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Vision Providers...
Effective October 1, 2000, until Upper Peninsula Health Plan (UPHP) begins standardized billing, we have cross walked the 41XXX series for optometrist. All claims that were submitted
with this series and denied must be re-billed with these crosswalks.
Effective August 1, 2001, UPHP will be following the Medical Services Administration (MSA) Policy Manual update for standardized billing, with the following exception: Attachment 3, Michigan Modifiers - do not
use VC, VH, or VI modifiers. Claims billed with these modifiers will be denied.
Are You Using a Clearing House?
It is the responsibility of the provider, using a clearing house for claims processing, to ensure the credibility of the clearing house and that they provide clean claims to
the claims processor. Some Electronic Data Interface (EDI) claims are being sent to clearing houses and dropped to a hard copy that’s missing several fields of information. These claims will not be reimbursed.
EPSDT
When billing for Early and Periodic Screening and Diagnostic Testing (EPSDT), be sure that all 21 components are accomplished, per the MSA policy guidelines. When seeing a patient for immunizations
only, bill Evaluation and Management (E/M) Clinic Codes, not the E/M Preventive Codes. Diagnosis codes V20.0 can be billed with E/M Clinic Codes 99201 through 99215.
Other Health Insurance
STAPLE the primary remittance advice to the UPPER, RIGHT CORNER of each claim you submit. This will prevent separation of documents.
Corrected Claims
All corrected claims must have supporting documentation STAPLED in the UPPER, RIGHT CORNER of the resubmitted claim. They also must have “Corrected Claim” indicated in block 19 of the HCFA
form and block 84 of the UB92 form.
Diabetes Education
Only one
Diabetes Self-Management Education Training Program may be billed in a six-month period, regardless of the number of visits needed for completion of the program. The MSA Policy Manual is very specific in this regard. This service
will not be covered if rendered by a physician in the office setting. Medicaid does not
cover Diabetes Self-Management Education services rendered by a non-enrolled provider or non-Community Public Health (CPH) certified facility. Reference MSA manual, Hospital, Chapter III, section 11, page 1, updated October 1, 2000 (Hopsital 00-06) - Bill Rev Code 942 for more information. This
can not be series billed. You must bill it with the last date the beneficiary was seen for Diabetes Self-Management Education, using “1” as the unit.
Overpayments
If you receive an overpayment from Wausau, send a copy of the Remittance Advice along with your check to Upper Peninsula Health Plan, 228 W. Washington St., Marquette, MI 49855.
If you receive an overpayment from UPHP’s new Third Party Administrator (TPA), DO NOT send a check. Notify UPHP to have the claim offset. Any checks sent to UPHP without supporting remittance advice(s) will not be
returned.
Modifier - 50, Bilateral Procedure
Bill the first line without the modifier and the second line, same code, with
the modifier in order to be paid appropriately. Your claim will be paid at 100% of UPHP’s fee schedule for the first line and 50% for the second.
Please contact UPHP Claims Services at 1-800-835-2556 if you have any questions regarding claims processing.
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t UPHP have the most current information on file. To assist UPHP in
providing you, as well as its members, with the best possible customer service, please contact UPHP in writing with any changes or corrections. For more information, call UPHP Customer Service.
Upper Peninsula Health
Plan’s (UPHP’s) Customer Service Department and one will be sent to you.
logy (CPT) codes (i.e., 90801 through 90887, per Medical
Services Administration (MSA) Manual). There are several behavioral health CPT codes that are not covered by Michigan Medicaid. Please do not bill them.
According to the American Academy of Family Physicians, health care
providers should routinely monitor growth patterns for all infants at ages 2 weeks, 2, 4, 6, 12, 15, and 18 months, and at least annually for children through adolescents thereafter. UPHP’s population consists of
70% members under the age of 18. An assessment of the monitoring practices of UPHP providers was recently conducted by a retrospective medical record
review on a representative sample of members, 0-18 years of age, during the calendar year 1999. The areas assessed were weight and height documentation and whether or not a growth chart was present and utilized.
rescheduled.
represent the level
of care your patients and our members receive. If you would like more detailed information on HEDIS indicators, please contact our Clinical
Services Department at 1-888-904-7526 or 906-225-7500 and speak with Carolyn, Tina or Marcie.
MIChild program participant? When UPHP MIChild recipients join the plan, they are given a UPHP MIChild card, which lists the members social security number as
the Recipient ID number. The benefit and authorization process mirrors that of UPHP’s Medicaid program. Be on the lookout for these cards so that there is no delay in the billing process.
Please contact UPHP Customer Service with any questions.
During the transition time, Upper Peninsula Health Plan (UPHP) experienced some
technical difficulties with its 1-800-835-2556 line. UPHP apologizes for any inconveniences this may have caused you. The line is now up and running, and it is accessible
nationwide. UPHP encourages you to use this line when calling Upper Peninsula Health Plan so that we may address your concern in a more timely and efficient manner. We hope that
using this phone line will make your experience with Upper Peninsula Health Plan a positive one. Please contact Customer Service if you have any further questions.