BILLING UPDATES APRIL 2017

By Tammy Bartlett, Billing Manager

YOURCARE FEE SCHEDULE CHANGES

Modifications to YourCare’s professional fee schedule will take effect April 1, 2017.  The changes will apply to services rendered to YourCare Option, Child Health Plus and Essential Plan members.

YourCare Health Plan fees are calculated utilizing 2016 Medicare RBRVS methodologies and RVU tables with conversion factors for appropriate code sets.  Nurse Practitioners and Physician Assistants will be reimbursed at 85% of their supervising physician’s conversion factor for most services.

Anesthesia services utilize the prevailing based conversion factor multiplied by the Anesthesia Society of America (ASA) base anesthesia service units and subsequent time methodology.  Non anesthesia services will be reimbursed at the community based professional fee schedule.

The fee schedule will be available on their website at www.yourcarehealthplan.com on or around April 1, 2017.

The latest referral and authorization requirements effective May 1, 2017 are also available on their website as listed above.

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

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