AAHAM April 24, 2015. Member Access Member access to any PCP/Specialist in network –No referral necessary –Don’t have to see PCP on card –Member can call.

AAHAM

April 24, 2015

Member Access

• Member access to any PCP/Specialist in network– No referral necessary– Don’t have to see PCP on card– Member can call Member Services to update their card

• 866-935-6760

• No copays– Arbor Health Plan does not charge copays for any service

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Additional member benefits

• Arbor Health Plan provides additional benefits to members:

Adult Preventive Visits and Vaccinations

24/7/365 Nurse Call Line

Rapid Response and Outreach Team

Diaper Reward Program

Parenting and Lamaze Classes

Breast Pump Purchases

YMCA 90 Day Membership (select locations)

Community Baby Shower

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Prenatal Care

• MCOs responsible for newborns effective 2/1/14.– Once DHHS is notified of birth, newborn is retroactively enrolled in

Managed Care the first of the month of the notification

• Obstetrical Needs Assessment Form (ONAF)– Receive $100 for completing form– Receive additional $300 if certain criteria are met– Available on our website

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Enhanced Obstetrical Care Payments

Additional payment of $300 ($100 for each measure) is automatically issued if an ONAF is received:

– First visit occurs in first trimester or within 42 days of member’s Arbor membership

– Infant is term (37 weeks) and not an elective delivery prior to 39 weeks gestation

– Post-partum visit within 21 to 56 days after delivery• Submit 59430 even if global code was billed.

Payments for deliveries in July through December 2014 issued in May or June.

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Recent Changes/Updates continued

• Enhanced PCP payments to continue

• Fee schedule updates will match Nebraska Medicaid effective dates.– Individual provider and facility rate updates will still be delayed 30 days

• Electronic Communications effective 7/1/15.– Email – Fax– Mouse

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Recent Changes/Updates continued

• HIPAA 5010 X12 effective 4/1/15.– Incorrectly formatted claims will be rejected.

• ICD-10 has been delayed until 10/1/15.– Providers will be able to test ICD-10 claims with us, when the time

comes. July and August is the projected timeframe.

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Reminders

• Timely filing is 365 days from DOS• Appeals/Resubmissions/Corrections within 90 days of

original remit– DO NOT send claims or corrections to Omaha office

• COB claims must be submitted within 365 days of DOS or 60 days from primary EOB generation, whichever is longer.

• When submitting with an invoice, item must be easily identifiable by code on the invoice.

• Routine and medical vision claims submitted to Avesis (anesthesia and facility fees for vision services submitted to Arbor).

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Credentialing

• Provider must be enrolled with Nebraska Medicaid at practice location– Enrollment Center – 877-255-3092– http://dhhs.ne.gov/medicaid/Pages/med_providerenrollment.aspx

• Credential via:– CAQH– Arbor Health Plan’s Full Credentialing Application

• Contact your Account Executive with questions

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NaviNet

• NaviNet Web Portal: www.navinet.net • Phone: 888.482.8057

– View Member Eligibility – Member Rosters – View Third Party Liability Information (TPL) – Claims Status & Updates– View/Print Remittance Advices – Prior Authorization Requests– Gaps in Care Report

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Provider Network Management

• Adam Steffen, Director Provider Network Management– [email protected]

• Jessica Wykert, PNM, Account Executive – Western Nebraska– [email protected]

• Cathy Bojanski, PNM Account Executive – Northeast Nebraska– [email protected]

• Kami Hudson, PNM Account Executive – Southeast Nebraska– [email protected]

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