Billing and Claims Overview - UHCprovider.com...Billing and Claims Overview BH1906-032019 Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express

Nebraska Billing and Claims Overview

BH1906-032019

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Claims Submission Option 1 LINK Portal

Entry through uhcprovider.com

• You must have a registered user ID and password to gain access to the onlineclaim submission function in LINK. To obtain a user ID, register online or call1-866-842-3278

• Submitting claims closely mirrors the process of manually completing aCMS-1500 form

• This option is not available for claims submitted on a UB-04

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More information regarding LINK can be found at:1) claimsLink Self-Service Tool2) Clicking on the claimsLink Enhancements link found on the homepage

http://www.unitedhealthcareonline.com/

https://www.uhcprovider.com/en/claims-payments-billing/claimslink-self-service-tool.html

https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2019/claimsLink-Enhancements-New-Search-Options-Claims-Info.pdf


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Claims Submission Option 2 Provider Express Portal

Entry through providerexpress.com

In order for providers to use the Provider Express portal, providers must have an Optum ID. If you do not have an Optum ID, you can create one by clicking on "first-time user."

You can watch a short video to learn more about the process.

https://www.providerexpress.com/


Claims Submission Option 3 EDI/Electronically

• Electronic Data Interchange (EDI)

• This method is ideal for high volume providers who would like to submitbatches of claims electronically, right out of their practice managementsystem software. Transactions are conducted through a clearinghousevendor and can be configured for either single-payer or multi-payer needs.

• Electronic Claims Payer ID: 87726

• You may use any clearinghouse vendor to submit claims

• Additional information regarding EDI is available on:uhcprovider.com/en/resource-library/edi.html

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http://www.uhccommunityplan.com/health-professionals/la/electronic-data-interchange.html

http://www.uhccommunityplan.com/health-professionals/la/electronic-data-interchange.html

http://www.unitedhealthcareonline.com/

https://www.uhcprovider.com/en/resource-library/edi.html


Claims Submission Option 4 Hardcopy

Paper claims submitted via U.S. Postal Service should be mailed to:

UnitedHealthcareP.O. Box 31365Salt Lake City, UT 84131

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For Claims/Customer Service, call:

866-331-2243


Claim Submission Reminders

Providers must bill on the appropriate Form - HCFA-1500: Used for CPT/HCPCS Codes- UB-04: Used for Revenue Codes and/or Revenue + HCPCS Code

combinations

• Providers must refer to their Fee Schedule/Payment Appendix for theappropriate codes/modifiers

• Providers are responsible to obtain Prior Authorizations for applicableservices. A list of those services can be found atuhcprovider.com/content/dam/provider/docs/public/commplan/ne/behavioral-health/NE_BH_Prior_Authorization_List.pdf

• All services performed by non-participating Providers require a PriorAuthorization

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https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/ne/behavioral-health/NE_BH_Prior_Authorization_List.pdf


uhcprovider.com

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Behavioral Health Information: uhcprovider.com/en/health-plans-by-state/nebraska-health-plans/ne-comm-plan-home/ne-cp-bh.html

https://www.uhcprovider.com/en/health-plans-by-state/nebraska-health-plans/ne-comm-plan-home/ne-cp-bh.html


uhcprovider.com

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HOMEPAGE:


Check Member Eligibility on uhcprovider.com

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Click on: uhcprovider.com/en/patient-eligibility-benefits.html

OR

Call the NMES Line at 1-800-642-6092

https://www.uhcprovider.com/en/patient-eligibility-benefits.html


Claims, Billing and Payments - uhcprovider.com

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uhcprovider.com/en/claims-payments-billing.html

https://www.uhcprovider.com/en/claims-payments-billing.html


Billing Reference

Providers with NPI & Medicaid Numbers

• Enter the name, licensure/certification and NPI number of the Provider who is directly renderingservices:

• Box 24J: NPI number of the Rendering Provider

• Box 31: Signature of Provider including degrees or credentials, if applicable

• Box 33: Provider name, address, and phone number

• Box 33a: Provider Group NPI number - NPI billed should match the pay to NPI per enrollmentwith NE Medicaid

• Provider Types include: APRN, BCBA, DO, LADC, LIMHP, LMHP, LP, MD, PA, PhD Prov.,PLADC, PLMHP, RN

• The name and license/certification should be exactly the same as it appears on the agency rosteror individual application.

