance record on patient account when adding to any patient account. We are encountering claim denials due to claim being billed to BCBS of New Mexico, but should have been billed to BCBS PPO or BCBS POS and/or BCBS HMO U H C C O M M U N I T Y Some of the Dallas providers are now showing in-network with this product and have been added to the grid. Please still call and verify benefits as there are 8 different plans listed under this product. B C B S We have been terminated from the Medicare Advantage HMO, Dual Special Needs and WellMed MA HMO Plans under Blue Cross Blue Shield. Contract has been sent to contracting once we are back in-network you will be notified B R I G H T H E A L T H P L A N F O R H O U S T O N A N D D F W Per contracting we are on a direct contract and providers will not be added to the super plan. With that said, eventually the providers who are showing in-network with the super plan will be updated to the standard plan only. Please continue to verify benefits prior to seeing these patients M E R I T I A N H E A L T H H O W T O V E R I F Y P A T I E N T S F O R : 1. Call the number on the card to verify if we are PAR with the network the patient is part of. 2. When calling, please look at your latest MCO grid to see the providers that are PAR with Aetna. 3. As mid-levels are not credentialed with Aetna, only MD’s, please give them the name of the midlevels supervising physician so they are able to locate them on the list. Also, let them know the location in where the supervising physician works, because most of the rep’s search by location first. C I G N A 1. As mid-levels are not credentialed with Cigna, only MD’s, please give them the name of the midlevels supervising physician so they are able to locate them on the list. Also, let them know the location in where the supervising physician works, because most of the rep’s search by location first. Please contact LeKeysha Sewell if you have any question 972-957-3000 ext. 8182 Notice: It is important to call every time a patient comes in with this card, since there are many different networks under Meritain Health. All patient encounters should have insurance verification attached for each encounter which includes front/back copy of identification card H E A L T H C A R E 2 U P A T I E N T S S H O U L D N E V E R B E B I L L E D F O R L A B S We should be charging patient for labs not covered based upon their current plan after we have verified benefits. If labs are billed to LabCorp it is the clinic responsibility to update requisition form “Bill to Client”, so that the patient does not receive a statement from LabCorp. *Updates found in green font.
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Billing Newsletter | August 2022

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