Urgent Claims Notification for Skilled Nursing Facilities

Bridgeway has identified a payment issue with a small percentage of SNF claims that were processed on the check run for May 7, 2013 that has resulted in zero-dollar claim payments.  Bridgeway has corrected the issue and is currently in the process of appropriately reprocessing the claims to pay at the correct amount.  If you have any questions on this issue please contact the Bridgeway claims department at 866-475-3129.

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Please take note that the Bridgeway Payer ID Code for Emdeon has been changed.  The new Payer Code is 68069.

Agency with Choice is a new member-directed option that will be available to home-based ALTCS members beginning on January 1, 2013.  Under the Agency with Choice option, the provider agency and the member enter into a co-employment relationship and share employer-based responsibilities for the paid caregiver. The provider agency maintains the authority to hire and fire the caregiver and provide or arrange for the required minimum standardized training for the caregiver.  The member, or their individual representative, may choose to assume one or more of the following employer-based responsibilities:

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Section 1202 of the Affordable Care Act requires that Medicaid reimburse designated primary care providers who provide primary care services and vaccine administration services at rates that are not less than the Medicare fee schedule in effect for 2013 and 2014, or, if greater, at the payment rates that would result from applying the 2009 Medicare physician fee schedule conversion factor to the 2013 or 2014 Medicare payment rates. These reimbursement requirements apply to dates of service between January 1, 2013 and December 31, 2014. To receive the enhanced payment, CMS requires that physicians meeting one of the required criteria provide a “self-attestation” to AHCCCS verifying that they qualify for the enhanced payment through either the requisite Board certification or the 60% CPT code requirement. This means that before AHCCCS or its Contractors can provide an enhanced payment, the physician must submit an Attestation form.

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