Claims
Ex Code 014 states what for next steps?
Advise the caller that services are not covered when provided at no charge to the member. If needed, advise the caller to submit a corrected claim. DO NOT send to CRU as CRU cannot adjust the claim.
Per the benefit grid, how many tests can a child under 21 receive for allergy services?
60 tests every 3 years!
For Fee Schedule Copies, what do we advise the provider?
The fee schedule is unique for each provider. They can request their fee schedule from OKMedicaidProviderRelations@Humana.com
Does CBT code 99507 require a PA?
No!
What is the timeframe for CRU to investigate a case?
14-30 Calander days!
Provider states they received an overpayment letter, and Humana is requesting the money back. Who handles this?
Provider Payment Integrity Customer Care department.
Claims Payment Overview CCC Provider - mentor
Per the benefit grid, are outpatient services covered for chemotherapy & radiation therapy?
Yes! Both are covered below!
* Outpatient services
* Inpatient services
Provider indicates they are working with someone from the Provider Relations Team, where can we check the status of this?
Quickbase Touchpoint!
Touchpoints (quickbase.com)
Does CBT code 47371 require a PA?
No!
Is the statement below True or False?
Providers can submit requested medical records as well as view remittance documents on Availity.com
True!
Availity Overview CCC Provider - mentor
Denied claim shows an Ex-Code of 088, you notice the claims on file have different diagnosis codes & different providers on each, what should you do?
If the denied claim has the same procedure but with different diagnosis billed/rendering provider (different specialties), document and send the claim to CRU.
Per the benefit grid, what is excluded for telehealth services?
Not covered: Physical therapy, occupational therapy, and/or speech and hearing services as a part of telehealth
Provider wishes to terminate the contract with Humana, what do we advise?
1. Explain that all termination requests must be submitted in writing in accordance with the terms of their agreement with the Humana and/or ChoiceCare Network.
2. Provide the caller with the appropriate Market email address:
• Behavioral Health: OKBHMedicaid@humana.com
• All others: OKProviderDevelopment@humana.com
Note: An acknowledgment letter is sent with the actual term date included in the letter.
What's CBT stand for?
Current Procedural Terminology! ( CBT Code)
What is the Complaint address for Oklahoma?
Addresses and Payer IDs CCC Provider - mentor
What is the correct service center, department, and topic when routing a case to CRU?
• Service Center: Provider
• Department: Medicaid Claims Research Unit (CRU)
• Topic: None
Per the benefit grid, is cosmetic surgery covered?
Not covered. Provider can submit an auth to determine if its medically necessary!
Provider is needing Medicaid State Enrollment info, and they do NOT have access to the state's provider portal, what do we advise?
(800) 522-0114, Hours: 8 a.m. - 5 p.m
Does CBT code 98563 require a PA?
Medical Code not found, repeat the code back to the provider to verify!
Provider is needing the correct mailing address for Payment Recovery (PPI)
Addresses and Payer IDs CCC Provider - mentor
Which CAS screen is needed to display waivers that have been added for a member AND the easiest control line to find it?
PCI Screen CCC Provider - mentor
PCI,UMID - control line
Per the benefit grid, for hospital services that are inpatient, are pacemakers covered?
Yes!
Payment includes but is not limited to:
* Laboratory services;
* Prosthetic devices, including pacemakers, lenses, artificial joints, cochlear implants, implantable pumps;
* Technical component on radiology services;
* Transportation, including ambulance, to and from another facility to receive specialized diagnostic and therapeutic services;
* Pre-admission diagnostic testing performed within seventy-two (72) hours of admission; and
* Organ transplants.
Provider wishes to speak to a supervisor and is NOT happy; after trying to deescalate the situation you are unable to turn it around & need a supervisor on the line, what's the internal phone number for Oklahoma Medicaid Escalation line PER the Escalation Procedure CCC Provider
Oklahoma Medicaid 1390070
Adding a walker to a previously applied cast, does this require a PA?
No! CBT code for this is 29440
What is the appeal mailing address for Oklahoma?
Addresses and Payer IDs CCC Provider - mentor