Tag: #ambulance

Posted in #reimbursement, #unitedhealthcare, Payer Updates, Training, Updates

UHC Minnesota Community Plan: non-emergency transport

Posted on by KR2Medical Billing

Effective immediately, UHC is going to process claims and payment for all non-emergency transportation services for Community Health Plans of Minnesota.

The following HCPCS codes are affected:

HCPCS code A0428: Ambulance service, basic life support, non-emergency transport

HCPCS code A0130: Non-emergency transportation: wheelchair van

This change applies to the following plans:

  • UnitedHealthcare® Families and Children Medical Assistance (PMAP)
  • MinnesotaCare
  • Minnesota Senior Health Options (MSHO)
  • Minnesota Senior Care Plus (MSC+)
  • Special Needs Basic Care (SNBC) plans

Providers please submit your claims directly to the UHC  Community Plan instead of submitting them to MTM Inc.

Any previousely unpaid claims that were submitted to MTM Inc. on DOS 7/1/22 and thereafter can be resubmitted to UHC Community HealthPlan directly Oct 1,2024. Timely filling will be waived for these 2 particular codes.

Submitting claims:

Using UHC EDI or UHC portal.

For any further questions, providers can chat with UHC 7 a.m.–7 p.m. CT, Monday–Friday from the UnitedHealthcare Provider Portal.open_in_new For additional contact information, visit UHC Contact us page.

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Posted in Insurance, Training, Updates

Anthem Medi-Cal: Hospital Reimbursement Policy Update- 05/01/21

Posted on by KR2Medical Billing

Currently Anthem Medi-Cal reimburses for services for a covered member prior to admission to an inpatient hospital (referred to as the payment window) unless provider, state, federal or CMS contracts and/or requirements indicate otherwise.

However, Emergency and observation services are included in the inpatient reimbursement and, therefore, are not separately reimbursable expenses when performed within 24 hours prior to and including the day of the member’s admission.

Effective 05/01/21- Anthem Medi-Cal the following changes will take effect:

  1. For admitting hospitals: preadmission services are included in the inpatient reimbursement for the three days prior to and including the day of the member’s admission. Therefore, they are not separately reimbursable expenses.
  2. Anthem will not consider the following services to be included in the payment window prior to an inpatient stay for preadmission services:
  • Ambulance services
  • Maintenance renal dialysis services
  • Services provided by:
    • Skilled nursing facilities
    • Home health agencies
    • Hospices
  • Unrelated non-diagnostic services

If you have more information please visit:  https://mediproviders.anthem.com/ca. and review Preadmission Services for Inpatient Stays reimbursement policy