Embed Size (px)
Citation preview
AAHAM
April 24, 2015
Member Access
• Member access to any PCP/Specialist in network– No referral necessary– Don’t have to see PCP on card– Member can call Member Services to update their card
• 866-935-6760
• No copays– Arbor Health Plan does not charge copays for any service
2
Additional member benefits
• Arbor Health Plan provides additional benefits to members:
Adult Preventive Visits and Vaccinations
24/7/365 Nurse Call Line
Rapid Response and Outreach Team
Diaper Reward Program
Parenting and Lamaze Classes
Breast Pump Purchases
YMCA 90 Day Membership (select locations)
Community Baby Shower
3
Prenatal Care
• MCOs responsible for newborns effective 2/1/14.– Once DHHS is notified of birth, newborn is retroactively enrolled in
Managed Care the first of the month of the notification
• Obstetrical Needs Assessment Form (ONAF)– Receive $100 for completing form– Receive additional $300 if certain criteria are met– Available on our website
4
Enhanced Obstetrical Care Payments
Additional payment of $300 ($100 for each measure) is automatically issued if an ONAF is received:
– First visit occurs in first trimester or within 42 days of member’s Arbor membership
– Infant is term (37 weeks) and not an elective delivery prior to 39 weeks gestation
– Post-partum visit within 21 to 56 days after delivery• Submit 59430 even if global code was billed.
Payments for deliveries in July through December 2014 issued in May or June.
5
Recent Changes/Updates continued
• Enhanced PCP payments to continue
• Fee schedule updates will match Nebraska Medicaid effective dates.– Individual provider and facility rate updates will still be delayed 30 days
• Electronic Communications effective 7/1/15.– Email – Fax– Mouse
6
Recent Changes/Updates continued
• HIPAA 5010 X12 effective 4/1/15.– Incorrectly formatted claims will be rejected.
• ICD-10 has been delayed until 10/1/15.– Providers will be able to test ICD-10 claims with us, when the time
comes. July and August is the projected timeframe.
7
Reminders
• Timely filing is 365 days from DOS• Appeals/Resubmissions/Corrections within 90 days of
original remit– DO NOT send claims or corrections to Omaha office
• COB claims must be submitted within 365 days of DOS or 60 days from primary EOB generation, whichever is longer.
• When submitting with an invoice, item must be easily identifiable by code on the invoice.
• Routine and medical vision claims submitted to Avesis (anesthesia and facility fees for vision services submitted to Arbor).
8
Credentialing
• Provider must be enrolled with Nebraska Medicaid at practice location– Enrollment Center – 877-255-3092– http://dhhs.ne.gov/medicaid/Pages/med_providerenrollment.aspx
• Credential via:– CAQH– Arbor Health Plan’s Full Credentialing Application
• Contact your Account Executive with questions
9
NaviNet
• NaviNet Web Portal: www.navinet.net • Phone: 888.482.8057
– View Member Eligibility – Member Rosters – View Third Party Liability Information (TPL) – Claims Status & Updates– View/Print Remittance Advices – Prior Authorization Requests– Gaps in Care Report
10
Provider Network Management
• Adam Steffen, Director Provider Network Management– [email protected]
• Jessica Wykert, PNM, Account Executive – Western Nebraska– [email protected]
• Cathy Bojanski, PNM Account Executive – Northeast Nebraska– [email protected]
• Kami Hudson, PNM Account Executive – Southeast Nebraska– [email protected]
11
