TNAAP's Pediatric Council meets with payers regularly to resolve questions and concerns and improve quality of care for Tennessee children. The list below includes a few of the accomplishments so far this year. 

BlueCare Tennessee

Proof of Timely Filing Reminders

TNAAP worked with BlueCare to clarify what constitutes proof of timely filing. As a reslut of the efforts, BlueCare Tennessee provided us with the following list:

- If a claim for medical services is returned, your proof of timely filing is the black and white copy of the claim with error codes that we returned to you. Please keep this copy of the returned claim.

- If a claim is accepted or rejected, we will store an electronic image of the claim in our archives for future reference. We will also generate 277CA Health Care Information Status Notification reports.

- If a member didn't provide BlueCare Tennessee coverage information at the time of the visit, you may apply for timely filing reconsideration with documents showing your office confirmed the member had no coverage on the date of the visit and copies of billing statements that show the dates of bills, if members have no other insurance.

Coding Issues-

Flulaval 90686 – BlueCross will now allow 6 mos forward according to the ACIP recommendations

90461 denials corrected (commercial); incorrect edit put in place.  BlueCross corrected and reprocessed denied claims

Amerigroup

Amerigroup planned to implement a policy to reduce sick visit reimbursement to 50% when a sick and well visit were performed on the same day beginning in September of 2018.  In July, Amerigroup decided not to move forward with this policy. Sick and Well visits will continue to be reimbursed at 100% if performed on the same day; Amerigroup will be sending out a redaction.

United HealthCare

NDC edits removed to prevent denials - edit put in place in the UHC system which should not have been that was causing the rejections.  The edit was removed UHC will reprocess denied claims. 

 

 

 

Tennessee Chapter American Academy of Pediatrics