Timely Filing Update April 2024
Effective 4/1/2024 – Inclusa to 120 days for clean claims.
CLAIMS MUST MEET THE FOLLOWING PARAMETERS
- The claim is submitted to Wisconsin Physicians Services (WPS),Inclusa’s third party claims processer on or after 4/1/2024. See below examples:
- WPS receives a claim on 4/1/24 for dates of service 12/4/23: The claim will be paid based on the 120-day timeline being implemented on 4/1/24.
- The claim meets the following definitions:
- Clean Claim – a complete and accurate claim in which you have included all provider and member information necessary to process the claim, including all appropriate service and authorization codes.
- Filed Timely – claims must be received by WPS within 120 calendar days from the date of service or Primary Insurance Explanation of Benefits (EOB) date.
- WPS receives a claim on 3/31/24 for dates of service 12/4/23: The claim will be denied based on the current timeframe of 90-days.
Items to Note:
- The claim filing timeline does not end with the original claim submission.
- If a claim is rejected or denied in full, providers must correct all errors and submit as a new claim which must be received by WPS within the original 120 days from the date of service or the EOB remittance date.
- If a claim is partially paid (in dollars or units), a corrected claim must be completed and received by WPS within the original 120 days from the date of service or the EOB remittance date.
Provider Billing Support Change
There has been a change with who to contact at Inclusa when authorization and billing/claim support is needed.
This change will be effective immediately for the following service types:
- Adult Day Care
- Daily Living Skills Training
- Day Services
- Prevocational Services
- Vocational Planning/Support
- Supported Employment
Moving forward, the new contact will be:
Email: ACS-SHC-SDS-HomeHealth@inclusa.org
Phone: 1-888-544-9353, ext. 7
Home Health and Nurse Supervisory EVV Soft Launch Information for January 1, 2024
On January 1, 2024, the Wisconsin Department of Health Services (DHS) will implement the soft launch requirements for Electronic Visit Verification (EVV) for home health care services (HHCS) and nurse supervisory visits using the following service codes:
- Personal Care Nurse Supervisory Visit (T1019 and T1020)
- Service Code 99509 – Home visit for assistance with activities of daily living and personal care
- Private Duty Nursing (Independent Nurses and Agency Nurses)
- Service Code 99504 – Home visit for mechanical ventilation care
- Service Code S9123 – Non-vent private duty nursing care in home, by Registered Nurse (RN)
- Service Code S9124 – Non-vent private duty nursing care in home, by Licensed practical nurse (LPN)
- Non-Private Duty Nursing (Independent Nurses and Agency Nurses)
- Service Code 99600 – Unlisted home visit service or procedure
- Service Code T1001 – Nursing assessment/evaluation
- Service Code T1502 – Administration of oral, intramuscular, and/or subcutaneous medication
- Service Code T1021 – Home health aide or Certified Nursing Assistant (CNA)
- Therapy
- Service Code 92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder
- Service Code 97139 – Unlisted therapeutic procedure – Occupational Therapy
- Service Code 97799 – Unlisted physical medicine/rehab service or procedure – Physical Therapy
For a full listing of all service codes identified for EVV, visit: https://www.dhs.wisconsin.gov/evv/service-codes.htm
Soft launch is the time to learn and use the EVV system without affecting payments! Below are a few resources and supports to assist providers in preparing for EVV.
Resources
- ForwardHealth Update 2023-40: an announcement from DHS providing extensive details related to EVV and Home Health services.
- ForwardHealth Update 2021-41: an announcement from DHS providing extensive details related to EVV and Nurse Supervisory Visit Service Code 99509.
- New to EVV Flyer: a great introduction to the required system, outlining steps to get started.
- What is EVV Flyer: a brief overview of the system and where to learn more.
- Wisconsin Electronic Visit Verification: a brief video focusing on the basics of EVV.
- EVV Fundamentals: a 30-minute training video about EVV and where to find resources.
- DHS EVV Training Page: a resource page on how to train workers and agency administrators.
- DHS EVV Website: a singular location to access these and all EVV related resources.
