Kids First Payor Update

Kids First Payor Update May 2006

Medicaid CMOs

WELLCARE & PEACH STATE  Labs- Kids First has checked with both WellCare and Peach State as to which labs they have contracts with. They are both contracted with LabCorp and Quest.

 Verification of Eligibility-By the end of the month you can go to the current Medicaid web portal, www.ghp.georgia.gov, and it will tell which Medicaid CMO a patient is on. Then you can go to the appropriate CMO website and verify eligibility. Kids First will provide additional information once it becomes available.

WELLCARE

 CHOA- SIGNED THE WELLCARE CONTRACT ON MAY 23!!

 Patient Rosters-Rosters were mailed to the practices on May 23 from the WellCare corporate office in Tampa. If you have more than one location, there was a roster for each physician sent to each location. If your practice is closed to new Medicaid patients, when you receive your roster you need to compare it against your current Medicaid roster and return it to Kids First no later than Wednesday, May 31. WellCare is in the process of faxing Kids First the practice rosters so you will also be getting these rosters via email from Kids First. We felt that you should get these to you as soon as possible knowing it would take time to go through them and compare to your current patient rosters. To date, we have only received a few rosters and are getting them out as quickly as we can. Due to the fact that WellCare is faxing these rosters, we have noticed that some of the faxes have been incomplete (we have the practice totals) and we have not received the full roster for a few practices. We are working with WellCare to get the missing pages of these rosters re-sent to us.

 Corrected Claims-At this time corrected claims cannot be done online. They have to be mailed in to WellCare Health Plans, Inc, Georgia Region, P.O. Box 31224, Tampa, FL 33631-3224). Make sure to note on the HCFA1500 that it is a corrected claim. The IT department at WellCare is working to resolve this issue. However, they do not know when it will be resolved.

 PaySpan, the EFT/ERA provider- In order to receive Medicaid payment via EFT, you must be registered with PaySpan. Currently you have to get your registration number from WellCare in a letter you will receive after you enroll on the WellCare website. This process has been very cumbersome for practices so WellCare is in the process of adding a link on the Georgia WellCare website under Providers to PaySpan. This link should be different from the one currently on the website. You will not need this registration number for the new link in order to be directed to PaySpan’s website. In the past PaySpan was did not process Medicaid and some practices were not able to get signed up. PaySpan has now corrected this and it should not be a problem any longer as of May 16. Kids First is trying to get a list from WellCare of practices that have successfully been able to register with PaySpan. Some practices have indicated that they still have not received their registration number for PaySpan. In an effort to get their number, some practices called PaySpan directly. They had to leave a message, but received a call back and were able to successfully get registered. If you have not been able to successfully get your practice registered with PaySpan, please let us know.

 WellCare In Service Workshops-If you were unable to attend the Kids First meeting in April or want to send other staff members to an in-service training, WellCare is offering other In Service Workshops on May 25, 26 at WellCare’s office located behind Perimeter Mall. It is in Northpark Town Center at the intersection of Abernathy Rd & Peachtree-Dunwoody Rd. Times are: 10-12 and 1-3. Call WellCare’s Customer Service at 866-231-1821 to RSVP. Our rep Cheryl Harshbarger will be at these 3 workshops. Other dates are available by calling 866- 231-1821.

 McKesson-At the April PA meeting a question was raised that if you used McKesson clearinghouse for claims submission would the claims be accepted by WellCare. An email was sent from April Binion on May 5 addressing this. Practices that use McKesson as their clearinghouse will be able to submit their claims to WellCare through McKesson (which will in turn go through WebMD).

 Pediatric Specialist List- Kids First has requested an updated list of contracted Pediatric Specialist. Many pediatric specialists have not signed up with WellCare yet we hope that since CHOA has signed a contract, this will be changing. If you are interested in a particular specialist, you can check the WellCare website for the most current data.

 Well checks within first 90 days- Kids First has confirmed that your practice does not have to do well checks on all of Medicaid patients within the first 90 days of going live. This is only for newborns, new patients, and non compliant patients. Not established patients. Some of your patients may have already received letters from the state. The State is sending out letters to non compliant patients telling them they must get their well checks.

Nurse Practitioners/Allied Personnel- Kids First is working to ensure that WellCare has credentialed all allied personnel. Kids Fist sent a list of each practices allied personnel and have asked WellCare to verify that they have each practitioner in their system. If we find that there are any problems that need your assistance, we will notify your practice. PEACH STATE  Forms- April Binion sent a few emails requesting forms to be completed and faxed back to Kids First. The forms are: Website Enrollment-Email sent April 27 EFT Agreement-Email sent May 9 Physician Open/Closed Practice Status Form-Email sent May 15 The deadline for all of these forms has past, if you have not completed these please do so and return to Kids First as soon as possible. If you need a copy of the forms please call April Binion at 770-333-0033 ext 202.

 Pediatric Specialist List- Kids First has requested an updated list of contracted Pediatric Specialist. It will be forwarded as soon as it is received. CHOA has signed the contract with Peach State.

 Well checks within first 90 days- Kids First has confirmed that your practice does not have to do well checks on all of Medicaid patients within the first 90 days of going live. This is only for newborns, new patients, and non compliant patients. Not established patients. Some of your patients may have already received letters from the state. The State is sending out letters to non compliant patients telling them they must get their well checks.

 Website Log in- Some practices have stated that they have not received their log in and password for the Peach State website. Peach State has informed Kids First that log ins and passwords would be mailed next week (week of May 29), and you can verify eligibility and plan (CMO) on the current GHP/Medicaid website.