Provider Bulletin | March 2010
Welcome to the first edition of the Community Care Provider Bulletin. A new edition will be sent out each month to all providers who have a contract with Community Care. Each edition will contain important updates and information that you need to know to remain in compliance with Family Care rules and regulations, Community Care policies, and your contract. The Provider Bulletin will also provide you with helpful resources.
Please forward this bulletin to others in your organization who need to know this information. They are encouraged to sign up to receive it by emailing provider.bulletin@communitycareinc.org.
If you have any comments or questions, send them to provider.bulletin@communitycareinc.org.
In accordance with Wisconsin Statutes and Codes, Community Care members shall be protected from the unnecessary use of restrictive measures. Community Care providers may not use unnecessary restrictive measures and are expected to assist members to understand and assert their freedom from imposed restrictions of their voluntary movement, access to their bodies or isolation as defined in the Restrictive Measures Policy. If a restrictive measure is being used, please contact the member’s interdisciplinary team to discuss appropriate usage.
Community Care’s full policy was sent to providers in September 2009. To receive another copy, or for technical assistance regarding restrictive measures, please contact Jennifer.Taylor@communitycareinc.org. View the policy on our Web site at www.communitycareinc.org/ForProviders.
Community Care is now responsible for completing all aspects of the Certification process for 1-2 bed Adult Family Homes. Before Community Care will accept a new application for the certification of a new site, a provider will be required to go through a screening process. This process will ensure that Community Care has a need in the Network for the level of care that homc can provide. If it is determined that the Community Care Network does not have a need for that provider, the provider will have the option of being placed on a waitlist for potential match with a member in the future. This process will enhance our ability to match member needs with provider capability.
Please watch for more information as we will have an email inquiry mailbox set up soon. For additional information and assistance at this time, please contact 414-902-2482.
The training listed below will count towards your continuing educational requirements:
Adult Family Home Providers 23rd Annual Conference
April 15-16, 2010
Stoney Creek Inn & Conference Center
Onalaska-La Crosse, WI
800-659-2220
For more information, call 608-789-4891.
Did you know that Community Care has various provider resources available?
Provider Hotline: 866-937-2783
This hotline should be used for inquiries related to your contract, claims, authorizations, and member eligibility. Please listen carefully to the prompts to ensure you are directed to a representative who can most quickly and effectively address your inquiry.
Contract Inquiries Email: contractinquiries@communitycareinc.org
You can send an email to this address if you have any issues related to your contract such as: becoming a provider; adding a new location or service; contract language questions; and provider directory questions.
Claim Inquiries Email: claimsinquiries@communitycareinc.org
You can send an email to this address if you have any issues such as: authorization questions; billing questions; and payment questions.
Website: www.communitycareinc.org/ForProviders
This site contains more information and additional resources such as Community Care’s Provider Directories and information on how to apply to become a provider in Community Care’s Network.
Community Care provides claims education training to providers on a monthly basis. Please attend any of the sessions listed below. Current and new non-medical providers welcome.
Sheboygan Site
When: March 17, 2010
Times: 9:00 a.m. to 11:00 a.m. or 1:00 p.m. to 3:00 p.m.
Where: Community Care, 615 South 8th St., Suite 130, Sheboygan, WI 53081
Waukesha Site
When: March 18, 2010 and April 15, 2010
Time: 1:00 p.m. to 3:00 p.m.
Where: Community Care, 1801 Dolphin Drive, Waukesha, WI 53186
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, please email provider.education@communitycareinc.org.
1. Why is my claim denied or delayed?
Here are two common reasons why claims are denied, delayed or paid incorrectly:
Claim does not reflect the correct or current authorization. Verify that the authorization covers the dates of service you are billing and that the procedure codes and units match those on your authorization. If it does not, contact the case manager to obtain a corrected authorization before submitting your claim. If you do not have an authorization, contact the case manager to obtain an authorization before submitting your claim.
Claims submitted without an authorization will be delayed and/or denied. Claim is submitted for non-contracted services/procedures. Claims are only authorized and paid for services/procedures in your contract and are only reimbursed at contracted rates. Please refer to your current contract.
2. How can I receive my claim reimbursement faster?
Try E-forms! E-form claim submission speeds up the reimbursement process about 3-5 days. Email provider.education@communitycareinc.org for more information. If you have questions regarding member eligibility or claims please contact the provider hotline at 1-866-937-2783.
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