1. Billing Training Lauren Sumrell VP Project Management

2. Review UM Process Claims Submission Billing Tools Payment Schedule
Reminders
FAQs
Questions

3. LifeWorks Advantage Utilization Management Process
Authorizations can be requested via:
EZNet Provider Portal
Faxing the Plan UM Department
Calling Plan UM Department

4. Claims Submissions
LifeWorks Advantage follows all Medicare guidelines in regard to timely filing requirement (12 months from date of service)
Cannot bill future dates of service
Bill LifeWorks Advantage as you would bill Medicare in 30 day increments
Acceptable claim forms:
CMS 1500 for Professional Claims
UB04 for Center Claims
Claims can be submitted via paper, EZNet or EDI
Paper Claims Mailing Address:
PO Box 4440
Glen Allen, VA 4

5. Billing Resources: EZNet
Functionality:
Member Eligibility Lookup
Authorization/Referral Submittal & Inquiry
Claims Submittal & Inquiry
User Guide & Training Video available on home page
Monthly provider trainings offered on last Friday of each month at 12:30 PM EST 5

6. Center Reimbursement Choose LifeWorks Advantage as Payer Source
Central Office will electronically submit batch claims
Central Office will distribute Center’s payments
Monthly Capitated Rates
Payment for Skilled Services

7. Payment Schedule
835s, RAs and Payments will be sent within 30 days of claim received date per Medicare requirements for all claims paid or denied with explanation of status
Billing is completed centrally within MFA. The Plan pays MFA claims and MFA Corporate distributes the funds to the MFA Centers.
Explanation of Benefits will be provided to all members

8. Reminders UM Department can be reached at:
Phone:
Fax:
For help, LifeWorks Advantage Provider Services Representatives can be reached at:
Helpful provider information will be available on the LifeWorks Advantage website beginning 10/01/2016

9. Frequently Asked Questions
Q: Does LifeWorks Advantage reimburse at RUGS or level of care?
A: 100% of CMS RUGs rates and midnight rules are followed per standard Medicare regulations
Q: Are the MDS’ for LifeWorks Advantage handled like other managed care plans?
A: Yes, they should be handled like any other plan that pays on RUGs.
Q: What to tell hospitals/physicians about how to submit claims to LifeWorks Advantage:
A: Direct them to the plan website or the Provider Services team at 9

10. Frequently Asked Questions
Q: How can the Center staff or residents/family members access the complete list of in-network providers for the plan?
A: Via the provider directory on the LifeWorks Advantage website, under Member Resources.
Interactive Provider Search Portal Coming Soon! 10