Hello!

I received a response from our U-Care Rep, it is below in red.  Fingers crossed this goes well 😊

1. Ucare – Care Core M Fairview Program claims denied for: a. Value code 61 & value code 85 = Medicare value codes This appears to refer to specific events which have already happened. Nothing for the HHA Pricer project has been put into production yet, so this is not related to the bulletin for 1/1/2023.  Please refer to the Provider Assistance Center for specific claims inquiries.

b. Bill Type 323 invalid = want 322 NOA/327/328/329 Final;  This appears to refer to specific events which have already happened. Nothing for the HHA Pricer project has been put into production yet, so this is not related to the bulletin for 1/1/2023.   Please refer to the Provider Assistance Center for specific claims inquiries.

c. Does this mean this program needs to be billed CMS/NOA/Episodic? Per the CMS Claims Processing Manual, UCare is accepting claims submitted for an NOA. We are not applying a penalty at this time for providers that are contracted under a methodology other than CMS Home Health PPS.

2. Clarification around bulletin 11/14/22 stating U-Care is now “following CMS guidelines”.  Specifically are NOAs required?  If yes, what plans? Are there financial penalties to late NOAs?  Do they want 30 day billing periods?  Monthly claims?  Are you accepting TOB 32A? Per the CMS Claims Processing Manual, UCare is accepting claims submitted for an NOA. We are not applying a penalty at this time for providers that are contracted under a methodology other than CMS Home Health PPS.

3. Does this change override providers who are contracted to bill monthly visits?  (FFS) If we do, which plans are impacted?  Is it by group numbers?  Is it by name which we would have to find from the U-Care portal?  Following PDGM/CMS requiring 322/329?  Assuming HIPPS code required? For 2023 we will require all providers to bill using the CMS billing requirements. We ask that you reference the CMS Claims Processing Manual (Chapter 10), Medicare MLN and the Federal Register.  This covers use of HHRGS, HIPPS, TOB, Billing Periods and all other requirements.

4. As of 1/1/23 – is PDGM/CMS/NOA/Episodic billing required?  When calling were told to refer to chapter 10 Medicare billing manual but that hasn’t applied to providers who have a contract that is FFS.  Is that going away?  For 2023 we will require all providers to bill using the CMS billing requirements. We ask that you reference the CMS Claims Processing Manual (Chapter 10), Medicare MLN and the Federal Register.  This covers use of HHRGS, HIPPS, TOB, Billing Periods and all other requirements.

5. Is it required of all Medicare advantage plans? Yes, please reference the provider bulletin as applicable products are noted.

6. Contact has been billing using Medicare methodology but being reimbursed as FFS.  This week 12/8 first time it was reimbursed and paid like Medicare, not FFS.  Is U-Care now reimbursing at the Medicare HIPPS rates? This appears to refer to specific events which have already happened. Nothing for the HHA Pricer project has been put into production yet, so this is not related to the bulletin for 1/1/2023.   Please refer to the Provider Assistance Center for specific claims inquiries.

Jaime Kummer | Administrator | River Valley Home Care Inc.

916 8th Street Farmington, MN 55024

Phone: 651-460-4201 Fax: 651-460-4208

Email: jkummer@rvhci.com