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October 2023

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Welcome to the first issue of Kids Health First's Billing & Coding Connection newsletter- an all-in-one resource dedicated for all things billing and coding.


Do you have billing topics, best practices, claim questions, or good news to share? Email KHF at Payorconcerns@khfirst.com.


To add billing staff members to the distribution list, please also email us at Payorconcerns@khfirst.com

CURRENT TRENDS

Aetna Fee Schedule Issue 


Multiple practices have reported that Aetna is underpaying claims beginning 9/13/2023. This appears to affect all codes on the fee schedule. Multiple claims examples from various practices were sent to Aetna for review. We are pending a response on the cause and resolution.

Coming Soon!


The Payor Issue Database will be available in the Members section of the KHF Intranet under the Financial menu. The Payor Issue Database contains a list of payor issues KHF is tracking on behalf of the practices. Included is a description, resolution and practices impacted.

PAYOR UPDATES

United Healthcare updated their Preventative Medicine and Screening policies. See helpful information about Modifier 25, same day services, and other preventative services. Preventive Medicine and Screening Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans (uhcprovider.com)

CareSource updated the usage of modifier 25 effective 12/1/2023

medicaid-ga-policy-reimburse-py-1361-20231201 (caresource.com)

Medicaid face-to-face Physician Services workshops in November 2023. Providers are encouraged to send their practice managers and billing staff that submit Medicaid claims. Provider Messages (georgia.gov)

BILLERS SPOTLIGHT

Cobb Pediatric Associates uses the GAMMIS Claim Tool to resolve Medicaid claims issues and improve their A/R. It saves their staff time, increases productivity, and improves the process of correcting claims. 


Biller Carol V. says We can correct claims on the portal and see immediately if the claim paid. We work denied claims as soon as we receive an EOB, which prevents timely filing denials.” 

 

Instructions on how to Correct a Medicaid Claim on GAMMIS are provided in Best Practices.

BEST PRACTICES & QUICK TIPS

Medicaid Claims on GAMMIS


Quick Tips


Planning to use a Locum Tenens? 


AAPC Billing Guidelines can help! 

Congratulations to DV Pediatrics on celebrating their 20-year anniversary!



RESOURCES

Kids Health First Intranet Page