UnitedHealthcare Community Plan Provider Orientation Presentation MLTSS go-live July 1, 2014

UnitedHealthcare Community Plan Provider Orientation Presentation MLTSS go-live July 1, 2014

Agenda 1. Overview UnitedHealthcare Community Plan of New Jersey 2. Overview MLTSS Program 3. Prior Authorization and Continuity of Care 4. Utilization Management 5. Critical Incident Reporting 6. Unable to Contact/Gaps in Care 7. Credentialing, Re-Credentialing, Criminal Background Checks and Demographic Changes 8. Provider Advocate Program 9. Claims and Appeals 10. Claim Billing Tips 11. Key Contacts 12. Links to State Training Materials 13. Questions 2

Overview: UnitedHealthcare Community Plan 3

Highlight Summary: Founded as Managed Healthcare Systems of New Jersey (MHS) in 1995. Operated as AmeriChoice of New Jersey from 1998 2010. Acquired by UnitedHealth Group (UHG) in 2002. Re-branded as UnitedHealthcare Community Plan in January 2011. Licensed in all 21 counties for NJ FamilyCare/Medicaid 4

Profile United Healthcare Community Plan: Is a business segment of UnitedHealth Group Nation s premier provider of trusted and high-quality personalized public sector health care programs Serves more than 2.6 million beneficiaries of government health care programs in 24 states and the District of Columbia. Has operated since 1989, serving these programs exclusively Developed the unique Personal Care Model Pioneered 24/7 bilingual Member Services Helpline Emphasizes preventive health and education 5

Personal Care Model (PCM) A holistic approach to care for members with complex needs and chronic conditions. Benefits include: Focused hands-on outreach Comprehensive needs assessment clinical and socio-economic Comprehensive treatment plan Health education activities Member evaluation stratifies members according to diagnosis and severity of the member s medical and psychosocial conditions Member Referrals Providers may contact United Healthcare Community Plan Care Management hotline at (877) 704-8871 6

Overview: MLTSS Program 7

MLTSS Overview Historically the State of NJ had four waivers: ACCAP TBI GO CRPD Please note that the CCW Waiver is not part of MLTSS. As of 7/1/2014 the State of NJ is combining the services provided under these four waivers into one waiver, Managed Long Term Care Services and Supports (MLTSS). The benefits covered under this new waiver will move from Fee-for-Service Medicaid to Managed Care. The Managed Care Organizations (MCOs) will be responsible for reimbursement of these services effective 7/1/2014. Authorizations provided under Fee-for-Service Medicaid will remain in effect during the Continuity of Care period. Assessments will be made by a Care Coordinator and that time a new authorization will be provided to the provider. 8

Services covered under MLTSS MLTSS Service MLTSS Code Modifier Unit Adult Family Care S5140 Per Diem Assisted Living ALR T2031 Per Diem Assisted Living ALP T2031 U2 Per Diem Assisted Living CPCH T2031 U1 Per Diem TBI Behavioral Management Individual H0004 Per 15 Minute TBI Behavioral Management Group H0004 HQ Per 15 Minute Caregiver/Participant Training S5111 Per Diem Chore Services S5120 Per 15 Minute Chore Services S5121 Per Diem Cognitive Therapy Individual T2013 HQ Per Hour Cognitive Therapy Group T2013 HQ Per Hour Community Residential Svs (low) T2033 Per Diem Community Residential Svs (medium) T2033 TF Per Diem Community Residential Svs (high) T2033 TG Per Diem Community Transition Svs T2038 Per Service Community Transition Svs (administration) T2038 U6 Per Service Home Based Supportive Care Individual S5130 Per 15 Minute Home Based Supportive Care Group S5130 HQ Per 15 Minute Home Delivered Meals S5170 Per meal Medication Monitoring monthly S5185 Per month Medication Monitoring initial setup T1505 Per Service Occupational Therapy Individual Habilitation 97535 U2 Per 15 Minute Occupational Therapy Group Habilitation 97535 U3 Per 15 Minute Occupational Therapy Individual Rehabilitation 97535 U4 Per 15 Minute Occupational Therapy Group Rehabilitation 97535 U5 Per 15 Minute 9

