Fax Telephone 855-454-5584 502-719-8600 9900 Corporate Campus Dr. Ste. 1000 Louisville, Ky. 40223 FAX To: From: <<Physician>> CoventryCares of Kentucky Fax: <<Location_Fax>> Date: December 9, 2013 Pages: 5 pages with cover Provider Relations Re: Updates Taxonomy Update Updated Provider Relations Representative Listing  Urgent  For Review  Please Comment  Please Reply  Please Recycle Notes: We appreciate your participation in the CoventryCares of Kentucky provider network and hope you find the enclosed information helpful. IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is STRICTLY PROHIBITED. If you have received this message by error, please notify us immediately and destroy the related message. To: From: Date: RE: CoventryCares of Kentucky Providers CoventryCares of Kentucky Provider Relations December 9, 2013 Updates 1. Taxonomy Requirement ******************** ATTENTION PAPER UB04 CLAIM SUBMITTERS ********************* Coventry Cares of Kentucky has received numerous UB04 paper claims this past week with the taxonomy code submitted in the wrong field. Institutional claims will reject for missing taxonomy code when the value is submitted in Field 57 on the UB04 form, which is titled “other ID”. The correct location for billing provider taxonomy code is Field 81 with a qualifier of B3. Please see the chart below for key fields on institutional paper claims. Data Element Billing Provider NPI Billing Provider TIN Billing Health Care Provider Taxonomy Attending Provider NPI Operating Physician NPI Other Provider NPI UB04 Field Locator Field 56 Field 05 Field 81 (Qualifier B3) Field 76 Field 77 Field 78-79 (With Qualifier: DN Referring, ZZ Other Operating Physician, 82 Rendering and NPI) If your claims are submitted on paper or being dropped to paper by your clearinghouse, please verify the correct placement of your taxonomy code. If you have submitted electronic claims without taxonomy numbers, you should have received the rejections through your clearinghouse. Paper claims and Medicare crossover claims submitted without taxonomy numbers will be denied. The following is a recap by type of claim and the rejection or denial that you will receive for the incorrect claim submission: Coventry Cares of Kentucky Reject Messages  EDI Claims When a rendering provider’s taxonomy code is missing from professional claims, a provider will receive back through their clearinghouse a Payer/Level 2 Reject messages that states: Rendering Taxonomy Missing/Invalid When a billing provider’s taxonomy code is missing from institutional claims, a provider will receive back through their clearinghouse a Payer/Level 2 Reject messages that states: Billing Taxonomy Missing/Invalid  Paper Claims When a rendering provider taxonomy is missing from paper professional claims, the claim will be denied for missing taxonomy number if the NPI is populated on the claim. When a billing provider taxonomy is missing from paper institutional claims, the claim will be denied for the missing taxonomy number. Again, if you need assistance with this change, please contact your Provider Relations Representative by dialing 1-855-454-0061. Thanks for your prompt attention to this matter. 2. Benefit and Co-Pay Change Notice The Kentucky Department for Medicaid Services is implementing new and modified “essential benefits” for the Kentucky Medicaid program effective January 1, 2014 to comply with the Affordable Care Act. In addition, member co-pays will be modified. CoventryCares of Kentucky intends to adopt the co-pays being implemented in the Kentucky Medicaid Fee-For-Service program. We will modify our coverage to include the revised benefits. Highlights of the changes follow. More detailed information will be sent out upon approval of the benefit changes by the Centers for Medicare & Medicaid Services. Benefits changes include:  Increased visit limits for physical therapy, occupational therapy and speech therapy  Expansion of allergy testing and shots to include all ages  Expanded substance use and behavioral health benefits   Addition of private duty nursing benefits Expanded preventative health services Co-pays will be:  $4  $3  $3  $3  $4  $50  $1  $4  $8  $8 3. outpatient hospital or surgery office visits (medical, dental, vision) therapy visits (PT, OT , ST) lab, diagnostics and radiology durable medical equipment inpatient stay generic drugs preferred drug list drugs non-preferred drug list drugs non-emergency us of ER Provider Representative Listing Update Providers in Region 5 – please see the attached update to the provider representative list. Who is my Provider Relations Representative? Region 1 Region 2 Region 3 Region 4 Ballard Christian Breckinridge Adair Anderson Region 5 Region 6 Region 7 Boyle Boone Bath Bell Region 8 Leslie Caldwell Daviess Bullitt Allen Bourbon Estill Campbell Boyd Breathitt Letcher Calloway Hancock Carroll Barren Clark Fayette Gallatin Bracken Clay Magoffin Carlisle Henderson Grayson Butler Franklin Garrard Grant Carter Floyd Martin Crittenden Hopkins Hardin Clinton Harrison Jackson Kenton Elliot Harlan Owsley Fulton McLean Henry Cumberland Montgomery Jessamine Pendleton Fleming Johnson Perry Graves Muhlenberg Jefferson Edmonson Nicholas Lincoln Greenup Knott Pike Hickman Ohio Larue Hart Owen Madison Lawrence Knox Whitley Livingston Todd Marion Logan Scott Mercer Lewis Laurel Wolfe Lyon Trigg Meade Metcalfe Woodford Powell Mason Lee Rockcastle Menifee Marshall Union Nelson Monroe McCracken Webster Oldham Pulaski Shelby Russell REGION 4 Robertson Spencer Simpson Casey Rowan Morgan Trimble Taylor Green Washington Warren McCreary Wayne Illinois Indiana All Other States Tennessee Central Nashville Missouri North Carolina Ohio W. Virginia Pennsylvania Virginia Knoxville - TN Regina Gullo Kimberly Berry Lesley Lewis Phillip Kemper Sherri Briscoe Sherri Briscoe Jennie Cahill Donna Moor Jacqulyne Pack Jacqulyne Pack (502) 612-9958 (812) 660-1394 (502) 719-8743 (502) 719-8604 (502) 719-8764 (502) 719-8764 (859) 412-0052 (502) 689-3629 [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] (606) 331-1075 (606) 331-1075 [email protected] [email protected] **FOR INITIAL OR GENERAL INQUIRIES CALL CUSTOMER SERVICE AT 1-855-300-5528** Revised 12.09.13 T Koreck