How to Become A 3 rd Party Provider Addressing: Preparation for enrolling with a 3 rd PartyPreparation for enrolling with a 3 rd Party Contact information for 3 rd Parties in Nebraska Contact information for 3 rd Parties in Nebraska

Disclaimers This information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD. To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free. It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.

Disclaimer The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services. The Nebraska Optometric Association, and its presenters, agents, consultants and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.

4 Enrolling as a Provider Multiple page application forms with considerable documentation: copies of NPI (National Provider Identifier)NPI (National Provider Identifier) Optometry DiplomaOptometry Diploma State LicenseState License DEA Registration (need it)DEA Registration (need it) Proof of Malpractice InsuranceProof of Malpractice Insurance Photo IDPhoto ID …plus more in some cases Turn-around time : weeks to months Turn-around time : weeks to months

5 NPI (National Provider Identifier) Need before enrolling as any provider Need before enrolling as any provider Need a separate NPI for Need a separate NPI for –Each doctor (only one NPI for any doctor), –Each office location, –Each separate business entity (optical dispensary may need separate NPI if has a separate tax ID number) Enrolling as a Provider

6 NPI (National Provider Identifier) Exception: Sole Proprietor (Not a PC or partnership, etc.)… Exception: Sole Proprietor (Not a PC or partnership, etc.)… –Only one NPI total (represents both doctor and her/his practice). –Get specifics at Enrolling as a Provider

7 NPI enrollment information found at National Plan and Provider Enumeration System (NPPES)National Plan and Provider Enumeration System (NPPES)

8 NPI (National Provider Identifier) Information on NPI application must match information on Information on NPI application must match information on – Medicare B application (855i and 855b) – Medicare DME application (855s) – IRS information (Employer ID number, etc) Enrolling as a Provider

9 Contacts to Become a Provider Routine Care (July 2011) Routine Care (July 2011) –Avesis –EyeMed (Eyecare Plan of America) –Optum (Spectera) – Vision Service Plan (VSP)

10 Contacts to Become a Provider Standard Medicaid Standard Medicaid Via Nebraska Dept. of Health & Human Services Via Nebraska Dept. of Health & Human Services Both Routine & Medical Both Routine & Medical Patients age 65+ &/or in nursing home Patients age 65+ &/or in nursing home

11 Contacts to Become a Provider Medicaid Managed Care Organizations (MCOs) –MCOs cover all Medicaid patients that are not also covered by Medicare. MCOs cover Medical Diagnoses Medical Diagnoses Routine Care (sub-contracted) Routine Care (sub-contracted)

12 Contacts to Become a Provider Medicaid Managed Care Organizations (MCOs) –State divided into two parts, each having two MCOs MCOs for Eastern 10 counties: MCOs for Eastern 10 counties: –UnitedHealthCare Community Plan (United HealthCare) –Coventry Nebraska (Coventry) MCOs for Other 83 Counties: (starting July 1, 2012) MCOs for Other 83 Counties: (starting July 1, 2012) –Coventry Cares (Coventry) –Arbor Health (AmeriHealth Nebraska via BCBS)

13 Contacts to Become a Provider Medicaid Managed Care Organizations (MCOs) MCOs for Eastern 10 counties : MCOs for Eastern 10 counties : –UnitedHealthCare Community Plan (United HealthCare) –Coventry Nebraska (Coventry) Eastern 10 Counties include Eastern 10 Counties include Seward Washington Otoe Sarpy Saunders Cass Dodge Douglas Gage Lancaster Cass Dodge Douglas Gage Lancaster Otoe Sarpy Saunders Cass Dodge Douglas Gage Lancaster Seward Washington Otoe Sarpy Saunders Cass Dodge Douglas Gage Lancaster

14 Contacts to Become a Provider Eastern 10 county Medicaid MCO Contact Info : UnitedHealthCare Community Plan (United HealthCare) Routine Care (Block Vision subcontractor) Routine Care (Block Vision subcontractor) – –Call Adrienne Bennett, VP, Operations at x1067; Medical Care (United HealthCare) Medical Care (United HealthCare) – –Contact: Jeremy Sand, at , or

