Tag: #reimbursement

Posted in Insurance, My services, Training, Updates

Aetna Better Health of Louisiana (ABHLA)-Specialized Behavioral Health Claims-Reimbursement update

Posted on by KR2Medical Billing

This policy applies to services performed in a facility: HCPCS and CPT codes

Aetna Better Health of Louisiana would like to remind providers that its Behavioral Health Reimbursement policy is aligned with the Louisiana Department of Health’s Medicaid Services. Providers need to check the Provider Manual regarding the proper billing practices for Behavioral Health Services. If the manual requires additional guidance for appropriate reimbursement, the details will be outlined by ABHLA in a supporting reimbursement policy.

To check the compliance with billing practices of the Louisiana Department of Health’s Medicaid Services, Aetna Better Health of Louisiana conducted an internal audit. ABHL found that many of the claims did not have the INDIVIDUAL PROVIDER as RENDERING provider but instead a FACILITY was listed as a rendering provider.

In order to comply with the proper billing and coding for these services, done in a facility setting, please put an INDIVIDUAL RENDERING PROVIDER NPI in the box 24J on the HCFA 1500.

Below are just some codes that might have been paid previously (with a facility NPI):

Claims with the Facility NPI listed as the rendering provider will be denied and paid claims may
be recovered by the health plan. Should you receive denials for this reason, you may rebill your
denied claim(s) as a corrected claim with the Individual Provider NPI listed as rendering for
ABHLA to reprocess and pay the claim(s).

Please note that providers may see reimbursement impacted if not aligned to the Louisiana
Department of Health’s Medicaid services manual within 30 days of the date of this notification.

Below is just a partial list of the Louisiana Department of Health’s Medicaid Services: Behavioral Health Services Fee Schedule:

For a full list of the Fee Schedule, please click here

Posted in Insurance, Training, Updates

Oxford Commercial Plan-E/M Code Reimbursement Policy Revised (non-physicians)-12/01/2020

Posted on by KR2Medical Billing

Effective 12/01/2020-Oxford Commercial Plan has revised their E/M code reimbursement policy for Non Physician providers.

The policy expanded the Non-Physician Providers List that are not allowed to report E/M codes. Please see the partial list below:

Definitions: Physician- MD or DO

Guidelines as per Oxford: Only Physicians and other qualified healthcare professionals are allowed to bill E/M codes. These other qualified healthcare professionals include: “nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM) and physician assistants (PA), none of which are considered non physician health care professionals for purposes of this policy”.

Oxford will not reimburse E/M services (CPT codes 99091, 99201-99499) when reported by nonphysician health care professionals reporting under their own individual or group tax identification number (TIN).

According to the Oxford Policy- non physicians should use HCPCS ot/and CPT codes that correspond to the services that were performed (the most comprehensive CPT code that describes the services performed- as written by CMS).

To see the whole list of Non-physicians that this policy applies too, please click here.

#Oxford #EvaluationandManagment #E/M CPT codes #UHC

Posted in Training, Updates

Aetna Better Health of Louisiana- Pain Management Program Update

Posted on by KR2Medical Billing

According to their update published in August 2020, the following changes are going to take place.

Effective 09/15/2020, Aetna Better Health of Louisiana will no longer use eviCore to process their prior authorizations for Pain Management. Instead the Authorization requests will be processed directly by the Aetna Better Health of Louisiana.

Below is the partial list of those codes (except those with * or **)

 * — no prior authorization required

 ** — no prior authorization required, effective 9/1/2020

Please click here to visit the COMPLETE LIST OF THE CODES. (link)

P062010 Pain Management Program Changes

There are several options to request an authorization:

  • use ABHLA’s 24/7 Secure Provider Web Portal.
  • fax the request to 1-844-227-9205, using the Prior Authorization Form. Use a cover sheet with the practice’s correct phone and fax numbers to safeguard the member’s protected health information and to facilitate processing.
  • call our toll-free number: 1-855-242-0802

Reimbursement :  “Please note that providers may see reimbursement impacted if not aligned to the Louisiana Department of Health’s Medicaid services manual within 30 days of the date of this notification.”

Additional Information:

Questions and Support:
For questions, please contact LAProvider@AETNA.com or call 1-855-242-0802 and follow the prompts