When our nurses call to get auths, they’re asked if they bill per visit or episodic.  That could be the difference in your denials.  We are not doing episodic billing with Ucare and our per visit payments are getting paid.

Also don’t forget that there are now two different payer IDs for Ucare.  You’ll need to make sure you’re billing to the correct payer ID.

 

https://docs.ucare.org/filer_public/files/healthlines_2019_dec.pdf

 

 

 

 

So my partner billed hers per visit like normal and was paid so IDK why others are not.

 

 

 

After many failed attempts, we have been paid by billing TOB 322 but with Final lines of service, no occurrence codes, with value codes 61 and 85, with a PDGM HIPPS code and a Q code, and no auth/TAC number.  HOWEVER, the payment amounts are not our contracted rate. But at least the claims are processing, and I can work on the payment rate problem on the back end.

 

 

I have had my claims denied as well(billing like medicare) and was told that there system is not set up yet to handle the PDPM so they will reprocess when the system is ready

 

 

I never did hear any clarification on this. I was told last time they wanted claims billed per visit and that was a misunderstanding. OR did they want HIPPs codes on claims?

 

 

 

Good afternoon.  Has anyone billed and got paid for UCARE MEDICARE (UCARE FOR SENIORS) clients?  If so, are you billing per visit or PDGM (EPISODIC)? My claims are getting denied (PER VISIT) and when I called Ucare they stated that they need to be billed “like Medicare”.  Any information would be greatly appreciated.

 

 

Not very clear what the changes are since we do not bill UCare episodic.

 

 

 

Anyone see this yet? Now it looks like they do have some changes

 

 

Billing Requirements for Medicare Certified Home Health Care and ESRD Providers       Hello Tracy--   Effective Jan. 1, 2020, providers billing Medicare Certified Home Health Care or End-Stage Renal Disease (ESRD) services to UCare must submit claims in accordance with Centers for Medicare & Medicaid Services (CMS) billing guidelines, including all required claim elements. Please refer to the CMS Claims Processing Manual for detail on required elements.    This requirement applies to claims submitted for the following plans: UCare Medicare Plans, UCare Medicare with Fairview & North Memorial (to be renamed UCare Medicare with M Health Fairview & North Memorial in 2020), Minnesota Senior Health Options (MSHO), UCare Connect + Medicare, UCare Individual & Family Plans and UCare Individual & Family Plans with Fairview (to be renamed UCare Individual & Family Plans with M Health Fairview in 2020).      Read the bulletin.   UCare Provider Services Team         Join Our Mailing List Send to a Colleague

 

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