15 Contacts to Become a Provider Eastern 10 county Medicaid MCO Contact Info: Coventry Of Nebraska, Inc.(Coventry Health Care) Routine Care (Block Vision subcontractor)Routine Care (Block Vision subcontractor) – –Call Adrienne Bennett, VP, Operations at x1067; Medical Care () Medical Care ( Coventry of Nebraska ) – – Coventry of Nebraskas contracting area call

16 Contacts to Become a Provider Medicaid Managed Care Organizations (MCOs) –State divided into two parts, each having two MCOs MCOs for Eastern 10 counties: MCOs for Eastern 10 counties: –Share Advantage (United HealthCare) –Coventry Nebraska (Coventry) MCOs for Other 83 Counties: (starting July 1, 2012) MCOs for Other 83 Counties: (starting July 1, 2012) –Coventry Cares (Coventry) –Arbor Health (AmeriHealth Nebraska via BCBS)

17 Contacts to Become a Provider Western 83 County Medicaid MCO Contact Info: Coventry Cares (Coventry) Routine Care (Block Vision subcontractor) Routine Care (Block Vision subcontractor) – –Monica Jenifer- Sr. Network Development Specialist – – x 1067 – – –Teresa Moragne El- Sr. Network Development Specialist – – x 1067 – Medical Care (Coventry) Medical Care (Coventry) – –Scott Davis – –Manager, Network Development – – – –(800) Ext – – –15950 West Dodge Road – –Omaha, NE

18 Contacts to Become a Provider Western 83 County Medicaid MCO Contact Info: Arbor Health (AmeriHealth Nebraska via BCBS) Routine Care and Medical Care (Avesis subcontractor) Routine Care and Medical Care (Avesis subcontractor) –Contracting Specialist –Eilene Fennelly Contracting Specialist Phone: (800) , ext. 116 Phone: (800) , ext –Cheryl Beyenka Contracting Specialist Phone: (800) , ext. 141 Phone: (800) , ext

19 Contacts to Become a Provider Medical Coverage Blue Cross Blue Shield of Nebraska Apparently BCBS will pay claims retroactive to the date of application for enrollment, but only when their special form is completed. Midlands Choice

20 Contacts to Become a Provider Medical Coverage Coventry , press 6 for credentialing, 877/ , then using a fake tax ID # , follow their phone voice response. When given the choice, say United HealthCare, 877/ , then using a fake tax ID # , follow their phone voice response. When given the choice, say First choice, Press 5 or say …Other First choice, Press 5 or say …Other Next choice Press 1 or say Credentialing Next choice Press 1 or say Credentialing Next choice Press 2 say Medical Next choice Press 2 say Medical Next choice Press 2 or say Join network Next choice Press 2 or say Join network UHC convoluted web site found at: UHC convoluted web site found at:

21 Contacts to Become a Provider Medical Coverage Medical Coverage Medicare Medicare –Medicare Part B –Rail Road Medicare Part B 877/ Enrollment?openhttp:// Enrollment?openhttp:// Enrollment?openhttp:// Enrollment?open –Medicare Durable Medical Equipment Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Brochure [PDF,87KB]Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Brochure [PDF,87KB]Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Brochure [PDF,87KB]Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Brochure [PDF,87KB]

22 Becoming a Provider Once Approved you will be given… Once Approved you will be given… –Provider number –Manuals &/or other (Web) resources Claim requirements Claim requirements Explanation of various plans Explanation of various plans Other important data Other important data –Be sure to read these resources…ignorance is not an excuse for incorrect claims! –Fraudulent filing is a Federal crime.

Thank You for Listening We hope this information has been helpful. Thank you for listening! See our NOA Website for more 3 rd Party Educational Videos. 3 rd Party Services Nebraska Optometric Association