Molina Healthcare of Ohio has released their October Provider Bulletin. Below are some tidbits from the bulletin related to SNFs.
Updated Provider Information Update Form: Molina Healthcare has made several changes to the Provider Information Update Form (PIF), including:
As a reminder, this form is used to notify Molina of demographic or informational changes. The form is available on our website under the “Forms” tab. Send the completed form to one of the following:
- no longer requiring signatures in Attachments A, B and D
- the addition of the Americans with Disabilities Act (ADA) Attestation Form
- separate sections for individual or group service location changes and additions
Fax: (866) 713-1893
Mail: Molina Healthcare of Ohio,
P.O. Box 349020,
Columbus, Ohio 43234-9904
New Post-Acute Provider Intake Form: The new Molina Post-Acute Care (PAC) Provider Intake Form is coming soon to our website! The PAC form should be used for all post-acute admission and continued stay requests. It can help you receive a faster response from Molina by increasing our efficiency in processing requests by having all required information available on one form. Look for the PAC form in the “Forms” tab, under “Other Forms and Resources.” For questions contact us at (855) 322-4079.
Nursing Facility Care Coordination Visit Guide: The "Nursing Facility Care Coordination Visit Guide" is available on the MyCare Ohio website under the “Manual” tab. This guide is intended as a tool to help Nursing Facility staff understand the types of visits Molina staff make to members and the purpose of each visit including compliance related, transition of care and acuity visits.
Notice of Changes to Prior Authorization (PA) Requirements: The Oct. 1, 2018, PA Code List is located on our website under the “Forms” tab. Molina updates the PA Code list quarterly. Always use the list available on our website, do not print the list.
Provider Training Sessions: Molina is offering monthly training sessions!
Provider Portal Training:
Thurs., Oct. 25, 2 to 3 p.m. meeting number 803 201 694
Wed., Nov. 21, 2 to 3 p.m. meeting number 807 808 195
Claim Submission Training:
Tues., Oct. 23, 1 to 2 p.m. meeting number 805 700 653
Tues., Nov. 27, 1 to 2 p.m. meeting number 807 743 754
Click “Join” at WebEx.com or call (855) 655-4629 and follow the instructions. Meetings do not require a password.
Corrected Claims: Corrected claims must be received by Molina by the filing limitation stated in the provider contract.
Submission of Corrected Claims: Corrected claims must be submitted with the Molina claim ID number from the original claim being corrected, and with the appropriate corrected claim indicator based on claim form type.
Corrected claims received without this information will not be accepted and will receive the following denial information on the Molina remittance:
Category Code A3
Status Code 748
Entity Code 41
Error Description "Missing incomplete/invalid payer claim control number"
Submission of Final Claims after Interim Billing: Inpatient facility claims billed on a UB claim form, bill type 0117 are no longer accepted as the final original claim. Facilities which have submitted interim claims should submit a final claim upon patient discharge using the 0111 bill type.
Please Remember: Corrected claims are used to change or add information to a previously submitted claim. Corrected claims should be sent through the original claim submission process with a corrected claim indicator and Molina claim ID number as outlined in the Corrected Claim Billing Guide, located on our website. Corrected claims are not adjustments. Find additional information in our Provider Manual under the “Claims and Encounter Data” under “Claim Corrections.”
Outpatient Therapy Caps: In accordance with the Bipartisan Budget Act (BBA) of 2018, Medicare claims are no longer subject to the therapy caps: one cap for occupational therapy services and one cap for physical therapy and speech-language pathology combined. For Molina Medicare Plans, claims for therapy services above a certain amount of incurred expenses, which is the same amount as the previous therapy caps ($2,010 in 2018), continue to require prior authorization.
ODJFS provides guide for protecting elders
The rules requiring more professionals to report elder abuse go into effect tomorrow. Professionals such as CPAs and lawyers are obligated to report suspicion of elder abuse or risk criminal charges and fines up to $500. The Ohio Department of Jobs and Family Services has created a guide to help people comply with the latest regulations. Please click here to learn more about the requirements and download the guide in a PDF format. You can also learn more about elder abuse, including how to recognize warning signs and who to call if you suspect abuse, neglect or exploitation, by visiting the Ohio Department of Aging's Elder Abuse webpage at www.aging.ohio.gov/elderabuse.
- Click Here to read The Academy Weekly in PDF format