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Guidelines and Policies for Providers, Winter 2019

Oct 30, 2019
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Important information on claims review policy, routine supplies, services and medical equipment reimbursement, and itemized bill submission.

 

Community Health Options Claims Review Policy

Claims submitted to Health Options are evaluated for compliance with CMS coding and billing rules, any applicable contractual requirements, and our own policies. For transparency about the claim edits noted on your Bill Audit Review Summary Reports we include direct links to the applicable policy rules. The full Payment Integrity Audit Reimbursement Policy is available at https://healthoptions.org/media/2127/payment-integrity-audit-policy.pdf.

Healthcare providers are responsible for accurate and timely documenting, coding and billing to enable appropriate claims review. We recommend a proactive review of the policy to ensure compliance and reduce your claim denials. Please be particularly aware that claims lacking appropriate CPT or HCPCS coding and associated modifiers will not be guaranteed appropriate reimbursement.

Routine Supplies, Services, and Medical Equipment

Community Health Options uses the CMS definition for routine supplies and services that are considered bundled into a main procedure and are not reimbursable separately. This includes medical equipment, instruments, apparatuses, implements or items that are generally used for diagnostic or therapeutic purposes, are not implanted or incorporated into a body part, and are reusable. The Routine Supplies, Services, and Medical Equipment Reimbursement Policy is available at https://www.healthoptions.org/media/2031/routine-supplies-services-and-medical-equipment-06-27-19.pdf.

Itemized Bill Submission

Claims of $20,000 or more must include an itemized bill to be considered for payment. You can avoid payment delays by emailing the itemized bill to itemizedbill@healthoptions.org on the same day the associated claim is submitted. We may also request Itemized bills on claims identified for further review. The Itemized Bill Submission Reimbursement Policy is available at https://www.healthoptions.org/media/2033/itemized-bill-submission-07-15-19.pdf. 

For additional information on these, or other guidelines and policies, contact Health Options’ Provider Relations Team at (207) 402-3347.

SEE ALSO

Community Health Options is closely monitoring the progress of the virus and is coordinating with healthcare organizations and government agencies.

We are posting important information about the virus here, and will keep you updated as more facts become available.

Coronavirus Prevention

Until a vaccine is developed, the best way to prevent illness is to avoid being exposed to the virus. You can do that by taking the same steps you would take to prevent the spread of other respiratory viruses. That includes:

  • Cleaning your hands regularly and thoroughly with an alcohol-based hand rub or washing them with soap and water;
  • Maintaining at least six feet of distance between yourself and anyone who is coughing or sneezing;
  • Refraining from touching your eyes, nose and mouth, where the virus can be transmitted into your body;
  • Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze, then disposing of the used tissue immediately.

To avoid misinformation about COVID-19, look to trustworthy sources, such as the CDC, the World Health Organization, and local health departments websites to stay informed. 

You can access more information about coronavirus prevention on the CDC website.