Our understanding from UCare is that they are still paying fee for service (or at least for Allina they are per current contract), but they want agencies to submit claims per “Medicare requirements”.  We are trying to avoid doing retro payer changes with new SOCs for all our UCare patients but are having the issue you all are sharing with not getting paid (we created a new payer in the system but those claims are not being paid)

 

From our UCare rep:

 

“They confirmed they DO want providers to bill them according to Medicare guidelines, including the use of HIPPS codes.   This will allow them to better align par and nonpar billing requirements, and will also provide them with additional data elements should they need to report on that information.   UCare will continue to pay us on our contracted methodology (based on LUPA)”

 

 

 

We have had issues getting UCare to even accept our PDGM UCare Medicare claims for processing. First it was because of the change to the electronic payer ID for the plan, now its something with the admission hour – or at least that’s what code its giving, but I wouldn’t be surprised if it was some other underlying issue that triggered that code. We’ll see.

 

I would love to hear that someone else has successfully billed and been paid for PDGM UCare Medicare claims – need some light at the end of the tunnel over here!

 

 

 

Good question, Karen. Also, it’s nice to “hear” from you! I would assume that they would transition to PDGM like Medicare is doing at the recert rather than a new SOC, but I don’t know and I’m curious what other agencies are doing. Have you reached out to UCare to inquire?

 

Thanks for posting,

Katie

Katie Troumbly, BSN, RN, PHN, CNML | Home Care Manager

Grand Itasca Clinic & Hospital part of Fairview Health Services

Grand Itasca Professional Building | 111 SE 3rd Street | Grand Rapids, MN 55744

ktroumb1@fairview.org | www.granditasca.org

Office: 218-999-1047 | Cell: 218-259-1383

 

 

 

 

Good morning,

 

With the UCare’s change outlined below, have you performed new SOCs for the UCare patients who were on service 1/1/2020 and continued into the new year?  And if not, are you having any issues with payment?

 

 

 

Thank you,

Karen

 

 

Karen Leutner

PT • Manager Quality and Compliance

Allina Health Home Health

Phone • 612-262-3474 • Pager 612-654-0540 • Cell 952 807-4922

karen.leutner@allina.com

Mail Route 34100 • 1055 Westgate Drive Suite 100 • St. Paul, MN 55114-1451 

 

 

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