Pennsylvania Medicaid: Billing updates for personal care services

Efficient Might 1, 2022, the Pennsylvania Division of Human Companies (DHS) has up to date its billing necessities for private care companies which are verified utilizing an digital go to verification (EVV) system. Our EVV vendor, HHAeXchange, has up to date its system to mirror these modifications.

What this implies for you
For dates of service beginning Might 1, 2022, well being care professionals administering private care companies to UnitedHealthcare Group Plan members of their dwelling should use HCPCS code T1019 when submitting claims and requesting prior authorization.

Code G0156 will now not be accepted for private care companies however could proceed for use for dwelling nursing shift care. Please be aware you need to invoice for companies utilizing a CMS-1500 declare kind or digital information interchange (EDI) 837 transaction.

We’re updating all presently accepted prior authorization data to mirror code T1019 for companies rendered on or after Might 1, 2022.

Well being care professionals who make the most of HHAeXchange for EVV ought to overview the speed configuration for code T1019 inside the HHAeXchange system to make sure it’s in step with contracted charges.

NPI quantity requirement
Moreover, for dates of service beginning June 1, 2022, DHS is requiring that the Nationwide Supplier Identifier (NPI) quantity included on private care service claims should match the NPI quantity within the prior authorization request. A mismatch in NPIs between the prior authorization document and the billed declare might result in a declare denial.

Questions?
Name Supplier Companies at 800-600-9007.