For non-anesthesia services:
A letter was recently sent out to all providers regarding a new UniCare requirement. Effective October 10, 2011, specialists and other providers must obtain a referral from the PCP to treat UniCare (Medicaid Replacement) members. These changes affect all providers and specialists who are not a member’s PCP and who render services to Health Wave 19 and 21 members.
Exceptions (the referral by the PCP is NOT required):
- Health Education
- Urgent Care Centers
- FQHCs
- Emergency Services
- The member has not been assigned a PCP
- The provider rendering services is in the same group (or same Tax ID) as the member’s PCP and is one of the specialties below:
- Family Practitioner
- General Practitioner
- General Pediatrics
- Internal Medicine
- Nurse Practitioner
- OB/GYN
- Physicians Assistant
UniCare has provided PCPs with a Record of Referral to Specialty Care Form. The referring PCP can fax the form to the specialist to ensure that the specialist has his or her NPI and referral.
Note: A Record of Referral is valid for as long as the member is under the care of the specialist or other provider.
There is no need to send a copy of the PCP referral to ABI. Simply list the PCP as the referring provider and our office will enter the proper data into the system. We will contact your office for a copy of the referral if UniCare challenges the claim, so please keep each referral in the patient’s records to provide as necessary.
If this information is missing, your claim will be denied. If the referring provider’s name we submit on the claim is not the patient’s PCP, we suspect the claim will also be denied.
Please contact Stephanie Kurtz, (316) 281-3710, if you have any questions regarding this new requirement.
abinsights Contact Information
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388. Phone 316-281-3700. Fax 316-282-4322.
Our purpose is to help you meet inevitable challenges. We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.
Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
No Comments