This past month, the managed care plans have published updates on events and policy changes impacting their organizations.
- Reminder: SL Modifier for Vaccine for Kids (VFC) Claims: Effective March 1, 2023, AmeriHealth Cartias VFC claims received without the SL modifier and/or the billed amount will be denied for providers participating in the VFC program. Use of the “SL” modifier to indicate the provider is participating in the program. The SL modifier must be listed on the administration and all associated immunization & toxoid lines of the claim. By applying the SL modifier, this will indicate no reimbursement of the associated toxoid/ immunizations. Toxoid/Immunization CPT codes must be submitted with a charge amount greater than zero. Providers will receive reimbursement for the administration of the vaccine only. Click here to read the full notification.
- Guidance Regarding 270 Eligibility Inquiry, Claim Submissions and Payer ID: Effective February 1, provider claims and 270 Eligibility Inquiry submission to trading partners through the Ohio Department of Medicaid Fiscal Intermediary should include the 12-digit ODM assigned Medicaid member ID (MMIS). To ensure you do not receive mismatched data errors during the transition, the 271 Eligibility Responses will match your 270 Eligibility Inquiry. This change will be effective on Feb. 14, 2023. Click here to read the full update.
- 2023 Quarter 1 CareSource Live Instructor-Led Provider Training and Education Series: CareSource has announced their 2023 quarter 1 live instructor-led training and education series. Click here to view the quarter 1 calendar and information on how to register
Humana Healthy Horizon Update:
- Updates to some Humana Healthy Horizons in Ohio Member ID cards: Humana posted a network notification making practices aware that some Humana Healthy Horizons in Ohio Medicaid member ID cards were sent out with values mismatched under Member ID Number and Plan ID Number fields. The Member ID Number is showing up in the Plan ID Number field, and vice versa. Patients are being re-issued new ID Cards and the online versions under their MyHumana accounts are accurate. However, Humana communicated when using the Member ID Card for billing, please use the field that begins with the number and not the letter H. Click here to read the full network notification.
- Molina Legacy Provider Portal Sunsetting: Effective March 28, 2023 the Molina Provider Portal will sunset. Providers will no longer be able to access the Molina Provider Portal and its functions directly. Availity Essentials (Availity) is now the official, secure provider portal for Molina providers. If your organization is not yet registered for Availity Essentials, visit Availity.com/MolinaHealthcare and select the Register button. For registration issues, call Availity Client Services at (800) AVAILITY (282 4548) Monday-Friday from 8 a.m. to 8 p.m.. Click here and scroll to the bottom of page 4 to read more about this change.