I fell behind in my caresource payments

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At initial appointments, we will go over your Health Assessment that you filled out online prior to your appointment or when you arrived at our office. Once we go over your Health Assessment and discuss your goals, we will dig into FOOD… what you should be eating, what a typical day should look like, etc.

We will brainstorm meal and snack ideas that fit into your lifestyle but also nudge you to improve your eating and stress, exercise, sleep habits to further improve your health. In the beginning we may see clients more often weekly, bi-weekly, monthly but once you are in the maintenance phase, you may only schedule a couple times a year to check in.

Again… whatever works for YOU! Us too! We set aside minutes for most initial appointments, although the time can be split between appointments if you cannot stay for the full time we understand. Follow-ups totally depend! Some clients have quick 30 minute appointments to check in and stay accountable, whereas other clients spend ninety minutes with us to follow-up.

Most of our clients have health insurance that pay for the cost of their appointments with us. Many other insurance companies have great out-of-network coverage, too. Insurance coverage varies greatly and is dependent on individual policies and medical diagnoses.

We encourage you to check with your insurance company to determine if Medical Nutrition Therapy is a covered benefit. You will be responsible for any balance not covered by insurance.

Use our Insurance Coverage a document that provides the codes we use to bill and walks you through what questions to ask your insurance provider, to determine if they will cover your visits with us. If you must cancel your appointment please do so by email or phone, 48 hours prior to your scheduled appointment. Emergencies may be exempt, at the discretion of the dietitian. To get to our office, enter the building and go up to the third floor.

Turn right out of the elevator and down the hallway to suite You will see the WIM office with Dr. Angela Rouse, Dr. Our third office is located in Dublin, OH at 75 S. Parking is available behind the office in a private parking lot or on the street in front of the office. Our office is located at the private entrance on the left side of the house if looking at the front of the house.

We have availability on Mondays — Saturdays. We also have evening availability, too! Currently, Jackie, Jaclyn, and Emma are seeing clients at the Westerville office.

All of our dietitians can see clients virtually as well! Please go to our scheduling page to check their availability and schedule an appointment! Currently, Jackie and Jenna are seeing clients at the Dublin office. Instead, coinsurance must be billed separately to the MyCare plan that provides the person's Medicaid benefits. To qualify for the Medicare cost report - which determines bad debt payments for and interim payments for - a zero pay remit must be issued by December 31, , about 40 days from now.

Accordingly, billing these claims now is critical. OHCA is engaged with all five MyCare plans to ensure that each plan issues appropriate remittance advices for bad debt purposes.

We also submit specific examples of remits from the plans to CGS for approval. At this time, the MyCare plans are in different places. Molina Healthcare is generating remits with the necessary wording in response to coinsurance claims billed according to standard billing practices. Laura Wheeler of Buckeye Health Plan informed us that as of November 12, , Buckeye corrected an error in their system and now is doing the same.

Previously, providers had to remove RUG codes from the coinsurance claims to get zero pay remits instead of denials from Buckeye. Aetna also seems to be providing acceptable zero pay remits, although we need to verify that with CGS. United Healthcare and CareSource, however, often pay the coinsurance or a different amount instead of issuing a zero pay remit. Both plans said they would quickly look into this problem and provide an update to us.

We also emphasized to all five plans that providers need rapid turnaround on coinsurance claims to meet the December 31 deadline. If you have submitted coinsurance claims to one or more of the plans and have not received a response, please feel free to send a spreadsheet of those claims to Pete Van Runkle or Diane Dietz , and we will follow up with plan key contacts for coinsurance issues.

While the numbers will be greater starting in January, there already are some dual enrollees, and OHCA members are filing a few skilled claims with MyCare plans. To aid in our discussions with the plans, we very much would appreciate examples from you showing how the plans currently are handling skilled claims. Specifically, we need copies of UB04 claims and remittance advices for skilled claims submitted to each of the plans - either paid or not paid.

In the case of claims that have been pending for a period of time, a copy of the plan's portal showing the pending claims, along with the UBs, would be helpful. Medicare MyCare Participation All MyCare Ohio beneficiaries and new enrollees have the right to have their Medicare benefits covered by their MyCare health plan or to opt out of the Medicare portion of MyCare - the portion that allows "integration" of all of the beneficiary's services.

Please be aware of some key facts about opting out:. If a beneficiary opts-out after January 1, once their enrollment has become effective they will automatically be returned to original Medicare and temporarily enrolled in the Limited Income Newly Eligible Transition program LI Net for their Part D benefits.

If the beneficiary does not select a Part D plan within 60 days, one will be selected for them. As a reminder, any dual eligible individual who has a Medicare supplement Medigap policy or other creditable third party coverage generally not including Medicare Advantage cannot participate in MyCare Ohio for either Medicare or Medicaid. Use the ODM form to notify the department of third party coverage. Molina Authorization Renewal MMolina Healthcare only authorizes custodial SNF care in 6 month increments, which means that new authorizations will be needed soon.

Please use the spreadsheet to fax in your list of Molina patients, or you may call Molina at A reminder from Molina's Ami Cole: the plan does not require an authorization number on the claim form.

Additional information is available in the Molina SNF frequently asked question document. This form is designed to allow skilled centers to correct erroneous patient liability data that MyCare plans use to pay claims. It is essential that you submit, with the spreadsheet, forms supporting the patient liability amounts you enter on the spreadsheet.

The plan will not be able to reconcile the claims without the documentation. The plans in general still appear to be paying a large percentage of claims incorrectly, often because of patient liability errors.

Please note that assisted living providers should not use the reconciliation spreadsheet. The health plans and the Area Agencies on Aging AAAs are working on a separate process whereby the AAAs will update the plans on client liability changes for Medicaid assisted living consumers.

Other Patient Liability Notes Relative to SNF claims, Buckeye Health Plan tells us they are reconciling erroneous payments themselves and taking back the overpayments without the provider having to use the spreadsheet.

Molina Healthcare sent to their providers a detailed communication explaining that they implemented a system fix on November 13, , that allows them to start deducting patient liability.

Like Buckeye, Molina will reconcile past, incorrectly paid claims themselves, as described more fully in their bulletin.

We believe for both plans, a portion of the adjusted claims still will have wrong patient liability because of inaccurate data provided by the Department of Medicaid. In those cases, use the reconciliation spreadsheet to report the errors. Both Buckeye and Molina say they will complete the recoupments by the end of the year.

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