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Hospice nursing home webinars scheduled

8/8/2013
You are cordially invited to attend one of the following WV C3 Hospice Nursing Home Transition for Revenue Code 0658 Webinars.

 
WV C3 HOSPICE NURSING HOME TRANSITION FOR REVENUE CODE 0658
Meeting Location: https://apshealthcare.webex.com
Starting date: Tuesday, August 20, 2013
Starting time: 11:00 am
Meeting number: 493 027 837
Meeting password: None
Audio conference: Audio is a separate function.
Please call 1.888.330.1716
Use Access Code 8489942

WV C3 HOSPICE NURSING HOME TRANSITION FOR REVENUE CODE 0658
Meeting Location: https://apshealthcare.webex.com
Starting date: Thursday, August 22, 2013
Starting time: 1:00 pm
Meeting number: 497 348 915
Meeting password: None
Audio conference: Audio is a separate function.
Please call 1.888.330.1716
Use Access Code 8489942

WV C3 HOSPICE NURSING HOME TRANSITION FOR REVENUE CODE 0658
Meeting Location: https://apshealthcare.webex.com
Starting date: Tuesday, August 27, 2013
Starting time: 11:00 am
Meeting number: 490 811 842
Meeting password: None
Audio conference: Audio is a separate function.
Please call 1.888.330.1716
Use Access Code 8489942

WV C3 HOSPICE NURSING HOME TRANSITION FOR REVENUE CODE 0658
Meeting Location: https://apshealthcare.webex.com
Starting date: Thursday, August 29, 2013
Starting time: 1:00 pm
Meeting number: 493 541 089
Meeting password: None
Audio conference: Audio is a separate function.
Please call 1.888.330.1716
Use Access Code 8489942

APS Healthcare, in conjunction with WVMI, the Bureau for Medical Services, and Molina would like to alert you to some updates to the current Prior Authorization Process for Hospice services provided to WV Medicaid members in Nursing home (NH) care (Revenue code 0658).

Beginning on September 1, 2013, Hospice revenue codes 0651-0656 that are submitted untimely (post 7 days from date of admission) will be denied for policy unless retrospective policy is met (retroactive Medicaid or TPL). Please ensure that you have all 2012 and 2013 Hospice prior authorizations up to date at this time. We would also ask that you endeavor to be as current as possible with 0658 claims in Molina to facilitate your transition to the new system which is described in the remainder of this notice.

Also, beginning September 1, 2013, providers will enter authorization requests for members in Nursing Home care who elect Hospice services (revenue code 0658) through the APS Medical CareConnection® (known as C3). As of this date, APS will do the pricing for these requests based on the established formulas instead of the current process of going through Molina for pricing. Molina will now pay claims based on prior authorization and pricing of revenue code 0658 completed by APS. Prior authorization (PA) will be granted for the election period (the C3 system will reflect a status medical necessity is met pending pricing) and pricing will be sent to Molina for the PREVIOUS month with a corresponding prior authorization number. See the example below for a member’s current 90 day election period that spans 5/10/13 – 8/7/13, with a Prior Authorization granted (Medical Necessity Met Pending Pricing) on 5/12/13.

Authorization Dates with Pricing Month Authorization Created
5/10/13 – 5/31/13 June 2013
6/1/13 – 6/30/13 July 2013
7/1/13 – 7/31/13 August 2013
8/1/13 – 8/7/13 September 2013

Using the example above, if another authorization request is submitted for a subsequent election period, the September 2013 authorization would span 8/1/13-8/31/13, and so forth, through election period 2 and any subsequent election periods until the member is discharged. If a member is discharged, the existing monthly authorization for the month of discharge will be pro-rated as necessary. Providers may bill for the previous month as soon as the PA is in place. Documentation requirements are the same as with any other Hospice code. The process for sending the request is also the same as any other Hospice code-request the election period and choose service code 0658.

If you have questions please contact APS at 1-800-346-8272 or e-mail us at wvmedicalservices@apshealthcare.com.
Please direct claims inquiries to Molina Customer Service at 1-888-483-0793.