Medicaid Re-validation, Amerigroup authorizations,and more

Thought I would touch base with everyone on some changes going on in the wonderful insurance world. Most of you know these already, but please read the following as a refresher as well.

Medicaid is requesting providers who have been in the system for awhile re‐validate their Medicaid application information. If your application is new, meaning within the past year, you will get an error stating "The revalidation application is not available to this provider at this time" if you do not need to do so.

Log into the web portal: http://www.mmis.georgia.gov

Select the Providers tab, then Provider Revalidation.

Follow the steps by answering and making sure that the information they have on file is correct.

Make sure you put a contact person's name on the first page that can answer any of the questions about the application they might have

Make sure both servicing address and mailing address is correct on the second page. IF YOU NEED TO CHANGE YOUR ADDRESS FOR A SECOND LOCATION, THIS IS NOT THE PLACE TO DO THIS. ONLY CHANGE IF YOU HAVE ONE LOCATION. Documentation will have to be submitted if change address information. Once the application questions have been completed, make sure you save the pop up pdf document created, print, sign, and mail to the following:

HP Provider Enrollment Unit 

Attn: MEDICAID REVALIDATION

PO Box 105201

Tucker, GA 30085‐5201

Amerigroup and Availity

Like BCBS, Humana, Aetna and so on, Amerigroup has joined partnership with McKesson's web site called Availity.com

As most of you know, to obtain authorization from Amerigroup, you must either fax in a request or upload the request to Amerigroup via Availity.com

If you are not a participating Amerigroup provider and have a patient that is a member of AG, you can request an authorization via fax to Amerigroup AS LONG AS YOU ARE ATTEMPTING TO GET INTO NETWORK WITH AMERIGROUP. This option should not be used for more than 6 months while trying to contract.

To request an auth, you must include the following:

IFSP OR IEP OR IF NEITHER ATTACH AN ATTESTATION FORM

1 MONTH WORTH OF NOTES, 2 MONTHS IS NICER if a continuing patient

TX PLAN/WSP/POC WITH TEST RESULTS WITHIN THE PAST 6 MONTHS

Make sure to contact Amerigroup in about a week after sending the request at 800‐454‐3730!!!

IF YOU ARE IN NETWORK, I recommend using Availity instead. There is a much faster turn around time with the online requests, often back within a week.

To request an authorization via Avality:

Once logged in, select Auths and Referrals, then Authorizations

Select Amerigroup as the payer, this will take you into the Amerigroup web site.

Select For General Services

(this is also where you can check on any authorizations that are pending under Check Status)

Select General Services again

Select outpatient

Authorization start date (this can be selected for a week back (doesn't always work))

Authorization end date (I usually put the end of the tx plan's month(example: tx plan ends 2/15/15, then I enter 2/28/15)

Place of service: 11 or 12 for Home

Member ID: Medicaid ID can be used here, then Find member

Next page, select provider

Provide a contact name (this can be anyone that can talk about the auth request)

Referring provider (pediatrician, pcp)

Servicing provider: select the name of the provider that will servicing the patient

Enter diag code and select add code. Multiple codes can be added here one at a time

Additional Details: R‐Rehab Other

Procedure Code, add code, input the number of units (example speech therapy would be 52 for 2x per week), add procedure code

Notes: THIS IS AN IMPORTANT ENTRY. Make sure you put in detail what you are uploading, how many visits you will be seeing the child per week, if you are seeing a child under an IFSP, IEP or attestation, or if the child has an IFSP but you are NOT a BCW provider. Give as much detail information here as possible.

Next page will give you the opportunity to upload documents. This is what is required:

For a new patient:

Tx plan/Evaluation with standard scores within the past 6 months, signed and dated by both therapist and doctor

IFSP, IEP, or attestation

Rx

If speech therapy is being requested: hearing screen

For a patient who already has received an authorization before:

Tx plan/Evaluation with standard scores within the past 6 months signed and dated by both therapist and doctor

IFSP, IEP, or attestation

If speech therapy is being requested: hearing screen

Notes for one to two months

The next page lets you review anything you have entered for the request. You can submit at the bottom of the page and then print the submitted confirmation.

Other

Remember to always check benefits. I've noticed BCBS denying services lately for autism and other common diagnosis codes that normally use to pay. Make sure when checking benefits that you ask if developmental delay or autism is a covered diagnosis code.

Speech therapists: your license will renew in March next year, make sure you will have enough continue education credits by this time

With the new year approaching, make sure you prepare to update all client information by having all

patients fill out a new patient information form. Most patients will receive their new insurance cards in January, and it's the best time to make sure you've got correct phone and address information on file. Remember you need to have an actual copy of their insurance card and parent's photo ID on file. It's also a good idea to request new Rx from their PCPs so that you can have an updated copy on file.

Medicaid, Peachstate, Amerigroup and Wellcare are making claims have the referring physician and their NPIs on all claims. This referring physician must be a Medicaid provider to be able to have the claims paid. Make sure the child has a pediatrician that is a Medicaid provider when requesting an RX. Only an RX from the patient's PCP (in most cases pediatrician) can be a valid referral, no specialists can be used

And as usual, if you have any information you would like for me to pass along I haven't mention, please email me! Any useful information or corrections are more than welcomed in this hectic billing world.