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How to Become A 3 rd Party Provider

How to Become A 3 rd Party Provider. Addressing: Preparation for enrolling with a 3 rd Party 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.

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How to Become A 3 rd Party Provider

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  1. How to Become A3rd Party Provider Addressing: Preparation for enrolling with a 3rd Party Contact information for 3rd Parties in Nebraska

  2. 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.

  3. 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 makeno 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) • Optometry Diploma • State License • DEA Registration (need it) • Proof of Malpractice Insurance • Photo ID • …plus more in some cases • Turn-around time: weeks to months

  5. Enrolling as a Provider NPI (National Provider Identifier) • Need before enrolling as any provider • 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) • http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage

  6. Enrolling as a Provider NPI (National Provider Identifier) • Exception: Sole Proprietor (Not a PC or partnership, etc.)… • Only one NPI total (represents both doctor and her/his practice). • Get specifics at http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage

  7. Enrolling as a Provider • NPI enrollment information found at • National Plan and Provider Enumeration System (NPPES) • https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

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

  9. Contacts to Become a Provider • Routine Care(July 2011) • Avesishttp://www.avesis.com/provider_benefits.html • EyeMed (Eyecare Plan of America)http://portal.eyemedvisioncare.com/wps/portal/emweb/providers/become_a_provider • Optum (Spectera)https://www.optumhealthvision.com/providers/OH_Vision_Provider.jsp • Vision Service Plan (VSP)https://www.vsp.com/cms/provider/provider-home.html

  10. Contacts to Become a Provider • Standard Medicaid • Via Nebraska Dept. of Health & Human Services • Both Routine & Medical • Patients age 65+ &/or in nursing home http://www.hhs.state.ne.us/med/providerenrollment.htm

  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 • 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: • UnitedHealthCare Community Plan (United HealthCare) • Coventry Nebraska (Coventry) • 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 : • UnitedHealthCare Community Plan (United HealthCare) • Coventry Nebraska (Coventry) • Eastern 10 Counties include • Cass • Dodge • Cass • Dodge • Cass • Dodge • Cass • Dodge • Douglas • Gage • Lancaster • Douglas • Gage • Lancaster • Douglas • Gage • Lancaster • Douglas • Gage • Lancaster • Otoe • Sarpy • Saunders • Otoe • Sarpy • Saunders • Otoe • Sarpy • Saunders • Seward • Washington • Seward • Washington

  14. Contacts to Become a Provider Eastern 10 county Medicaid MCO Contact Info: • UnitedHealthCare Community Plan (United HealthCare) • Routine Care (Block Vision subcontractor) • Call Adrienne Bennett, VP, Operations at 800-243-1401 x1067; Emailabennett@blockvision.com . • Medical Care (United HealthCare) • Contact: Jeremy Sand, at 402-445-5587, or jeremy_sand@uhc.com.

  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) • Call Adrienne Bennett, VP, Operations at 800-243-1401 x1067; Emailabennett@blockvision.com . • Medical Care (Coventry of Nebraska) • Coventry of Nebraska’s “contracting area” call 800-471-0240

  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: • Share Advantage (United HealthCare) • Coventry Nebraska (Coventry) • 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) • Monica Jenifer- Sr. Network Development Specialist • 1-800-243-1401 x 1067 • mjenifer@blockvision.com • Teresa Moragne El- Sr. Network Development Specialist • 1-800-243-1401 x 1067 • tmoragneel@blockvision.com • Medical Care (Coventry) • Scott Davis • Manager, Network Development • 402-995-7174 • (800) 471-0240 Ext. 7174 • asdavis@cvty.com • 15950 West Dodge Road • Omaha, NE 68118 .

  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) • Eilene Fennelly Contracting Specialist • Phone: (800) 643-1132, ext. 116 • Email: efennelly@avesis.com • Cheryl Beyenka Contracting Specialist • Phone: (800) 643-1132, ext. 141 • Email: cbeyenka@avesis.com

  19. Contacts to Become a Provider • Medical Coverage • Blue Cross Blue Shield of Nebraskahttp://www.bcbsne.com/Providers/Library/Credentialing.aspx Apparently BCBS will pay claims retroactive to the date of application • for enrollment, but only when their special form is completed. • Midlands Choicehttp://www.midlandschoice.com/Provider/Credentialing/Index.html

  20. Contacts to Become a Provider • Medical Coverage • Coventry 800 865-2673, press 6 for credentialing • United HealthCare, 877/842-3210, then using a fake tax ID # 471234567, follow their phone voice response. When given the choice, say • First choice, Press 5 or say “…Other” • Next choice Press 1 or say “Credentialing” • Next choice Press 2 say “Medical” • Next choice Press 2 or say “Join network” • UHC convoluted web site found at: http://www.uhc.com/physicians/join_our_network.htm

  21. Contacts to Become a Provider • Medical Coverage • Medicare • Medicare Part B http://www.wpsmedicare.com/j5macpartb/departments/enrollment/ • Rail Road Medicare Part B 877/288-7600 • http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/Providers~Railroad%20Medicare~Resources~Provider%20Enrollment?open • Medicare Durable Medical Equipment • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Brochure [PDF,87KB] • https://www.noridianmedicare.com/dme/enroll/

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

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

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