Services covered under MLTSS - continued MLTSS Service MLTSS Code Modifier Unit PERS monthly S5160 Per month PERS initial setup S5161 Per Service Personal Care Services Individual T1019 Per 15 Minute Personal Care Services Group T1019 HQ Per 15 Minute Personal Care Services Live-in T1020 Per Diem Physical Therapy Individual Habilitation 97110 U2 Per 15 Minute Physical Therapy Group Habilitation 97110 U3 Per 15 Minute Physical Therapy Individual Rehabilitation 97110 U4 Per 15 Minute Physical Therapy Group Rehabilitation 97110 U5 Per 15 Minute Private Duty Nursing over 21 RN T1002 UA Per 15 Minute Private Duty Nursing over 21 LPN T1003 UA Per 15 Minute Private Duty Nursing under 21 RN T1002 EP Per 15 Minute Private Duty Nursing under 21 LPN T1003 EP Per 15 Minute Residential Modifications S5165 Per Service Residential Modifications Evaluation T1028 Per Service Respite (non hospice) in the home T1005 Per 15 Minute Respite (non hospice) in AL S5151 Per Diem Social Day Care S5102 U3 Per Diem Speech Therapy Individual Habilitation 92507 U3 Per 15 Minute Speech Therapy Group Habilitation 92508 U3 Per 15 Minute Speech Therapy Individual Rehabilitation 92508 U4 Per 15 Minute Speech Therapy Group Rehabilitation 92507 U4 Per 15 Minute Structured Day Program S5100 Per 15 Minute Supportive Day Services T2021 Per 15 Minute Vehicle Modifications T2039 Per Service Vehicle Modifications Evaluations T2039 U7 Per Service 10

What s changing/not changing for Assisted Living? Any service that was considered inclusive of your Assisted Living per diem remains inclusive of your Assisted Living per diem. Any service that you received separate reimbursement for (in addition to your AL per diem) under FFS you will receive separate reimbursement for when billing United. Procedures on how you handle a member coming into an AL that is not currently approved for Medicaid and will be applying for Medicaid coverage will not change. United will not be responsible for any payment to the AL or other MLTSS provider until the member is enrolled with United. There is no retro enrollment to an MCO for members that are newly enrolled to Medicaid. Assignment to an MCO takes place prospectively. 11

Description of Units Per Diem one unit equals once per day, only one unit can be billed per date of service. Per Service one unit equals one service (i.e. one PERS instillation set up would be one unit of service). Per Meal one meal equals one unit of service. Per Month one unit equals one unit of service, only one unit can be billed per month. Per Hour one unit equals one hour of service. Per 15 Minutes one unit equals 15 minutes of service. 12

Member Liability Members receiving services in an Assisted Living Facility or via Adult Family Care may be subject to member liability. If a member has member liability it is the responsibility of the provider to collect payment from the member. Your explanation of benefits will reflect whether member responsibility is applicable. Any payment due to the provider will be less any member liability if applicable. 13

Prior Authorization Requirements and Continuity of Care 14

Prior Authorization Required Prior Authorization is required for ALL MLTSS services regardless of whether the provider is participating or non-participating. The Complete Prior Authorization List for Medicaid and MLTSS is available under the Billing & Reference Guides Tab at: www.uhccommunityplan.com. Dedicated MLTSS Intake/Prior Authorization number is (800) 262.0305. 15

Continuity of Care All State approved services will be authorized until the member is assessed by his/her care manager Once the member is assessed a new service plan will be created with corresponding authorizations where necessary All MLTSS requests prior to 7/1/14 are the responsibility of the State The State is providing prior authorization files to UHC that contain the services that members receive under FFS prior to 7/1/14 UHC is responsible for services once the individual s Medicaid eligibility is confirmed AND is enrolled in managed care. 16

Long Term Care Team UHC has a dedicated unit to provide customer service for MLTSS members All members receiving MLTSS services will receive a face to face assessment for evaluation of needs Providers/members are provided with a direct line for contacting their Care Manager (800) 645-9409 Members can reach a nurse 24x7 by calling Member Services or the Nurseline at 888-433-1904. 17

