BILLING UPDATES – OCTOBER 2016

BLUE CROSS

Last month, our client memo indicated the new partnership between Blue Cross and Amerigroup for Medicaid Managed Care (MMC) and Child Health Plus (CHP) members. Blue Cross has indicated that the effective date has been delayed until November 1, 2016.

MEDICAID NEWS

On September 29th, the NYS Dept. of Health notified the provider community that NYS has redesigned the Common Benefit Identification Card for Medicaid beneficiaries. Cards with the new design will begin statewide in late September. An image of the new card is reflected below.

There will be no mass replacement of existing cards as a result of the new card design. Existing cards will remain active throughout the transition period.

Additional information on the new card design is located at:  www.otda.ny.gov/workingfamilies/ebt.asp

mEDICAID

HEALTH REPUBLIC UPDATE

As a first step in the claims adjudication process, a third party will conduct an independent audit of the existing inventory of policy claims. Based on the audit results, Explanation of Benefits (EOB’s) will be issued for each policy claim to providers.

The EOB’s will advise providers of the amounts of their respective claims against the estate and their rights. It is anticipated that EOB’s will begin to be mailed to providers in the first quarter of 2017.

If a provider accepts the EOB, they are not required to take any further action. If a Provider disagrees with the EOB, they will have the opportunity to appeal the determination through Health Republic’s website or by paper to the address indicated in the Claims Adjudication Procedure.

The written appeal and supporting documentation must be submitted within 60 days of the date of mailing of the EOB. The Liquidator will review each appeal and, within 60 days, either grant the appeal and issue a revised EOB or deny the appeal and provide the reasons for the denial.

It is anticipated that the total amount of allowed claims will not be known until at least mid-2017.

For additional information, please access Health Republic’s website at: www.healthrepublicny.org

For Billing questions, please contact Tammy Bartlett at 716-348-3923 or tammyb@pracfirst.com

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