The BreastCare Program
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- Ilene Welch
- 7 years ago
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1 The BreastCare Program
2 BreastCare Is a Program of the Arkansas Department of Health (ADH) that Offers: Screening and diagnostic services to qualifying women at no cost Public and professional education related to breast and cervical cancer Mission: BreastCare s mission is to increase the rate of early detection of breast and cervical cancer and reduce the morbidity and mortality rates among women in Arkansas by lowering barriers to screening that result from lack of information, financial means or access to quality services. 2
3 BreastCare Services BreastCare is for uninsured and underinsured Arkansas women ages 21 to 64 who are at or below 250% of the Federal Poverty Level (FPL). Services include: Mammograms (age 40) Pelvic exams and Pap tests (age 21) Human Papilloma Virus (HPV) testing (age 30) Most biopsies some require prior authorization from program Follow-up test as needed Policy and decision making 3
4 Medicaid Provider Portal 4
5 Client Eligibility Why Should You Check Eligibility? Providers are encouraged to check the eligibility status of a client before providing services because: A provider rendering services without verifying eligibility for BreastCare does so at the risk of not being reimbursed for the services. An accepted eligibility verification ensures that claims will not deny due to client ineligibility. Each client has an ID card with initial dates of eligibility listed, but these may change over time. 5
6 Submitting Claims Three Ways to Submit BreastCare Claims Provider Electronic Solutions (PES) software Hewlett Packard Enterprise s free eligibility and claims submission software available for download from the Arkansas Medicaid website BreastCare s Claim Form paper claims Direct Data Entry (DDE) the Provider Portal 6
7 Expanded Eligibility BreastCare is happy to announce new BreastCare eligibility guidelines will take effect on March 14, 2016 The expanded guidelines include providing Pap test screening for 21 to 64 year old women and diagnostic services to underinsured women who qualify. The BreastCare Online System and billing system have been updated to reflect these changes. For questions, contact your Regional Care Coordinator or the BreastCare program. 7
8 ICD-10 Information Claims Submitted without ICD-10 Codes for Dates of Service on or after 10/1/15 WILL NOT BE PAID. All claims submitted to BreastCare for dates of service on or after 10/1/15 must bill using ICD-10 codes. Claims that do not bill ICD-10 codes will deny and you will not be paid by BreastCare. This is a federal mandate. If you currently use PES to bill claims, you MUST upgrade to version 2.23 to submit claims using ICD-10 codes. Upgrade your software in sequential order; each lower version must be upgraded before you can upgrade to the next version. Please refer to the BreastCare website for specific billing criteria. For all the latest BreastCare information, log on to and click the Just for Providers link. 8
9 New CPT Codes Effective for Dates of Service on and after 1/1/ (Ultrasound Exam Pelvic Complete) (Transvaginal Ultrasound Non-OB) 9
10 Replaced CPT Codes Effective for Dates of Service on and after 5/18/ is no longer payable and has been replaced with and is no longer payable and has been replaced with G0462 is no longer payable and has been replaced with G0461 is no longer payable and has been replaced with Please refer to the BreastCare website for specific billing criteria. 10
11 Modifier 50 Added for Bilateral Ultrasounds Effective for Dates of Service on and after 5/18/15 Modifier 50 (bilateral procedure) has been added to CPT codes and in order to accommodate billing the bilateral procedure. When billing the bilateral procedure, put modifier 50 on the claim to indicate the bilateral procedure. Use modifier 50 for the complete component. Use modifier 50 along with modifier 26 if billing the professional component. Use modifier 50 along with modifier TC if billing the technical component. If billing without the modifier 50, you will be paid for the unilateral procedure. 11
12 Cancer Treatment Medicaid 07 ended on December 31, Contact your ADH BreastCare Regional Care Coordinator to refer a patient who is diagnosed with breast or cervical cancer, CIN II or CIN III and requires treatment. You may also contact the BreastCare Cancer Treatment Case Manager or Patient Navigator at
13 Contacts Arkansas Department of Health Policy and standards Patient enrollment questions Provider enrollment (new or renewal) Hewlett Packard Enterprise BreastCare Provider Services Claims and eligibility processing Provider visits for billing issues (on-site or virtual) Virtual training Provider billing assistance
14 Hewlett Packard Enterprise BreastCare Team Patrice Gilmore Provider Representative Terrie Withers Billing Analyst Rickie Swopes Billing Analyst Jessie Smith BreastCare Manager
15 Questions?
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