Sorry me again, but what about the ones over 65? 

Hi All!

 

This is off topic a bit, but I felt the need to share since it pertains to BCBS Medicaid:

 

Today I spoke with Lauren B. RN, from BCBS utilization/authorization department, regarding authorization requirements for RN (T1030) and HHA (T1021) services provided to Blue Plus members who are under 65 and not on MSHO or MSC+ plans.

 

In late March I was informed that these codes require authorization for dates of service starting 4/1/19, so I sent in requests starting 4/1/19 through 7/31/19.  When I received authorization approval letters, these dates were shortened to end 4/30/19, along with a note stating that after 5/1/19, these codes do not require prior authorization.

 

I called BCBS to see what the new rule is because this seemed odd, and I was told by provider services that these codes require prior authorization for all visits, even after 5/1/19.  When I mentioned the note that accompanied the authorization letters, the representative said it must have been human error and it was not correct.  After some discussion, she put in a message for Lauren to contact me to help clarify.

 

Lauren B. reached out to me today and informed me that just two days ago, the rule was changed yet again.  The two codes I had questioned do require prior authorization for all visits during April.  However, starting May 1^st the rule is that after 20 visits, prior authorization is required.  She went on to say that the time frame for counting these visits will begin on 5/1/19 and any visits performed prior to 5/1/19 will not be counted towards the 20 visit threshold.

 

Lauren stated that the newly updated authorization grid has not yet been published, but should be coming out soon.

 

This has been such a confusing mess this year with Blue Plus PMAP plans and I hope that this email may assist others to help clarify what the authorization requirements are to avoid denials.

 

To note, services performed from 1/1/19 through 3/31/19 do not require a prior authorization and claims will be paid with or without prior authorization.

 

Thank you

 

Tina Tomberlin

Patient Accounts/Hospice Volunteer Coordinator

Mille Lacs Health System Home Care/Hospice

200 Elm St N

Onamia, MN 56359

P. 320.532.2807

F. 320.532.4325

 

From: billers@list.mnhomecare.org [mailto:billers@list.mnhomecare.org] On Behalf Of Cindy Erkel
Sent: Friday, April 26, 2019 9:05 AM
To: billers@list.mnhomecare.org
Subject: PCA BCBSMN for 2019

 

Good Morning Everyone –

 

Have any of you been successful with billing for PCA service under the new BCBS ID numbers for 2019? 

 

Thanks,

 

Cindy

 

 

Cindy Erkel

Accounting Coordinator

MRCI

1961 Premier Drive, Suite 318 | Mankato, MN 56001

D: 507-386-5708 | T: 800-829-7110 | F: 888-800-7336

cerkel@mymrci.org

 

Mankato | Chaska | Fairmont | New Ulm | Rosemount | Shakopee

 

As an industry leader, MRCI is excited to offer two online options.

Participant Dashboard is an online viewing portal to review monthly spending and E-Timesheets is a one stop online timesheet submission.

Connect with me to learn more. MRCI, your selected FMS provider.

 

 

 

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