For provider reconsiderations, will Amerigroup allow any other spreadsheet format other than Excel?

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1 JUNE 0.IMGMA Panel of Payers Event Q&A Index: 74, 76, 79, 5, 6-4, 3, 76, 79,, IME 4 39, 73, 76, 79, 7,, 94 Payer IME UHC - UHC 40-4, 75-7, 0,, 90, 9, 93 United Hecare 5,6, 7,, 9, 43-47, 5-65, 76, 79 United Hecare 66-7, 76, 79 0, 4-57, 76, 79, 9 Question Will an informational letter be sent to providers advising the UA, CPT 003 should be billed with modifier 59? IME will be the issuer of the letter if they deem necessary. IME 3 IME UHC - UHC UHC - UHC For provider reconsiderations, will allow any other spreadsheet format other than Excel? Excel is the standard format. Are provider reps on website? Yes, the maps are shown on the website.

2 JUNE 0.IMGMA Panel of Payers Event Q&A 4 IME IME How do you want a twin baby delivery billed? UHC - UHC The use of the appropriate modifier is required with twin billing. When are the updates on Availity available? UHC - UHC Updates will be effective on 9//. IME UHC - UHC Do you feel is financially sound and here to stay with the new MCO coming to Iowa? is committed to the Iowa Market. 3 UHC - UHC Has the SE modifier issue been fixed?

3 JUNE 0.IMGMA Panel of Payers Event Q&A IME 4 IME UHC - UHC Can we sign up for your newsletter on your website? At this time, it is only shown on the website. We are working towards an blast program. 5 IME For Cpt codes 00 to 003 should a modifier be used for our OB patients because we are getting paid without one? UHC - UHC A modifier should be used when the CPT is deemed to be separate and payable from other CPT codes on the claim. 6 IME UHC - UHC Why are there so many recment s on older claims? Changes is regulatory issues have caused numerous recment projects. is working issues as quickly as possible.

4 JUNE 0.IMGMA Panel of Payers Event Q&A Where are the Obstetric billing guidelines on your website? 7 IME UHC - UHC Billing guidelines are shown on the website under provider resources and quick tools. 9 IME IME UHC - UHC UHC - UHC Why do you restrict ultrasound coverage on patients? We have many ultrasounds claims that have not been paid. IME paid our ultrasound claims without issue. CG-MED htm&na=onlinepolicies&rootLevel=0&label=Over Why are you still denying OB ultrasounds with diabetes diagnosis codes? We were told this issue was fixed over a year ago. CG-MED htm&na=onlinepolicies&rootLevel=0&label=Overview 0 Are claim currently denying? Why are some tests in a post service review mode on AIM?

5 JUNE 0.IMGMA Panel of Payers Event Q&A UHC - UHC IME Results are needed for some tests and using the post service model, it allows those results to be recorded in the member s file. IME UHC - UHC Why are hysterectomy claims being denied for the sterilization consent form when they are not being done for sterilization? One standard form is used for these types of procedures. We are working on re-education with processing reps to understand when the form is needed. IME UHC - UHC Does follow IME billing guidelines? may have different guidelines due prior authorization guidelines. typically follows CMS guidelines. 3 UHC - UHC Why do our refund checks get separated from the documentation attached and then sit for long periods of time without being applied to the correct claims?

6 JUNE 0.IMGMA Panel of Payers Event Q&A IME CCU has been working to clean up backlog where this issue occurred. Please let you rep know if this is still occurring. 7 6 IME UHC - UHC When we bill bilateral knee injections, code 060 with modifier 50, we are not being reimbursed for the appropriate # of units for the Kenalog, code J330. We use 0 units in each knee to total of 0. We are only getting reimbursed for 6, due to max # of units. How do we get paid for full 0 units? We have tried J330 on two lines with 0 units on each line as well as J330 on one line at 0 units. Submitted by: Toni Sitzmann Family Hecare of Siouxland Sioux City Toni.sitzmann@fhcsl.com Response Please include medical documentation with the claim or the appeal for clinical review. 7 9 IME UHC - UHC Is incident to- billing allowed and if so are the rules the same as? If not the same rules, what are they? Submitted by: Toni Sitzmann Family Hecare of Siouxland Sioux City Toni.sitzmann@fhcsl.com Response Further explanation will be needed for review. IME UHC - UHC Sleep Study denials authorization is obtained from facility where study is done. When sent to our office for our neurologist to read they are denying for no auth. The auth the facility uses should be our auth also. Submitted by: Gina Ross CNOS Dakota Dunes, SD Gina.ross@cnos.net Response Please submit claims to provider rep for help in review.

7 JUNE 0.IMGMA Panel of Payers Event Q&A Backlog of claims not paid what is the timeframe to get paid? 4 IME UHC - UHC Submitted by: Robin Higdon-Fleming Medical Associates of Clinton - Clinton rhfleming@maclinton.com Response Your claims are being reviewed by Operations. Please remember the timely filing guidelines as stated in the provider manual. 5 IME UHC - UHC Are we able to bill both the distant site was well as the originating site if we enroll the providers with our facility/gr? Submitted by: Mariah Ballantyne Trinity He Mason City ballantm@trinity-he.org Response Claim example will be needed for additional review. 6 IME UHC - UHC We are using POS home for CPT codes 93793, G049, G050 for home INR s. Is this the correct POS per your policy? Reached out to payers have inconsistent answers. WebCare reps state we should be using POS (office). Submitted by: Crystal Euchner McFarland Clinic Ames ceuchner@mcfarlandclinic.com Response Please follow CMS guidelines.