Aug 3, 2022 | Insurance & Reimbursement
The federal Consolidated Appropriations Act requires that health plans and insurers verify the demographic information for providers every 90 days. BCBSVT has been sending emails requesting this update/verification to providers this year; you may get similar requests from MVP, Cigna, or other health insurers–IT IS NOT SPAM.
If you are on the BCBSVT panel, you will get an email at the email address you gave BCBSVT at enrollment (or updated email address), and the email will be from noreply@bcbsvt.com. Please check your spam/junk folder for these previous emails and designate that email address as legitimate or “not junk,” depending on your email service.
The email will contain a link to your practice information/provider(s) which will allow you to accept or change the reported data.
For questions about the process or any technical difficulties you have updating or approving your information, you can contact BCBSVT Provider Relations by email at providerrelations@bcbsvt.com or phone them at (888) 449-0443, option 1.
If you have questions about the details related to your information, you will need to contact Provider Files either by email at providerfiles@bcbsvt.com or phone them at (888) 449-0443, option 2.
If you don’t respond to the requests for updated information, you can be removed from the provider directory, and the IRS, HHS, and in some cases your patients can enforce these requirements (usually with a hefty monetary fine).
Mar 23, 2022 | Insurance & Reimbursement
Providers submitting reconsideration requests to Gainwell Technologies should use the new form that is now located on the Vermont Medicaid website (http://www.vtmedicaid.com/#/forms). This form is to be used for non-timely filing reconsideration requests only; there is a separate form for timely filing reconsideration requests. Effective 4/25/2022, old versions of the Reconsideration Request Form will no longer be accepted and will be returned to the provider.
Mar 23, 2022 | Insurance & Reimbursement
The Payment Error Rate Measurement (PERM) audit has commenced and will examine sampled claims from July 1, 2021, through June 30, 2022. Providers with a sampled claim will receive a medical record request letter from NCI Information Systems, Inc., and are required to submit all requested claim medical records and documentation.
The first request letters are expected by early April. Providers have 30 days from date of receipt of notice to submit required claims medical records and adjoining documentation to NCI Information Systems, Inc. If additional information is needed, providers have 14 days from the date of receipt of notice to send in the information. DVHA will enforce a 10% withholding from all providers that do not submit the required medical record and adjoining documents within 30 days or the additional documentation within 14 days.
Beginning in March, providers with a sampled claim may be contacted by a state representative to confirm the correct contact information prior to the request letters going out.
NEW: CMS will be hosting a few webinar sessions for providers focusing on the below topics:
• The PERM process and provider responsibilities during a PERM review
• Recent trends, frequent mistakes and, best practices
• The Electronic Submission of Medical Documentation, esMD program
These sessions will be held on:
• Tuesday 4/12 1pm-2pm
• Wednesday 4/13 3pm-4pm
• Thursday 4/14 3pm-4pm
Please see https://dvha.vermont.gov/providers/audits/payment-error-rate-measurement for a link to register for the webinar. Registration closes April 10th.
Feb 28, 2022 | Insurance & Reimbursement
Switching SSN to FEIN for Enrollment Type “Individual” Vermont Medicaid does not require that providers switch their enrollment from SSN to EIN, but many providers are choosing to make this change. If you are an Individual Provider choosing to switch your enrollment from SSN to EIN, please navigate to http://www.vtmedicaid.com/#/home, click on “Provider Enrollment” at the top of the screen and choose the third option from the top; “Instructions”. Then, open the “Green Mountain Care Instructions for Enrollment & Revalidation”. Next, scroll to Section 12.3 Switching SSN to FEIN for Enrollment Type “Individual”. This section contains the specific process that must be followed in order to make this update. If you have questions about this process, please outreach to the Provider Services Help Desk at 800-925-1706.
2022 HEDIS Performance Measure Production Includes a Medical Record Review (MRR) Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used sets of health care performance measures in the United States. VT Medicaid produces these measures to measure health plan processes and member health outcomes. To produce some of the HEDIS measures, DVHA must request members’ medical records from providers and then trained clinicians review and abstract data from the member’s record that does not show up in claims data. Cotiviti is the record retrieval contractor for VT Medicaid and will begin outreaching selected providers in March and requesting the submission of medical records to support VT Medicaid’s 2022 Medical Record Review (MRR). For more info, please visit: https://dvha.vermont.gov/providers/audits/hedis-hybrid-measure-medical-record-review-mrr.
Feb 28, 2022 | Insurance & Reimbursement
The Payment Error Rate Measurement (PERM) audit has commenced and will examine sampled claims from July 1, 2021, through June 30, 2022. Providers with a sampled claim will receive a medical record request letter from NCI Information Systems, Inc., and are required to submit all requested claim medical records and documentation. The first request letters are expected in late March or early April. Providers have 30 days from date of receipt of notice to submit required claims medical records and adjoining documentation to NCI Information Systems, Inc. If additional information is needed, providers have 14 days from the date of receipt of notice to send in the information. DVHA will enforce a 10% withholding from all providers that do not submit the required medical record and adjoining documents within 30 days or the additional documentation within 14 days.In early March, providers with a sampled claim may be contacted by a state representative to confirm the correct contact information prior to the request letters going out. Please see https://dvha.vermont.gov/providers/audits/payment-error-rate-measurement for more information.