Gaps in care and when a new authorization is required Provider gets authorization to service a member. During the authorized time frame the member transfers to a new agency. Within the same authorized time frame the member decides to transfer back to the original agency. The agency will need to obtain a new authorization to resume servicing the member. When ever a member transfers agencies the authorization tied to the previous agency is always end dated. Provider gets authorization to service a member. Member goes on vacation for X amount of time. Member returns to same agency. The agency does not need to get a new authorization to resume services. Agency must notify the MCO that the member is on vacation to avoid an unable to contact issue resulting in a critical incident. * Please note provider should not bill for services when member is on vacation. Provider gets authorization to service a member. Member enters hospital or SNF for less than 30 days. Member returns home to same agency. The agency does not need to get a new authorization to resume services. Agency must notify the MCO and potentially the member may require a face to face assessment. Provider gets authorization to service a member. Member enters hospital or SNF for 30 days or more. Member returns home to same agency. The agency must get a new authorization for services. The agency can continue to service the member at the previously approved hours until a face to face assessment is completed. 18

19 Utilization Management

Utilization Management Appeals Claim appeals based on UnitedHealthcare s adverse determination regarding medical necessity, experimental or investigational services should be processed under the Utilization Management (UM) appeal process within 90 days from receipt of the original UM denial letter. Stage 1 Utilization Management Appeal should include: (a) copy of the original UM denial letter (b) a copy of the medical record (c) additional information which supports the need for medical necessity on the denied date(s) of services. Utilization Management Appeals should be mailed to the following address: UnitedHealthcare Community Plan Attention: UM Appeals Coordinator P.O. Box 31364 Salt Lake City, UT 84131 20

HIPAA Health Insurance Portability and Accountability Act (HIPAA) 1996 Improves the portability and continuity of health benefits Ensures greater accountability in the area of healthcare fraud Standardize both medical and non-medical codes across the entire health care industry Under HIPAA, all local medical service codes must now be replaced with appropriate HCPCS and CPT-4 codes. Among other types of acceptable disclosures, providers are permitted to disclose protected health information (PHI) to health plans for the purpose of quality assurance, quality improvement, and accreditation activities. No authorization needed from the patient when both the provider and health plan had a relationship with the patient and the information relates to that relationship. 21

22 Critical Incident Reporting

What is a Critical Incident? Critical incidents include occurrences involving the care, supervision or actions of a member that is adverse in nature or has the potential to have an adverse impact on the health, safety or welfare of the member or others. Critical incidents shall include but not be limited to the following incidents when they occur in a nursing facility (NF) /Special Care Nursing Facility (SCNF), inpatient Behavioral Health or home and community-based long-term care service delivery setting, including: community alternative residential settings, adult or child medical day care centers, other HCBS provider sites, and a member s home: a) Unexpected death of a member b) Missing person or unable to contact c) Suspected or evidenced physical or mental abuse (including seclusion and restraints, both physical and chemical); d) Neglect/Mistreatment, including self-neglect, caregiver overwhelmed, environmental e) Theft with law enforcement involvement f) Severe injury or fall resulting in the need for medical treatment Medical or psychiatric emergency, including suicide attempt g) Medication error resulting in serious consequences h) Inappropriate and/or unprofessional conduct by a provider/agency involving the member i) Sexual abuse and/or suspected sexual abuse j) The potential for media involvement k) Exploitation including financial theft, destruction of property l) Failure of a member s back-up plan m) Elopement/Wandering from home or facility n) Eviction/Loss of home o) Facility closure, with direct impact to member s health and welfare p) Cancellation of utilities q) Natural disaster, with direct impact to member s health and welfare r) Other, explain 23

