A list of all articles in the December issue is displayed under In This Issue in the right hand menu. An archive of past issues will soon be available under Archive. In the meantime, you can continue to access old issues of this newsletter on the previous eUpdate for Providers website.

We welcome your feedback on this newsletter as well as your suggestions for future articles. Please contact Provider Services at healthsolutionsprovserv@mayo.edu with any feedback, or if others at your organization would like to subscribe to our newsletter email announcements.

For additional ICD-10 information and guidance, please review our ICD-10 FAQ

Three important things you should know about this transition:

1. The official name of our Pharmacy Benefits Manager continues to be Mayo Clinic Health Solutions. When submitting an electronic prior authorization through Cover My Meds, select “Mayo Clinic Health Solutions," do not select “OptumRx” or “Catamaran.”
2. This change will not affect member benefits in any way. 
3. Members can continue to use their current health plan member ID cards with the Catamaran logo. The processing information listed on the cards that pharmacies require to fill prescriptions will not change. New member ID cards issued after January 1, 2016, will include the new OptumRx logo in place of the Catamaran logo.

The new PET scan prior authorization process requires providers or their delegates to complete the Authorization Request Medical/Surgical Services form found on the Provider Forms page at www.MayoClinicHealthSolutions.com. Fax the completed form to 1-888-889-7822.  Denials of coverage of services may be issued based on medical necessity and/or appropriateness determinations.  

Questions about this new requirement may be directed to Customer Service at the phone number on the back of the member’s ID card.

When you sign in to the Online Service Center, you can also access our Quick Reference Guide, which contains important plan-specific information, such as Customer Service phone numbers and samples of member ID cards. Each card image includes claims submission addresses and payer ID information. The Quick Reference Guide is available on the Support tab under Tutorials.

Please note: To sign in to Online Services for Providers, you must be a registered Super User or End User for your facility. To sign up for Super User access, please complete and submit the Super User Request Fax form.  

 

Provider Manual Updated
Our Provider Manual was recently updated. Providers are encouraged to bookmark the manual for easy access and to review it for information regarding claim submission, credentialing and contracting, and prior authorizations for our commercial plans. The Provider Manual is posted on the Provider Forms page at www.MayoClinicHealthSolutions.com.

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Managed Care Referral Request Form Revised
The Managed Care Referral Request form has been updated and is available on the Provider Forms page at www.MayoClinicHealthSolutions.com. The updated form now includes fields for National Provider Identifier (NPI). Please begin using this new form and discard any copies you may have of the old form.

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Three Important Tips for Submitting Forms
Please keep these tips in mind to ensure your forms are submitted correctly:

1. Chemical Dependency admission forms should not be submitted to Mayo Clinic Health Solutions until the member has been admitted.
2. South Country Health Alliance (SCHA) Chemical Dependency and Mental Health Authorization forms are posted on the SCHA website. Links to these SCHA forms are also available on our Provider Forms page at www.MayoClinicHealthSolutions.com in the Authorization/Referral section under Behavioral Health.
3. The Facility Change/Update form should be faxed to Mayo Clinic Health Solutions at least 30 days prior to the effective date of the facility change. Without proper notification, new facility locations may be considered out-of-network, or your provider agreement may become null and void.  

Please visit our Provider Forms page at www.MayoClinicHealthSolutions.com for the most current provider forms.

 

UCare No Longer Contracting with DHS for Prepaid Medical Assistance Program or MinnesotaCare, Except Olmsted County

As you may know, the Minnesota Department of Human Services (DHS) announced its intent not to contract with UCare for Prepaid Medical Assistance Program (PMAP) or MinnesotaCare in all Minnesota counties, except Olmsted County, beginning January 2016.
UCare will continue to offer the following products in 2016:

• Minnesota Senior Health Options (MSHO) – Integrates Medical Assistance and Medicare services and payments for people age 65 and older.
• Minnesota Senior Care Plus (MSC+) – For people eligible for Medical Assistance age 65 and older.
• UCare Connect (Special Needs BasicCare (SNBC)) – For adults with certified disabilities (physical and/or mental illness, certified by state or federal government) ages 18-64 (may remain in SNBC when they turn 65).
• UCare for Seniors (UFS) – Medicare Advantage products for people eligible for Medicare.

