There will be no immediate impact to health care providers who do business with Mayo Clinic Health Solutions. 

• Providers can continue to file claims, access Online Services for Providers, and call Customer Service as usual. 
• The acquisition is expected to be complete by the end of 2017, at which point agreements for current TPA clients will transition to Medica. However, there will be no administrative platform changes in 2017.
• Mayo Clinic Health Solutions staff will continue to support providers, clients and members as usual, using current systems and tools, until Medica is anticipated to assume full operational responsibility in 2019.

More information about this change will be shared, as it is available.

The purpose of this mailing was to ensure all contracted providers have up-do-date information on file with Mayo Clinic Health Solutions, such as tax ID number and facility names. We use this information to populate the provider search tools that members use to find in-network providers which, in turn, drives business to your practice. 

If you have any questions about completing the Provider Validation form, please contact us at RSTHealthSolutionsCredentialing@mayo.edu.

1. For stroke, remember to document the type, vessel affected (including laterality), and any immediate effects of the stroke. 
2. If a patient has residual effects after the initial acute care episode (hospitalization), such as hemiplegia or dysphagia, all deficits should be coded to “sequelae” of stroke.
3. Sequelae may occur any time after the onset of the stroke.
4. If a patient recovers from a stroke with no residual deficits, please report history of stroke. 
5. The classifications used presume a causal relationship between hypertension and heart involvement, and between hypertension and kidney involvement. The two conditions are linked by the term “with” in the alphabetic index. 
6. High blood pressure and stroke should be coded as related, unless the documentation clearly states that the conditions are not related. 
7. Use the following codes for stroke and hypertension:

Stroke

I63.	Cerebral infarction
I69.3	Sequelae of cerebral infarction
G45.9	Transient cerebral ischemic attack, unspecified
Z86.73	Personal history of transient ischemic attack (TIA) and cerebral infarction without residual deficits

 

Hypertension

I10.	Essential (primary) hypertension
I11.	Hypertensive heart disease, use additional code to identify type of heart failure (I50.-)
I12	Hypertensive chronic kidney disease, use additional code to identify the stage of chronic kidney disease (N18.1 - N18.9)
I13	Hypertensive heart and chronic kidney disease, use additional code to identify type of heart failure (I50.-), use additional code to identify the stage of chronic kidney disease (N18.1 - N18.9)
Z99.2	Dependence on renal dialysis

For the first time, Mayo Clinic in Arizona has also been named to the honor roll, coming in at No. 20. Mayo Clinic has ranked at or near the top of the Honor Roll hospitals throughout the history of the U.S. News & World Report Best Hospitals.

Mayo Clinic Global Business Solutions extends the same commitment to quality through the products and services we support. Thank you for the opportunity to serve you.

Taxonomy Code Requirements Now in Effect for Claims Payment 
Starting March 1, 2017, professional and facility claims will reject if billing and rendering or attending taxonomy is not properly reported. When providers submit National Provider Identifiers (NPIs) anywhere on a claim, the corresponding taxonomy must also be submitted. 

• Provider types that do not submit NPIs do not need to submit taxonomy on claims to UCare. 
• The taxonomy codes submitted must be registered with the corresponding NPI in the Centers for Medicare & Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES), and the codes must closely align with the services being provided. 
• It is important that providers regularly verify and update their enumeration with CMS. Please confirm the taxonomies linked to your CMS enumeration are up to date and accurately reflect the provider specialties billed under each NPI. 
• Rejected claims will be reported to providers by their clearinghouses on acknowledgement of 277CA reports. These reports indicate if a claim was accepted into or rejected from UCare’s claim payment system. The report also indicates why a claim was rejected. 

When a claim is rejected due to taxonomy not being properly reported, a provider may see the rejection or error category of A6 (the claim or encounter is missing the information specified in the status details and has been rejected) and error code 145 (entity’s specialty/taxonomy code). To avoid payment delays on these claims, add taxonomy to the claim and resubmit it to UCare.

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UCare Replaces Modifier for Submitting Separately Payable Laboratory Tests for State Public Program Members 
Effective March 1, 2017, modifier "-59" must be appended to outpatient claims for laboratory services for UCare’s State Public Programs. This indicates that these are the only services submitted on the claim and are eligible for separate payment. Please do not use modifier "–L1." If the "-59" modifier is not appended to stand-alone laboratory services, the service line will pay at zero. 

Modifier "-59" must be appended to laboratory services in this situation only. Previously, separately payable laboratory services were identified by the "-L1" modifier. The "-L1" modifier is no longer a valid modifier as of January 1, 2017.