How do I report a Critical Incident to UHCCP of NJ and what are my responsibilities? Providers are expected to assist the member immediately and then report to the State agency if appropriate BEFORE reporting to the MCO via the Call Center. Critical Incidents can be reported to the UnitedHealthcare by contacting the Call Center at (888) 702-2168 or by completing the Critical Incident form and faxing it to (855) 216-6408 within 24 hours of discovery of the incident. The form can be found on the UnitedHealthcare Community Plan of NJ web site: www.uhccommunityplan.com Any verbal notification must be followed up with a written report describing the incident and what the provider did to resolve the incident. There is no required format for the report. It should be faxed to (855) 216-6408. Participating providers must conduct an internal investigation and submit a written report advising of the root cause(s) of the incident and what steps were put in place to prevent such an incident from reoccurring. There is no required format for the report. It should be faxed to (855) 216-6408. 24

Who else do I need to report a Critical Incident to? Immediately report to the appropriate agency including 911, any knowledge of or reasonable suspicion of: Abuse, neglect, or exploitation of adult member to the State s Adult Protective Service office (APS) at 1-800-792-8820; Abuse, neglect, or exploitation of members residing in Nursing Home to the State's Office of the Ombudsman for the Institutionalized Elderly (O.O.I.E.) at 1-877-585-6995; Brutality, abuse or neglect of members who are children to the Division of Child Protection and Permanency, DCP&P, (formerly the Division of Youth and family Services, DYFS) DYFS Hotline at 1-877-NJABUSE (652-2873); Abuse, neglect, and exploitation of members who are children residing in Pediatric Nursing Facilities to Division of Child Protection and Permanency, DC&P, (formerly the Division of Youth and family Services, DYFS), DYFS Hotline at 1-877-NJABUSE (652-2873); or 25

Critical Incident Reporting Form This form must be received within 24 hours of discovery of the incident. Please complete this form and fax to the Quality Management Department along with any other supporting documentation to: 855-216-6408 As applicable, APS 1-800-792-8820 OOIE 1-877-585-6995 DCP&P/ DC&P 1-877-652-2873 SECTION 1: Member Information (complete all sections) Subscriber ID#: Member Name: DOB: Gender: Member Address: Medicaid ID#: Type of Services member receiving: Incident Reported to: APS OOIE DCP&P DC&P If reported, give date and time: If Police report filed, when and by whom? UHC Care Coordinator for member: SECTION 2: Critical Incident Information (complete all sections) Date/Time Incident Occurred: Date/Time Reported to UnitedHealthcare Clinical Quality Analyst: Who first reported incident to provider or UHC rep: member, POA/family, worker, Other Primary Medical Complexity: (check all that apply) Heart Condition (i.e. CVA, Hypertension, CHF) Muscular/Skeletal (i.e. Arthritis, Fracture) Neurological (i.e. Alzheimer s, MS, Head Trauma, Quadriplegia, Seizure Disorder) Psychiatric/Mood (i.e. Anxiety, Depression, Behavioral/Mental Illness, Psych Diagnosis) Pulmonary (i.e. Emphysema, Asthma, COPD) Sensory (i.e. Vision/Hearing Impaired) Date/Time Provider or UHC rep (CC etc) first learned of incident (discovery): Location of Incident: Private home, Facility-based setting: Comprehensive Personal Care Home, Nursing Facility, Pediatric Day Care, Adult Day Health Service/Medical Day Center, Assisted Living Residence, Social Day Center, Group Home/Boarding Home, Community Residential Service Home, Other_[name of facility], Community/General Public Area Infections (i.e. Pneumonia, TB, UTI) Other Diseases (i.e. Renal Failure, Cancer) 26

Critical Incident Reporting Form page 2 27

Critical Incident Reporting Form page 3 28

29 Unable to Contact & Gaps in Care

Unable to Contact Unable to Contact shall be defined as an MLTSS Member who is absent, without notification, from any program or service offered and MLTSS provider is unable to identify the location of the Member using contact information available. In the event that an MLTSS Member is unable to be contacted, MLTSS providers must take the following steps in investigating and reporting unable to contact events: 1. Immediate outreach to the client using contact information on file. 2. If no response, immediate outreach to emergency contact(s) for Member. 3. If unsuccessful to the above, immediately notify the Member s MLTSS Care Manager. 30