UCare will continue to be a MinnesotaCare and PMAP health plan option for residents in Olmsted County in 2016. For more information, visit www.ucare.org.

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UCare Authorization Requests Must Contain Valid ICD-10 Diagnosis Codes

All prior authorization requests for dates of service on or after October 1, 2015, must contain valid ICD-10 diagnosis codes. Providers submitting prior authorization requests with ICD-9 codes for dates of service after October 1, 2015, will receive the following faxed response:

Your request for authorization has not been accepted and is being sent back for completion.

• All requests for authorization for dates of service on or after October 1, 2015, must include a valid ICD-10 diagnosis code.
• Please review the request and resubmit with a valid ICD-10 diagnosis code.
• We can no longer accept authorization requests without a valid ICD-10 diagnosis code for dates of service on or after October 1, 2015.
• Please review past provider communications from August, September, and October on the UCare Provider website for ICD-10 implementation information and news.
• If you have any questions, please contact UCare Provider Assistance Center at 612-676-3300.

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Updates to UCare’s ANSI Code Grid Effective October 5, 2015

UCare updated the ANSI Code Grid that identifies what codes will be reported on UCare Explanations of Payment (EOPs) when processing claims from Federally Qualified Health Centers (FQHC) and Rural Health Clinic (RHC) providers under the Payment Carve-out process. The grid contains various FQHC/RHC claim status scenarios. 

What has changed in the grid? UCare previously distributed a bulletin on March 3, 2015, in which the ANSI Code Grid had only one scenario for “Voided Claim.” The updated grid now includes a second “Void Claim” scenario. The difference between the two scenarios is who initiated the void – UCare or the provider. In addition to the new void claim scenario, UCare has updated the scenario descriptions clarifying each for better understanding. 

Effective October 5, 2015, the claim adjustment reason codes and remittance advice remark codes/descriptions shown in the grid will be used for Provider-initiated claim voids.

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Medicare Opt Out Process for SCHA Providers 
No payment will be made directly or indirectly by SCHA for Medicare covered services furnished to a Medicare beneficiary by a physician or practitioner who has opted out of Medicare, except for emergency or urgent care services furnished to a beneficiary who has not previously entered into a private contract with the physician or practitioner. This does not apply to provider types that are not eligible to participate in Medicare. 

Providers choosing to opt out of Medicare need to file a written affidavit with Medicare. Providers must sign private contracts with all Medicare beneficiaries to whom they furnish services that would otherwise be covered by Medicare. Information about the Opt-out process can be found in MLN Matters SE1311.   

Providers must submit a copy of their approval letter from their Medicare Carrier or Medicare Administrative Contractor, to:

Mayo Clinic Health Solutions
Network Development
PO Box 211698
Eagan, MN 55121     

Providers that have informed Mayo Clinic Health Solutions that they have opted out of Medicare will be flagged on the online SCHA provider directory with the following note:

This provider has opted out of Medicare (not enrolled as a Medicare provider).  South Country Health Alliance will not pay for services covered by, but not billed to, Medicare because the provider has chosen not to enroll in Medicare.

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Changes to Primary Care Provider Child & Teen Check Up Requirements for Dental Health Examination 
The Minnesota Department of Human Services (DHS) has made changes to the primary care provider requirements for Child and Teen Checkups (C&TCs). The additional C&TC requirements are as follows: 

• Provide an oral health exam, anticipatory guidance, and education for children and their families at every C&TC screening. 
• Verbally refer children to dentists at the time of the eruption of the first tooth or no later than 12 months of age. 
• Refer to the Schedule of Age-Related Dental Standards for Minnesota’s age-related dental standards schedule details. 

 

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