Managed Care Minute May 2020 Volume 19

NEW THINGS COMING FOR YOU We have made some recent access changes to the MCCFL Client Portal https://client.mccfl.us/public/ .  Effective immediately, we are implementing individual access to the portal instead of the single log in per facility. Please email your liaison or wstone@mccfl.us to initiate an individual log in. You will then receive an email from ‘support@mccfl.us’ with the subject ‘portal access’.  The email will contain a link for you to create your own unique login credentials.

New items with Aetna: Aetna has moved their provider portal to Availity as of May. As of May 31, 2020, you will not longer be able to access Aetna on NaviNet.  Aetna’s provider portal and resources on Availity will allow for eligibility and benefits, claims, authorization and referral needs and more.  Please be sure that your facility is registered with Availity. Availity may ask for additional information upon initial requests such as a recent EOB from Aetna or your Aetna Provider ID.  New items with Availity: Did you know that Availity has live and prerecorded webinars for training on how to use their site? Training covers from Eligibility and Benefits to Authorizations to Claims and can be found on the top tool bar called Help & Training  New items with Freedom: We have received confirmation from Freedom/Optimum that all claims filed are now requiring PDPM HIPPS codes to be placed on the first line of the UB. Claims submitted with RUG scores will be denied. Please remember that the HIPPS codes for the Medicare Advantage plans are for data collection purposes only and the claim will still pay based on your current contract.  New items with Simply: Simply has identified an issue that is occurring with LTC Medicaid claims for March 2020 and April 2020 LTC claims have either been processing as crossover claims, or they are denying. We have spoken with our Simply Provider Representative, who stated that this “configuration” was identified.  Facilities do not need to do anything at this time, as Simply is pulling all claims and will be reprocessing and issuing payment. MCCFL has had numerous questions in regards to the timely filing limit for Medicare crossover claims. Facilities have 3 years to file these claims.  New items with Sunshine: Sunshine Medicare Part A crossover claims are being rejected/denied.  Some claims are being rejected and are not even making it into Sunshine’s system. Other claims are being denied due to invalid procedure.  We have learned that if these claims are submitted without the PDPM codes, Sunshine will accept the claims and process them accordingly. This is a temporary solution.  Sunshine is working on this issue internally to have this corrected on their end.

THINGS TO REMEMBER... We suggest as a best practice to re-validate all Medicare verification's on ALL skilled members on the 1st and 15th of the month to catch potential payer changes. When employees are no longer employed by a facility, please remember to remove their access to insurance portals.  This practice will assist in keeping the facility HIPAA compliant.

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