April 24 2014 Member Identification Card 2 Member Access Member access to any PCPSpecialist in network No referral necessary Dont have to see PCP on card Member can call Member Services to update their card ID: 463230
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Slide1
AAHAM
April 24, 2014Slide2
Member Identification Card2Slide3
Member AccessMember access to any PCP/Specialist in networkNo referral necessaryDon’t have to see PCP on card
Member can call Member Services to update their card
866-935-6760
No copays
Arbor Health Plan does not charge copays for any service
3Slide4
Additional member benefits
Arbor Health Plan provides
additional
benefits to members:
Adult Preventive Visits
24/7/365 Nurse Call Line
Rapid Response and Outreach Team
Diaper Reward Program
Parenting and Lamaze Classes
Breast Pump Purchases – effective November, 2013YMCA 90 Day Membership (select locations)Community Baby Shower
4Slide5
Prenatal CareMCOs responsible for newborns effective 2/1/14.Once DHHS is notified of birth, newborn is retroactively enrolled in Managed Care the first of the month of the notificationObstetrical
Needs Assessment Form (ONAF)
Receive $100 for
completing form
Receive additional $300 if certain criteria are met
Available on our
website
OB Billing Guide
Prenatal care billed on separate lines for each DOS
Progesterone (J1725 & J1725TH) covered.5Slide6
Recent Changes/Updates Enhanced Obstetrical Needs Assessment Form (ONAF) Payments
Effective 4/1/2014:
Additional payment of $300 is automatically issued for meeting ALL following requirements:
Completed ONAF submitted to Arbor within two weeks of Arbor member’s first visit
First visit occurs in first trimester or within 42 days of member’s Arbor membership
Infant is term and not an elective delivery prior to 39 weeks gestation
Post-partum visit within 21 to 56 days after delivery
6Slide7
Recent Changes/Updates continuedEarly Periodic Screening , Diagnosis, & Treatment (EPSDT)
DX
Code
V20.0
– V20.3
are
allowed for CPT’s 99381-99384 and 99391 - 99394.
DX
Codes V70.0 – V70.3 and V72.31
are allowed when billing CPT’s 99381-99384 and 99391 – 99394Referral indicator codes MUST be included on claims using CPT well-child preventive codes 99381-99395 with the required EP modifier. (Electronic 837P or CMS 1500 box 24H). 7Slide8
Recent Changes/Updates continuedEnhanced PCP payments currently being madeFee schedule updates will match Nebraska Medicaid effective dates.
Individual provider and facility rate updates will still be delayed 30 days
PT/OT/ST no longer require authorization effective 1/1/14.
Held to visit count limitation observed by Nebraska Medicaid
Quad screen (81511) added as a covered service.
8Slide9
Recent Changes/Updates continuedNew CMS 1500 Form must be submitted.Complete transition to new form effective 4/1/14.
ICD-10 has been delayed until 10/1/15.
P
roviders will be able to test ICD-10 claims with us, when the time comes.
9Slide10
RemindersTimely filing is 365 days from DOSAppeals/Resubmissions/Corrections within 90 days of original remitDO NOT send claims or corrections to Omaha office
COB claims must be submitted within 365 days of DOS or 60 days from primary EOB generation, whichever is longer.
When submitting with an invoice, item must be easily identifiable by code on the invoice.
Routine and medical
v
ision claims submitted to
Avesis
(anesthesia and facility fees for vision services submitted to Arbor).
10Slide11
CredentialingProvider must be enrolled with Nebraska Medicaid at practice locationEnrollment Center – 877-255-3092http://dhhs.ne.gov/medicaid/Pages/med_providerenrollment.aspx
Credential via:
CAQH
Arbor Health Plan’s Full Credentialing Application
Providers credentialed with Blue Cross Blue Shield of Nebraska are granted automatic approval
Contact your Account Executive with questions
11Slide12
NaviNetNaviNet Web Portal: www.navinet.net Phone: 888.482.8057
View
Member Eligibility
Member
Rosters
View
Third Party Liability Information (TPL)
Claims
Status &
UpdatesView/Print Remittance Advices Prior Authorization RequestsGaps in Care Report12Slide13
Provider UpdatesArbor Website www.arborhealthplan.comProvider Handbook – available online
Annual Provider
Newsletter
Arbor
Webkey
Mouse
List-serve in development
Watch website for updates
13Slide14
Electronic Data Interchange (EDI)To transmit claims electronically, contact your EDI software vendor and provide
Arbor Health Plan payer ID # 52312
Arrange electronic claims submission through your EDI vendor or through
Emdeon
at 877-363-3666
Electronic
Funds Transfer (EFT
) 866-506-2830
Simplifies
the payment process by providing fast, easy and secure payments Reducing paper Eliminating checks lost in the mail Not requiring a change to your preferred banking partner Enroll through our EFT partner, Emdeon Business Services or sign up via our fast and easy links on www.arborhealthplan.comElectronic Remittance Advice (ERA
) 877-363-3666
14Slide15
Provider Network ManagementAdam Steffen, Director Provider Network Managementasteffen@arborhealthplan.com
Jessica Wykert, PNM, Account Executive – Western Nebraska
jwykert@arborhealthplan.com
Cathy Bojanski,
PNM Account Executive –
Northeast
Neb
raska
cbojanski@arborhealthplan.comKami Hudson, PNM Account Executive – Southeast Nebraskakhudson@arborhealthplan.com15Slide16