Gaps in Care Gap in Care - the difference between the number of hours or services scheduled in a Member s plan of care and the hours or services that are actually delivered to that Member. When a provider is aware of an upcoming gap in care, it is required to contact the Member before the scheduled service to advise him/her that the regular caregiver will be unavailable, that the Member may choose to receive the service from a back-up substitute caregiver, at an alternative time from the regular caregiver or from an alternate caregiver from the Member s informal support system. 31 Whenever there is a gap in services, the provider must contact the Member immediately, acknowledging the gap and provide an explanation as to the reason for the gap, and the alternative plan being created to resolve the particular gap and any likely future gaps. The provider must also notify the Member s MLTSS Care Manager of any gaps.

Credentialing, Re-credentialing, Criminal Background Checks & Demographic Changes 32

Credentialing with United Healthcare Community Plan (UHCCP) Requirements: 1. Complete Component Application from United Health Networks 2. Component Attestation Section MUST be signed and dated. 3. Complete Demographic Update Information Sheet from United Health Networks 4. Copy of Current and/or Renewed Malpractice Liability Insurance 5. W-9 Form 6. Current and/or Renewed License from The Division of Consumer Affairs 7. Current Medicaid and/or Medicare Numbers 8. Certificate of Accreditation from one of the following (if applicable): Community Health Accreditation Program (CHAP) Commission on Accreditation for Home Care, Inc. (CAHC) The Joint Commission (TJC) National Association for Home Care/Home Care University (NAHC) 33

Re-Credentialing with United Healthcare Community Plan (UHCCP) Requirements: 1. Review the pre-filled Component Application from UnitedHealthcare Community Plan 2. Update the pre-filled form with any applicable changes. 3. Sign and date the Attestation page. 4. Return the application with the following current documents to the address/fax listed on the cover letter. Copy of current State License Copy of Medicare Certification letter (if applicable) Copy of Certifications and/or Accreditation Certificates (e.g. TJC, CHAP, etc.) Copy of Declaration Sheet and/or Certificate of Insurance for BOTH Current Professional Malpractice and Comprehensive General Liability Insurance Policies 34

Criminal Background Checks Criminal Background Checks All employees and/or agents of a provider or subcontractor and all providers who provide direct care must have a criminal background check as required by federal and State law. All contracted providers conduct criminal background checks on all prospective employees/providers with direct physical access to MLTSS Members. 35

Demographic Changes All demographic changes must be sent to Adrienne Collins via any of the below methods: Fax: 877-382-9298 Mail: UnitedHealthcare Attn: Adrienne Collins PO Box1276 Sharon Hill, PA 19079 E-mail: adrienne_r_collins@uhc.com 36

37 Provider Advocate Program

We are the Provider Advocate Team Serves as your primary contact Acts as a navigational specialist when dealing with all areas of UnitedHealthcare Community Plan Maximizes your ability to interact with us Provides a heads up to your practice on critical programs and processes within UnitedHealthcare Community Plan Specializes in issue resolution Dedicated Provider Advocates: Estelle Adams-Wright: Phone: (732) 623-1953 E-mail: eadams_w@uhc.com Handles All MLTSS provider types except NH/SCNF, Medical Day Care and Licensed Home Care Agencies/Health Service Firms Monica Harris: Phone: (732) 623-1119 E-mail: monica_d_harris@uhc.com Handles Licensed Home Care Agencies/Health Service Firms 38

Claims Submission and Appeals 39

Provider Portal UnitedHealthcare Community Plan Online provides an easy and convenient access to manage your business with us and to reduce your time on the phone with our Provider Service Call Center. To register for our Provider Portal please go to: https://www.unitedhealthcareonline.com On the Portal, providers and their administrative staff can view: Verify Member Eligibility Review Benefits and Coverage Limits Submit Claims Check Claim Status Access Capitation Rosters View your Panel Roster Access Remittance Advice and Review Recoveries Review your Preventive Health Measures Report Submit Demographic Profile Changes 40

Membership Eligibility Verification ID Card - check for applicable co-pays Provider Help Line: (888) 702-2168 or www.unitedhealthcareonline.com 41

