United HealthcareInformational Session

Thursday, April 26, 2018

1:00pm

Call Summary

Presenter:Christopher M Bowlby, United Healthcare (UHC) Provider Service Department Manager

Center Attendance:

  1. Packard Health
  2. The Wellness Plan Health Center
  3. Intercare Health Center
  4. Baldwin Family Health Center
  5. Alcona Health Center
  6. Grace Health Center
  7. Western Wayne Health Center
  8. Centers for Family Health
  9. Family Health Center of Kalamazoo
  10. Oakland Integrated Health Network
  11. Muskegon Family Care

If you joined after roll call, please send an email to Charmaine to record your center’s attendance.

Reimbursement Strategies

  • PPS Rate, Contract Rate, GCode Line, etc.
  • UHC has adopted the reimbursement screen per MDHHS
  • Initially, there were issues with the REV code, but has now been corrected
  • Per diem rate covers the bulk of services
  • There are still carved out services that will receive the FFS rate (OB for example)

Status of Outstanding Claims

  • Denied or paid at $0
  • Chris recommends the centers become engaged with LINK via UHCswebsite to assist with reviewing claims and status, reconsiderations, upload attachment when resubmitting for processing
  • UHC website and tools also allow CHCs to verify benefits, COB’s, pre-check formularies, and verify center demographics
  • UHC also has its own YouTube channel for additional resources
  • There will be a Michigan specific video available soon
  • Chris also offered to connect centers with an advocate to assist in claims resolution
  • Centers are encouraged to connect with Chris on outstanding issues, please see contact information under the presenter bullet
  • Policy for submitting claims for reprocessing
  • 12 month timely filing allowance for reprocessing claims
  • Appeal timeframe will vary
  • Medicaid is usually6 months from denial date
  • Commercial is 365 days from denialdate
  • For reconsideration, this request can now all be processed online
  • You can request review through the reconsideration process
  • Request will receive full clinical review
  • List of UHC Service Links
  • Claims andPayments
  • Eligibility and Benefits
  • Link Self-Service Tools
  • Prior Authorization and Notification
  • Referrals
  • Reports and Quality Programs

CHAMPS Data

  • Process for resolving missing data
  • CHAMPS data will not be uploaded if Provider is not enrolled in CHAMPS (for new Providers)
  • MDHHS has postponed in moving forward on this policy, State has a large backlog and will notify UHC once updated
  • Please review MDHHS Biller Beware announcement below as a resource for this discussion topic
  • February 23, 2018: Attention ALL Providers:
  • The Michigan Department of Health and Human Services (MDHHS) requirement of Managed Care Organization (MCO) typical providers needing to be enrolled in CHAMPS by March 1, 2018, has been delayed. Additional communication will be issued when a date has been finalized. We continue to encourage all typical rendering, referring, ordering, prescribing and attending MCO providers to enroll in CHAMPS. As at a future date, MDHHS will prohibit MCOs from making payments to all typical non enrolled providers.
  • Enrollment in CHAMPS neither requires nor mandates those providers who are part of a managed care network to accept Fee-for-Service Medicaid beneficiaries. Enrollment in CHAMPS is solely used for the purpose of screening providers participating in Medicaid.

Policy Updates

  • None noted during the call

CHC Questions

  1. Claim denied for primary Substance Abuse diagnosis as provided by a Primary Care Provider

for example, providing Vivitrol with opioid use as the primary dx

  • UHC is currently working on this error, the problem is Substance Abuse is carved out for MHP, when the claims were received after moving to the UB Format, UHC was not prepared
  • As of 4/10, UHC reached out to MDHHS for clarification and awaiting a response;

UHC will reprocess the claim if they are responsible or if not, will send a notice out on next steps to all CHCs; please remember to review the Provider Portal for updates and policies

  1. Denials for Med/BH and/or not being paid for the BH portion; one center reports using the modifier but only being paid on the medial portion
  2. Chris stated both should be paid and would like examples sent for review
  3. Chris recommended attaching Modifier -25 on the claim

Resources:

  • LINK Online Tool:
  • Centers are encouraged to submit question via UHC’s Self-service portal, this will allow UHC to build an FAQ and trainings that are FQHC specific
  • There is an opportunity to enter CPT codes that will list all policy requirements and coverage details, to include PA
  • You can status claims, request reconsideration, etc.; this system was put in place to reduce lengthy hold times. There is also an online helpdesk to route callers to the right person/department
  • There is also the EDI and clearinghouse options, you are able to use your internal system to communicate with UHC directly; you can learn more information by speaking with your UHC Advocate, Chris or send an inquiry to Charmaine to connect you with the right person
  • VisitUHCs Provider Portal to receive network bulletins
  • Bulletins are released the first week of every month that lists new policies and updates occurring in MI