JULY 2017 BILLING UPDATES

By Tammy Bartlett, Billing Manager

MVP

MVP Health Care has created reference guidelines that may provide you and your staff with helpful tools that explain HEDIS measures as well as providing the CPT, HCPCS and ICD-10 codes that count towards the completion of these measures.

You will find these coding reference guides by going to mvphealthcare.com, selecting the Provider drop-down, and then selecting the Quality Programs and the Reference Library sections. The Behavioral Health Guide will also be available on their website in the next couple of weeks.

If you have any questions with respect to this notice, please contact Mike Farina at 518-388-2463 or email at mfarina@mvphealthcare.com.

EXCELLUS – CHILD HEALTH PLUS RENEWAL UPDATE

Beginning August 1, 2017, the New York State Department of Health is requiring all Child Health

Plus (CHP) members who originally enrolled in this program through Excellus BlueCross BlueShield to

now complete their renewal for the CHP Program through the New York State of Health Marketplace.

This transition begins with the CHP members who are renewing for an August 1, 2017 effective date.

As a result of this renewal transition, CHP members will be mailed a new Member Identification Card with a new identification number.

In addition, if a CHP member has obtained preauthorization under his or her current identification number, but the preauthorized services will be delivered to the member after the date the member is transitioned to the New York State of Health Marketplace, a new preauthorization must be requested with the member’s new identification number.

As a reminder, please ensure you forward Practicefirst any changes in insurance coverage for your patients, including new identification numbers. This will ensure claims are submitted correctly to the appropriate insurance plan.

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

Medicare is taking steps to remove Social Security numbers from Medicare cards.  Through this initiative CMS will prevent fraud, fight identify theft and protect essential program funding and the private healthcare and financial information of Medicare beneficiaries.

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN). This will occur both on the cards and in various CMS systems currently used.  CMS will start mailing new cards to Medicare beneficiaries in April 2018.  All Medicare cards will be replaced by April 2019.

Based on feedback from healthcare providers, practice managers and other stakeholders, CMS is developing capabilities where doctors and other healthcare providers will be able to look up the new MBI through a secure tool at the point of service.  To make this transition easier for you and your business operations, there is a 21 month transition period where all healthcare providers will be able to use either the MBI or the HICN for billing purposes.

Even though your systems will need to be able to accept the new MBI format by April 2018, you can continue to bill and file healthcare claims using either number during the transition period.  Medicare encourages providers to start working with their software vendors to make sure systems will be updated to reflect these changes.

To learn more about this new initiative, please visit:  www.cms.gov/Medicare/SSNRI/Providers/Providers.html

For Billing questions, please contact Tammy Bartlett at 716-389-3223 or tammyb@pracfirst.com

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