NJ MLTSS ID Card 42

Claim Submission -EDI EDI Support Services provides support for all electronic transactions involving claims, electronic remittances and eligibility. EDI Performance Management: Phone: (800) 210-8315 E-mail: ac_edi_ops@uhc.com UnitedHealthcare Community Plan Use Payer ID 86047 If you do not have office software and would like to submit directly, at no cost you, submission can be done through our vendor - Office Ally. Direct connections for health care claims via Office Ally is a simple, secure, and HIPAA-compliant solution offering you: Direct connectivity via the Internet No cost to providers...no installation, transaction, or support fees Free setup and training Easy to use (batch and single claims) 24/7 Customer Support Office Ally Enroll now at www.officeally.com, E-mail: info@officeally.com Call: (866) 575-4120 43

EFT and Electronic EOBs EFT to enroll online: Log on to UnitedHealthcareOnline.com. Select "Claims and Payments" from the top navigation bar, and then choose Electronic Payments & Statements" from the drop-down menu. Choose your Corporate Tax ID from the drop-down menu and click Continue. Choose your Physician/Provider Tax ID from the drop-down menu and click Continue. Complete the EPS Online Enrollment form and Continue Verify the information entered is accurate. If you need to make changes click Edit. If everything is correct click Submit. Print a copy of your enrollment for your records. Alternatively, you can download the enrollment form from UnitedHealthcareOnline.com and mail or fax to the location indicated at the top of the form. For assistance, call 866-UHC-FAST (866-842-3278) and select option 5. A representative will be able to assist you with enrollment questions, or online enrollment. Note: if you plan to route payments to accounts based on NPI, it is recommended that you call for assistance with enrollment. Electronic Remittance Advice (835): Contact your clearinghouse to request direct delivery of your UnitedHealthcare 835 files. Once we receive the request for 835s from your clearinghouse/edi vendor, it takes about 30 days to set up delivery of the ERA/835. 44

Claim Submission Coordination of Benefits (COB) Coordination of benefits (COB) is used when a member is covered by more than one insurance Claims Policy and Submission being provided for Dual Private Enrolled Duty Nursing. Members If the member is enrolled in a Commercial Insurance Plan and UnitedHealthcare Medicaid is secondary, the provider should first submit the claim to primary insurer. Then the secondary claim must be submitted on paper with the Commercial Insurance EOB attached to the claim to UnitedHealthcare 45

Claim Payment Appeal Process To resolve billing, payment, and other administrative disputes, such as: Lost/incomplete claim forms or electronic submission Requests for additional explanation as to services or treatment rendered by a provider Inappropriate or unapproved services initiated by providers Any other reason for billing disputes Claim payment disputes do not require any action by the member. 46

Claims Payment Appeals Submission Process Informal Claim Payment Appeal: Submit the UnitedHealthcare Community Plan of NJ Single Claim Resubmission Request Form outlining the resubmission request at: www.uhccommunityplan.com under the Provider Forms Tab. Form can ONLY be used for the following: Claim previously denied for Additional Information to process claim. Claim is being resubmitted as a Corrected Claim Claim is being resubmitted with Prior Authorization information Claim is being resubmitted because it was a Bundled Claim Claim previously denied/closed as Exceeding Timely Filing Include a copy of the claim in question, and submit all supporting documentation, if applicable, within 90 days from receipt the EOB/PRA to: UnitedHealthcare Community Plan Attention: Claim Administrative Appeals P.O. Box 5250 Kingston, NY 12402-5250 You can also submit your information through the Provider portal at www.unitedhealthcareonline.com or by calling the Provider Service Center at (888) 702-2168. Submission of an Informal Claim Payment Appeal does not replace the submission of a Formal Claim Payment Appeal. 47

