Neighborhood Health Plan of Rhode island

1. Neighborhood Health Plan of Rhode island OSCIA Reimbursement Forum Michael Watkinson

2. 2009-2010 Influenza/Pneumococcal Billing & Reimbursement • Children, ages 6-35 months • 90655 - Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use • 90657 - Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use • 90660 - Influenza virus vaccine, live, for intranasal use • Children, ages 36 months through age 18 • 90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use • 90660 – Influenza virus vaccine, live, for intranasal use • 90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

3. 2009-2010 Influenza/Pneumococcal Billing & Reimbursement • Adults 19-65 • 90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use • 90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use • 90660 – Influenza virus vaccine, live, for intranasal use (members aged 19-49 only) • 90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

4. 2009-2010 Influenza/Pneumococcal Billing & Reimbursement • Vaccine Administration Coding (under 8 years) • 90465 – Initial IM • 90466 - Subsequent IM (add-on code) • 90467 – Initial oral/nasal • 90468 – Subsequent oral/nasal (add-on code) 90465 & 90467 will bundle when billed together on the same day.

5. 2009-2010 Influenza/Pneumococcal Billing & Reimbursement • Vaccine Administration Coding (all ages) • 90471 - Initial IM • 90472 – Subsequent IM (add-on code) • 90473 – Initial oral/nasal • 90474 – Subsequent oral nasal (add-on code) • 90471 & 90473 will bundle and deny if billed together on the same day

6. 2009-2010 Influenza/Pneumococcal Billing & Reimbursement • Eligible place of service codes for reimbursement: • 03 – School • 11 – Office • 20 – Urgent Care • 22 – Outpatient Hospital • 23 – Emergency Room • No authorization is required. • CMS-1500, UB-04 or electronic billing accepted. • Roster billing and public health clinics are not accepted.

7. 2009-2010 Influenza/Pneumococcal Billing & Reimbursement • State Supplied Vaccines: • When billing the vaccine code billed amount should reflect $0.00 or $0.50. • Both the vaccine code and the vaccine administration code must be billed together to receive reimbursement for the vaccine administration. • Office Visit 99211 • Bundles with 90465, 90467, 90471 and 90473 and will not reimburse.

8. Patricia Huschle – Director, Provider Services phuschle@nhpri.org 401-459-6012 Venissa Martinez – Administrative Assistant, Provider Services vmartinez@nhpri.org 401-459-6152 Hospitals Lisa Caton – Provider Services Specialist lcaton@nhpri.org 401-459-6182 Provider Services – who we are

9. Primary Care Charles Scaletta, Manager, Provider Services cscaletta@nhpri.org 401-459-6098 Nancy Butera, Provider Services Specialist nbutera@nhpri.org 401-459-6108 Michael Watkinson, Provider Services Specialist mwatkinson@nhpri.org 401-459-6170 Provider Services

10. Specialty Providers Maureen Brousseau, Manager, Provider Services mbrousseau@nhpri.org 401-459-6033 Kevin Kruth, Provider Services Specialist kkruth@nhpri.org 401-459-602 Paul John, Provider Services Specialist pjoun@nhpri.org 401-459-6683 Provider Services

11. Customer Service • 401-459-6020 • Claims Inquiry • Member Information • Member Education • Interpreter Services • Transportation Services; if meets criteria