UCare State Public Programs include: PMAP, MSC+, MinnesotaCare and Special Needs BasicCare (SNBC) and UCare Connect. 

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New Provider Appeal Process and Form 
UCare implemented a new formal provider appeal process April 1, 2017. When a provider requests an adjustment, recoupment or appeal on a claim, the provider should complete the new Universal Claim Reconsideration Request Form and submit it to UCare, along with additional documentation to support the appeal request. 

• Providers must use the new form for appeals, adjustment and recoupment requests effective April 1, 2017. The previous Adjustment/Recoupment Request Form is no longer accepted.  
• If the previous form is submitted to UCare after April 1, 2017, it will be returned immediately to the provider. No action will be taken on the request until the new Claim Reconsideration Request Form is submitted. 

UCare will review claim appeal requests upon receipt and a determination will be made within 60 calendar days. After review, providers will receive a written notice of appeal determination. For more detailed information regarding the provider appeal process, please refer to the UCare Provider Manual, Claim Adjustments section.

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Non-Credentialed Provider Type Updates
Effective April 1, 2017, UCare Minnesota is no longer accepting any add, change or termination notifications for non‐credentialed provider types for groups contracted through Mayo Clinic Health Solutions. To ensure timely claims processing, this information must be submitted directly to Mayo Clinic Health Solutions within 30 days of the change effective date. Submit completed change forms by fax, email or mail to the attention of the Mayo Clinic Health Solutions Credentialing Unit.

The following types of providers must submit change notifications using the Minnesota Uniform Practitioner Change Form:

• Audiologists
• Occupational Therapists (OTs)
• Personal Care Assistants (PCAs)
• Physical Therapists (PTs)
• Registered Dieticians (RDs)
• Speech Language Pathologists (SLPs)

Taxonomy Code Requirements Effective August 1, 2017 
Taxonomy codes are required on all professional and facility claims submitted to South Country Health Alliance when a National Provider Identifier (NPI) is submitted on the claim. Claims will be denied if the taxonomy is not properly reported on claims sent to South Country Health Alliance with a date of service August 1, 2017, or after. 

To avoid payment delays, please add taxonomy codes to the claim and resubmit it to South Country Health Alliance. Refer to the National Uniform Claim Com¬mittee (NUCC) for guidance on where taxonomy should be reported on paper and electronic claims. 

The corresponding taxonomy code must be reported on a claim whenever a NPI is submitted. Provider types, such as transportation, interpreters, and personal care assistants (PCAs)—which are not required to be assigned NPIs—do not need to submit taxonomy on claims. The taxonomy for the billing and rendering or attending provider must be submitted when the billing and rendering NPI are submitted.

Since a provider can have more than one taxonomy code, it is important to use the specific taxonomy code representing the specialty when filing claims. Claims submitted without taxonomy codes will be denied. 

Providers can verify the primary and other taxonomy codes that are registered for their NPI(s) on the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) web site. Providers should confirm the taxonomies linked to their CMS enumeration are up-to-date and accurately reflect the provider specialties billed under each NPI.

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Important Information for RideConnect Transportation Providers 
You may have noticed a change in the way SCHA identifies transportation services for members: 

• Special Transportation Services (STS) will now be identified as Assisted Transportation. 
• Access Transportation Services (ATS) will be identified as Unassisted Transportation. 

To identify members who have been approved for Assisted Transportation, make sure you are set up as a Super User with Mayo Clinic Health Solutions and review the member eligibility record using tools available through Online Services for Providers. 

The South Country Provider Manual, Chapter 27 “RideConnect Non-Emergency Medical Transportation Services,” is available to transportation providers. It is important that you follow the directives outlined in the manual. Your billing staff should review pages 4 and 5 of the chapter for information on coding as well as reviewing the Fee Schedule with your Participation Agreement. 

Reminder: The HCPCS Origin/Destination Codes need to be submitted on the claim in addition to any other modifiers you are identifying on your claim. These modifiers are required for certain services on your claim to properly adjudicate.

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Claim Reconsideration Form 
South Country Health Alliance has updated its Claim Reconsideration Form. This form can be found on the SCHA Provider Forms page. The Claim Reconsideration Form should be used whenever you have a claim that needs to be reconsidered for payment. Upon completion, the form should be submitted to Mayo Clinic Health Solutions using the instructions at the top of the form. Do not submit this form directly to South Country Health Alliance. If you do, your form will be returned to you and you will be asked to follow the process outlined above. 

It is important that complete and detailed documentation is provided to support your request to review your claim. If documentation is not provided, your claim will not be reconsidered for payment, and the previous determination will be upheld. 

Questions about the Claim Reconsideration Form may be directed to South Country Provider Services at 1-800-995-4543.