Claims Payment Appeals Submission Process Formal Claim Payment Appeal: These appeals MUST be submitted to UnitedHealthcare utilizing the New Jersey Department of Banking and Insurance approved form: Health Care Provider Application to Appeal a Claims Determination (HCAPPA). If Provider submits a claim payment appeal using this form within 90 days following receipt of the EOB/PRA and UHCCP upholds the claim payment denial, the provider has the right to file an external Claims Arbitration via MAXIMUS. If Provider does not submit the original claim payment appeal on an HCAPPA Form, the provider does not have the right to a Claims Arbitration case; however, the appeal will be processed by UHCCP as an Informal Claim Payment Appeal. If UHCCP upholds a claim payment denial on an Informal Claim Payment Appeal, there is no 2 nd Level of Appeal Claim Payment decisions will be final. 48

49 Claim Billing Tips

15 Minute Unit Conversion Per every one hour of services performed, you should bill 4 units Per every half hour of services performed, you should bill 2 units Example 1: 6 hours of PCA or HBSC services provided would be billed as 24 units Example 2: 4 ½ hours of PCA or HBSC services provided would be billed as 18 units 50

Sample Per Diem Claim Below is a sample of a per diem claim was billed incorrectly. The date range is listed for multiple dates of service. The number of units billed exceeds one unit. In addition, the number of units does not match the number of days represented in the date range billed on the line. WRONG WAY 51

Sample Per Diem Claim Below is the correct way a per diem claim should be billed. The date range should be for one date of service per line. Each line should be billed with one unit to represent one date of service. Provider should bill their billed charges for each date of service. CORRECT 52

Sample Claim when more than one aide is providing services Below is the incorrect way a claim should be billed when multiple shifts take place on the same date of service. WRONG WAY 53

Sample Claim when more than one aide is providing services Below is the correct way a claim should be billed when multiple shifts take place on the same date of service. Each DOS must be billed on it s own line. CORRECT 54

Sample claim when billing monthly Below is the incorrect way to bill a claim when billing for a service that spans a month. WRONG WAY 55

Sample claim when billing monthly Below is the correct way to bill a PCA claim when services are rendered during the weekday and weekend. Each DOS must be billed on it s own line. CORRECT 56

Reminder: Key Contact List Web Portal (newsletters, bulletins, forms) - Provider Portal (claims, eligibility) www.uhccommunityplan.com www.unitedhealthcareonline.com Provider Services Line for MLTSS - (888) 702-2168 Prior Auth/Intake for MLTSS - (800) 262-0305 Health Services - (888) 362-3368 or Fax: (800) 766-2597 Member Services 24 Hour Help Line - (800) 941-4647 (TTY:711) TTY/TDD at (800) 852-7897 Demographic Change Fax (877) 382-9298 Credentialing Center Fax/E-mail (877) 620-3782 or NJ_MLTSS_CRED@uhc.com Medications requiring prior authorization (800) 310-6826 Fax: (866) 940-7328 Prescription Solutions (PSI) for Pharmacy specialty injectables - Fax: (800) 853-3844 57

Links to State Training Materials Resources for Providers: MLTSS Provider Communications: http://www.state.nj.us/humanservices/dmahs/home/al_crs_administrators_letter.pdf MLTSS Provider Frequently Asked Questions (FAQs): http://www.state.nj.us/humanservices/dmahs/home/mltss_provider_faqs.pdf The Comprehensive Medicaid Waiver: http://www.state.nj.us/humanservices/dmahs/home/waiver.html Resources for Consumers: MLTSS Consumer Communications: http://www.state.nj.us/humanservices/dmahs/home/mltss_consumer_communications.pdf MLTSS Frequently Asked Questions (FAQs): http://www.state.nj.us/humanservices/dmahs/home/consumer_faqs.pdf Frequently Asked Questions (FAQs) for Dual Eligible Special Needs Plans (D-SNP) and MLTSS Consumers: http://www.state.nj.us/humanservices/dmahs/home/faq_d-snp_mltss.pdf NJ FamilyCare Managed Care Health Plans: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/hmo/ Program of All-inclusive Care for the Elderly (PACE): http://www.state.nj.us/humanservices/doas/services/pace/index.html The Comprehensive Medicaid Waiver: http://www.state.nj.us/humanservices/dmahs/home/waiver.html Slide Presentations: MLTSS: The Choice is Yours: http://www.state.nj.us/humanservices/dmahs/home/mltss_consumer_slide_presentation.pdf 58

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