Transcript AAHAM Conference

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
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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
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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
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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
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Submit 59430 even if global code was billed.
Payments for deliveries in July through December 2014
issued in May or June.
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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
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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.
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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).
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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
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NaviNet
• NaviNet Web Portal: www.navinet.net
• Phone: 888.482.8057
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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
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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]
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