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Provider Bulletin | April 2010 Welcome to the April edition of the Provider Bulletin. Whether you are receiving this copy via mail or email, you’ll find useful information to ensure you’re compliant with submitting member’s personal funds, alerting Community Care about vacancies at your facility, and tips to help your claims get processed as quickly as possible. Submitting Records of Member’s Personal Funds Community Care is required by the Social Security Administration (SSA) to obtain an accounting of each member’s personal funds for members where Community Care is Representative Payee. As a contracted provider, you are required to submit this accounting to the Community Care Representative Payee department. This includes monthly personal needs and any additional monies sent to the member or facility. This requirement is for members living in The responsibility of gathering this data necessitates the use of a detailed tracking log. This log must document all funds received and spent by or on behalf of the member at the time of each transaction. Your documentation must include the following: A downloadable electronic version of a preferred log can be found in the Provider section of the Community Care website. You may continue to use your existing tracking log as long as it meets the requirements outlined on page one. Tracking logs must be submitted to the Community Care Representative Payee department at least quarterly and can be sent monthly. At a minimum, providers need to forward tracking logs to Community Care within 15 days of the end of each quarter. Tracking logs are due on January 15, April 15, July 15, and October 15. Community Care reserves the right to inspect these tracking logs at any time. The preferred methods for submission of tracking logs are fax or US mail. Fax to the attention of Kim Neal at 414-944-0035, or mail to: Contact Kim Neal, member accounting manager, at Kim.Neal@communitycareinc.org or 414-902-2508 with any questions. Does Your Residential Facility Have Vacancies? Community Care has a process for reporting your facility’s vacancies. This process assists our care teams in making placements quickly along with providing you the opportunity to inform us of openings available at your facility. The Residential Vacancy Notification form can be completed when you have openings at your
contracted facilities. Complete this form each time you have a vacancy and contact us once it is filled so that it can be removed from our list. You can submit this form the following ways: The vacancy list is available to our care managers to use as needed for placement of members. We cannot guarantee placements since we are unable to predict how many members will be seeking placements at any given time. You are welcome to contact us to confirm your vacancy has been received, but please do not contact the Community Care sites directly to announce your vacancies. Our care teams and residential specialist continually monitor the vacancy list to locate the most appropriate placement for our member’s needs. If you have questions about expansion needs in the counties we serve, please contact Judi Persinger at Judi.Persinger@communitycareinc.org. Are you planning an open house? Contact Judi Persinger with the date and time of your open house and she will notify the care teams. If you have a newly certified or licensed Adult Family Home or Community Based Residential Facility you would like to have contracted with Community Care, complete and submit the application materials. Please note, completion of the application materials does not guarantee a contract. Why Is My Claim Denied Or Delayed? Two common reasons that claims are denied, delayed or paid incorrectly are: 1. Claim not submitted within the timely filing provision listed in your current contract Section 4.1: Provider shall submit all fee-for-service claims to Community Care within ninety (90) days of the date of service to Participants in accordance with the terms of this Contract. If Provider does not submit such claim within this ninety (90) day period, the Provider Claims shall be submitted via mail to: 2. Claims submitted without the primary insurer Explanation of Benefits attached. Section 4.1(c): All services which qualify for Medicare coverage must be billed to Medicare first, a copy of the Medicare Explanation of Benefits must be submitted with facility invoice. All providers must submit the Explanation of Benefits anytime a member has insurance primary to Community Care. Do you want to receive your claim reimbursement faster? Try E-forms! E-form claim submission will speed up the time it takes from submission to reimbursement an average of 3-5 days. If you are interested, email us at provider.education@communitycareinc.org. If you have questions regarding member eligibility or claims contact the Provider Hotline at 1-866-937-2783. Provider Claims Education Training Schedule Community Care conducts claims education training to providers on a monthly basis. You are Waukesha County Site Walworth County Site Additional training sessions will be provided in other counties on future dates. If you have any questions, or would like to sign up for a session, email provider.education@communitycareinc.org.
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Policy Material IDs: H2034WEB0910, H5207WEB0910, H5212WEB0910 | CMS Approved: 10/22/2010 |
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