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Placement of NPI Number on CMS1500

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Placement of Billing vs. Rendering Clinician Name on CMS 1500 Claim Form

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Placement of Billing Group/Agency on CMS 1500 Claim Form

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Prior Authorization Number Needed on CMS 1500 Claim Form

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Billing Units on CMS 1500 Claim Form

Bill the appropriate number of units for the applicable CPT/HCPCS code.

For example, this provider performed 30 minutes of support services on Oct 1. Support services are billed with HCPCS H2015 HE where 1 unit = 15minutes. Therefore, bill 2 units.

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Billing Reminder – 59 Modifier

Modifier 59 must be attached to a component code to indicate that the procedure was distinct or separate from other services performed on the same day and was not part of the comprehensive service. Claims submitted utilizing modifier 59 may be subject to Medical Review.

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Billing and Limitations and Common Codes

Some services may not be billed on the same day as other covered services and most codes have a daily or annual limit to the amount of services that may be provided.

Example: - Max Frequency Per Day Policy: the maximum allowed amount of units for

individual services- CCI Editing Policy: services that will not be reimbursed if billed on the

same day by the same health care provider

Codes may also have maximum unit, age or gender limits that flag a claim for additional review.

Example: • PRTF Services can only be billed for Member's age 19 and

under.

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Billing Tips

Providers may only bill with a Group NPI if you are contracted in a way that allows it. Examples of services that should always be billed with a Group NPI include, but are not limited to: Peer Support, Community Support, Community Treatment Aide, MRO Services.

UBH does not use modifiers to identify license level. License levels are identified by using the rendering provider NPI, billed in box 24J.

There are certain codes and license levels that primary insurance (including Medicare) will not cover. In that case, our systems will bypass the primary carrier remit requirement, allowing the claim to adjudicate. However, if the service and license level is covered by primary insurance (including Medicare), you must bill primary first and submit the remit with the claim.

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Submitting Corrected Claims (HCFA-1500)

Providers have 365 calendar days from the claims processing date to correct and resubmit claims, if the initial submission was received within the contracted time limit. • Corrected HCFA-1500 claims can be submitted electronically by entering

Medicaid Resubmission Code 7 in Box 22, along with the original claim #

• Corrected HCFA-1500 claims can be submitted on paper, with “Corrected”on the top of the claim form and the previous claim number located in box22 of the HCFA-1500.

United Healthcare PO Box 31365Salt Lake City, UT 84131

**REMINDER: All claims must be submitted within 180 days of the date of service

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Submitting Corrected Claims (UB-04)

Providers have 365 calendar days from the claims processing date to correct and resubmit claims, if the initial submission was received within the contracted time limit. • Corrected UB-04 claims can be submitted electronically by submitting with

the last character of the Type of Bill as 7, to indicate Frequency code 7.

• Corrected UB-04 claims can be submitted on paper, with the previous claimnumber located in field 64. Submit with the last character of the Type of Billas 7, to indicate Frequency code 7.

United Healthcare PO Box 31365 Salt Lake City, UT 84131

**REMINDER: Initial claims must be submitted within 180 days of the date of service

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Claim Disputes - NE Medicaid (C&S)

• First Level Dispute – Reconsideration

• Second Level Dispute - Formal Appeal

• Last Level - State Fair Hearing

• Additional information can be found starting on page 91 of the Provider Manual:uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/NE-Care-Provider-Manual.pdf

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Reminders

Timely Filing - Providers must submit initial claim within 180 days of date of service

Corrected Claims - Providers have 365 days from the claims processing date to correct and resubmit claims

Balance Billing - The member cannot be balance billed for behavioral services covered under the contractual agreement.

Member Eligibility - Provider is responsible to verify member eligibility through the NMES Line 1-800-642-6092.

NCCI Edits - United Healthcare follows the CMS National Correct Coding Initiative (NCCI edits/methodologies) when processing claims.

Rendering Provider - For codes that require a rendering provider, the rendering NPI goes in box 24J

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Nebraska BH Provider Advocates

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mailto:[email protected]

mailto:[email protected]

Thank You.

Billing and Claims Overview - UHCprovider.com...Billing and Claims Overview BH1906-032019 Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express

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