Transcript How to Become A 3rd Party Provider

How to Become A
rd
3 Party Provider
Addressing:
•Preparation for enrolling with a 3rd Party
• Contact information for 3rd Parties in
Nebraska
Disclaimers
This information was prepared by the 3rd Party
Consultant to the Nebraska Optometric
Association, Ed Schneider OD.
To the best of his knowledge, it was current and
accurate at the time it was prepared. It is not
guaranteed to be error or omission free.
It was prepared as general information to assist
doctors and staff, and is not intended to grant
rights or impose obligations.
Disclaimer
• The ultimate responsibility for the correct
submission of claims and compliance with provider
contracts lies with the provider of services.
• The Nebraska Optometric Association, and its
presenters, agents, consultants and staff make no
representation, warranty, or guarantee that this
presentation and/or its contents are error-free or
omission-free, and will bear no responsibility or
liability for the results or consequences of the
information contained herein.
Enrolling as a Provider
Multiple page application forms with considerable
documentation: copies of
•NPI (National Provider
Identifier)
•Optometry Diploma
•State License
•Turn-around
•DEA Registration (need it)
•Proof of Malpractice Insurance
•Photo ID
…plus more in some cases
time: weeks to months
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Enrolling as a Provider
NPI (National Provider Identifier)
 Need before enrolling as any provider
 Need a separate NPI for
– Each doctor (only one NPI for any doctor),
– Each office location,
– Each separate business entity (optical dispensary
may need separate NPI if has a separate tax ID
number)
• http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage
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Enrolling as a Provider
NPI (National Provider Identifier)
 Exception: Sole Proprietor (Not a PC or
partnership, etc.)…
– Only one NPI total (represents both doctor and
her/his practice).
– Get specifics at
http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage
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Enrolling as a Provider
NPI enrollment information found at
•National Plan and Provider
Enumeration System (NPPES)
https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do
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Enrolling as a Provider
NPI (National Provider Identifier)
•
Information on NPI application must match information
on
– Medicare B application (855i and 855b)
– Medicare DME application (855s)
– IRS information (Employer ID number, etc)
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Contacts to Become a Provider
 Routine Care (July 2011)
– Avesis http://www.avesis.com/provider_benefits.html
– EyeMed (Eyecare Plan of America)
http://portal.eyemedvisioncare.com/wps/portal/emweb/providers/become_a_provider
– Optum (Spectera)
https://www.optumhealthvision.com/providers/OH_Vision_Provider.jsp
– Vision Service Plan (VSP)
https://www.vsp.com/cms/provider/provider-home.html
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Contacts to Become a Provider
 Standard
Medicaid
• Via Nebraska Dept. of Health & Human Services
• Both Routine & Medical
• Patients age 65+ &/or in nursing home
http://www.hhs.state.ne.us/med/providerenrollment.htm
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Contacts to Become a Provider
Medicaid Managed Care Organizations (MCOs)
– MCOs cover all Medicaid patients that are not
also covered by Medicare. MCOs cover
 Medical Diagnoses
 Routine Care (sub-contracted)
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Contacts to Become a Provider
Medicaid Managed Care Organizations (MCOs)
– State divided into two parts, each having two MCOs
 MCOs for Eastern 10 counties:
– UnitedHealthCare Community Plan (United HealthCare)
– Coventry Nebraska (Coventry)
 MCOs for Other 83 Counties:
(starting July 1, 2012)
– Coventry Cares (Coventry)
– Arbor Health (AmeriHealth Nebraska via BCBS)
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Contacts to Become a Provider
Medicaid Managed Care Organizations (MCOs)
 MCOs for Eastern 10 counties :
– UnitedHealthCare Community Plan (United HealthCare)
– Coventry Nebraska (Coventry)
 Eastern 10 Counties include
• Cass
• Dodge
• Douglas
• Gage
• Lancaster
• Otoe
• Sarpy
• Saunders
• Seward
• Washington
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Contacts to Become a Provider
Eastern 10 county Medicaid MCO Contact Info:

UnitedHealthCare Community Plan
(United HealthCare)
 Routine Care (Block Vision subcontractor)
– Call Adrienne Bennett, VP, Operations at 800-243-1401 x1067;
Email [email protected] .
 Medical Care (United HealthCare)
– Contact: Jeremy Sand, at 402-445-5587, or
[email protected].
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Contacts to Become a Provider
Eastern 10 county Medicaid MCO Contact Info:

Coventry Of Nebraska, Inc.(Coventry Health Care)
• Routine Care (Block Vision subcontractor)
– Call Adrienne Bennett, VP, Operations at 800-243-1401 x1067;
Email [email protected] .
 Medical Care (Coventry of Nebraska)
– Coventry of Nebraska’s “contracting area” call 800-471-0240
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Contacts to Become a Provider
Medicaid Managed Care Organizations (MCOs)
– State divided into two parts, each having two MCOs
 MCOs for Eastern 10 counties:
– Share Advantage (United HealthCare)
– Coventry Nebraska (Coventry)
 MCOs for Other 83 Counties:
(starting July 1, 2012)
– Coventry Cares (Coventry)
– Arbor Health (AmeriHealth Nebraska via BCBS)
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Contacts to Become a Provider
Western 83 County Medicaid MCO Contact Info:

Coventry Cares (Coventry)
 Routine Care (Block Vision subcontractor)
– Monica Jenifer- Sr. Network Development Specialist
– 1-800-243-1401 x 1067
– [email protected]
– Teresa Moragne El- Sr. Network Development Specialist
– 1-800-243-1401 x 1067
– [email protected]
 Medical Care (Coventry)
–
–
–
–
–
–
–
Scott Davis
Manager, Network Development
402-995-7174
(800) 471-0240 Ext. 7174
[email protected]
15950 West Dodge Road
Omaha, NE 68118 .
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Contacts to Become a Provider
Western 83 County Medicaid MCO Contact Info:
 Arbor
Health (AmeriHealth Nebraska via BCBS)
 Routine Care and Medical Care (Avesis subcontractor)
– Eilene Fennelly Contracting Specialist
 Phone: (800) 643-1132, ext. 116
 Email: [email protected]
– Cheryl Beyenka Contracting Specialist
 Phone: (800) 643-1132, ext. 141
 Email: [email protected]
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Contacts to Become a Provider

Medical Coverage

Blue Cross Blue Shield of Nebraska
http://www.bcbsne.com/Providers/Library/Credentialing.aspx
Apparently BCBS will pay claims retroactive to the date of application
for enrollment, but only when their special form is completed.

Midlands Choice
http://www.midlandschoice.com/Provider/Credentialing/Index.html
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Contacts to Become a Provider

Medical Coverage

Coventry 800 865-2673, press 6 for credentialing

United HealthCare, 877/842-3210, then using
a fake tax ID #
471234567, follow their phone voice response. When given the choice, say


First choice, Press 5 or say “…Other”

Next choice Press 1 or say “Credentialing”

Next choice Press 2 say “Medical”

Next choice Press 2 or say “Join network”
UHC convoluted web site found at:
http://www.uhc.com/physicians/join_our_network.htm
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Contacts to Become a Provider

Medical Coverage

Medicare
– Medicare Part B
http://www.wpsmedicare.com/j5macpartb/departments/enrollment/
– Rail Road Medicare Part B 877/288-7600
• http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/Providers~Railroad%20Medicare~Resources~Provider%20
Enrollment?open
– Medicare Durable Medical Equipment
• Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Brochure [PDF,87KB]
 https://www.noridianmedicare.com/dme/enroll/
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Becoming a Provider

Once Approved you will be given…
– Provider number
– Manuals &/or other (Web) resources
 Claim requirements
 Explanation of various plans
 Other important data
– Be sure to read these resources…ignorance is not an
excuse for incorrect claims!
– Fraudulent filing is a Federal crime.
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Thank You for Listening
We hope this information has been helpful.
Thank you for listening!
See our NOA Website for more 3rd Party
Educational Videos.
3rd Party Services
Nebraska Optometric Association