March 2024 Newsletter

BaycarePlus has initiated a NEW provider portal which will require a new username and email even though it is at the same address Provider.BayCarePlus.org

Access to 2023 and prior information can be located at Provider.BayCarePlus2023.org 

utilizing your old log in credentials until 3/31/24. When looking for the member eligibility, do not enter an NPI number as these are not associated with the members eligibility. Select All Providers from the drop down and enter a member's ID or last name and DOB and that will pull up that member. 

BaycarePlus also has a new paper claim address effective 1/1/24 BayCare Health Plans PO Box 30764 Tampa, FL 33630

On November 28, 2023, Kepro held an appeals webinar. At the end of the webinar, there was a question and answer (Q&A) session.

Kepro compiled all the questions from that webinar, and their appeals team has answered them, to assist providers as they navigate the appeals process.

Kepro FAQ

Exclusive Provider Organization Plans (EPO Plans) can be a confusing managed care product. At first glance, you might see PPO but they have no relations to PPOs that offer out of network benefits. So, what is an EPO and how do they impact your admissions or intake of a member? EPO plans have exclusive networks which means that you may be contracted with the managed care organization’s PPO network but NOT necessarily the EPO network EPO networks do not allow for any out of network benefits with out prior arrangements; EPOs operate a very tight network. While individual plan rules may vary, EPOs do not always require authorizations either so your intake team may accept without fully understanding the non-contracted status. This is why the proper validations of benefits for all members is key to financial success. 

The VA Fee Schedule for calendar year (CY) 2024 is now available.  

Medical services, hospital care, and extended care services are reimbursed by VA up to the maximum allowable rate – generally the applicable rate published by Centers for Medicare and Medicaid Services (CMS). When there is no Medicare rate available, VA reimburses the lesser of the VA Fee Schedule or billed charges.   

For the Community Care Network (CCN), when there is no Medicare rate available, the VA Fee Schedule dictates the maximum allowable rate where applicable. In the event neither a Medicare nor VA Fee Schedule rate is available, third-party administrators (TPAs) reimburse a percentage of billed charges. 

VA calculates rates using a combination of VA claims data, Medicare policies and fee schedules, Medicaid fee schedules, TRICARE fee schedules, and industry benchmarking data.  

You can find more information at VA Fee Schedule - Community Care

United Healthcare / UHC is updating their provider portal access – One Healthcare ID sign in process.

‘On March 28, UHC will be removing security questions/answers as sign-in and recovery options. This means all portal users using this method in your organization will need to adjust their One Healthcare ID sign‑in settings to maintain portal access.’ UHC is requiring that providers update their sign in method by March 28^th. 

Additionally, “In summer 2024, we’ll also be removing email as a sign-in and recovery option. Because of this, we encourage all portal users to review and adjust their One Healthcare ID sign-in as soon as possible. If authenticator is not an option for your organization,* we’re working on other solutions to meet your needs. These options will be coming later in 2024. You can find the latest authentication details and resources on our Provider Portal authentication page.”

Portal security processes are continuing to increase for all payers. Please be sure your team members have their own log-in access; the ability to share log-ins is not only heavily discouraged but becoming increasingly difficult.   It is recommended that each provider have at least one individual with administrator access to easily add and remove users from portals.  We recommend at least 2 users with administrator rights to ensure proper management and potential employee turnover.

Exciting news for ARPNs and PAs!  The Florida House unanimously passed Senate Bill 1798 (2024) - The Florida Senate (flsenate.gov) and has referred it to the Senate for approval before it will be then sent to Governor DeSantis for final signature. This bill will enable advanced practice registered nurses (ARPNs) and physician assistants (PAs) to write orders for Medicaid home health services and the associated agency to also receive reimbursement. “HB935 grants APRNs and PAs the Authority to order Medicaid Funded home health care services. This enhances the efficiency and accessibility for home health care services for Medicaid recipients needing home health care but also introduces an innovative solution to address the healthcare workforce shortages particularly in underserved areas facing physician shortages which I consider healthcare deserts….The value proposition is rooted in reducing overhead costs, personalized care plans and heightened patient satisfaction….” Per sponsor Representative Gallop Franklin (D-Tallahassee). 

Medicare CMS Consolidated Billing in SNF

Consolidated Billing under Part A services in a Skilled Nursing Facility can be confusing to providers. It is important to understand how this CMS rule applies to a traditional Medicare Part A patient vs a Medicare Advantage patient. There are multiple articles and MLN publications that review the basics under traditional Medicare but few acknowledge how the impact Medicare Advantage plans.  Medicare Advantage (MA) plans have the flexibility in their contracting with CMS to develop their own networks, billing and payment processes and benefits over and beyond traditional Medicare.  It is important to review your managed care contracts to determine if they apply consolidated billing; note that some have the verbiage in their contracts but still allow for ‘outliers or exclusions’.

CMS has produced several publications regarding Consolidated Billing. This link r12175cp.pdf (cms.gov) provides a list of codes effective October 2023; effective January 8, 2024 is the exclusion of the services of marriage and family therapists and mental health counselors from consolidated billing; see r12283cp.pdf (cms.gov).  

WebTPA has sent out notification that they will be moving to Availity for Eligibility and Benefits, Claim Submissions and Claim Status.

WebTPA Payer ID is 75261

ERAs will not be moving to Availity

If your team works with a WebTPA plan (delegated Third Party Administrator for certain plans such as Self-Funded Employer Groups, Hospital Health Plans and others), they will need to validate their credentials on Availity.

WebTPA

Revenue Cycle Management | Healthcare | Availity