Supports
Inclusa is here to support providers with any contract or authorization specific questions as it relates to your contracted services.
- Contact Provider Relations at 877-622-6700 (select option 2, then option 3) or ProviderRelations@inclusa.org to discuss contract or service-related information.
- Contact Inclusa’s Home Health Authorizations & Claims Support Team at ACS-SHC-SDS-HomeHealth@inclusa.org or 888-544-9353 (select option 7) to discuss authorization or billing related information.
Wisconsin EVV Customer Care is available to provide support throughout the soft launch transition as it relates to the EVV vendor system. Customer Care is accessible by email at vdxc.contactevv@wisconsin.gov or by phone (in English, Hmong, and Spanish, among other languages) at 833-931-2035 Monday–Friday, 7 a.m.–6 p.m. CT.
Sign up for the DHS email list to receive updates and notifications on training opportunities, policy information, and other important details regarding EVV in Wisconsin.
EVV Hard Launch Information
On May 1, 2023 the Wisconsin Department of Health Services (DHS) implemented the hard launch of the Electronic Visit Verification (EVV) system for hands-on cares for the following Service codes:
- T1019 and T1020 – Personal Care services; per 15 minutes and per diem
- S5125 and S5126 – Attendant Care services; per 15 minutes and per diem
Claims will be denied for dates of service on May 1, 2023 and thereafter, if EVV requirements are not followed. Below are a few resources, reminders, and supports to assist impacted providers.
Resources
- New to EVV Flyer: a great introduction to the required system, outlining steps to get started.
- What is EVV Flyer: a brief overview of the system and where to learn more.
- Wisconsin Electronic Visit Verification: a brief video focusing on the basics of EVV.
- EVV Fundamentals: a 30-minute training video about EVV and where to find resources.
- DHS EVV Training Page: a resource page on how to train workers and agency administrators.
- DHS EVV Website: a singular location to access these and all EVV related resources.
- EVV Provider Billing Facts: a resource from Wisconsin Physicians Service (WPS), Inclusa’s Third Party Administrator (TPA) (claims processor), providing guidance to support the claims and billing process.
Important Reminders
EVV Visit Key Needed: Workers are required to check in/out using an EVV system at the start and the end of each visit. Claims without an EVV Visit Key will be denied. The EVV Flyers above provide further details regarding the EVV Visit Key.
No Date Span Billing: Claims for the related services must be submitted separately for each date of service. Claims submitted using date span billing will be denied. The WPS EVV Provider Billing Facts link above provides further details and helpful tips regarding claims and billing.
Date Span Example: A member received services on 14 dates in the month of May. Date span billing is when a date span of 5/1/2023–5/31/2023 is submitted for total units (days) and total charges. Instead, submit each day separately with units and charges on 14 individual claim lines.
Supports
Wisconsin EVV Customer Care is available to provide support throughout the process. Customer Care is accessible by email at vdxc.contactevv@wisconsin.gov or phone at 833-931-2035 Monday–Friday, 7 a.m.–6 p.m. CT.
Inclusa Authorization and Claims Support Team is available to provide support with authorization and claims:
- Supportive Home Care/Personal Care – contact ACS-SHC-SDS-HomeHealth@inclusa.org or 1-888-544-9353, option 7.
- Community Supported Living – contact ACS-Residential-CSL-NH@inclusa.org or 888-544-9353, Option 6.
Inclusa Provider Relations Team is available to provide support with contracting questions. Please contact your local Program Manager, ProviderRelations@inclusa.org, or 877-622-6700, option 2, then option 3.
Humana to Expand Medicaid Services in Wisconsin with Acquisition of Inclusa, Inc
We are excited to announce that Humana has agreed to purchase substantially all of Inclusa’s assets. This acquisition will allow us to create a model of care that provides industry-leading support for members across the health care continuum.
“Since our founding in 2000, the mission of Inclusa has been to maximize health outcomes for our members by proactively partnering with others to build vibrant and inclusive communities in Wisconsin that offer people dignity, choice, and connections,” said Mark Hilliker, Inclusa chief executive officer. “I am proud of the success we have achieved and look forward to the greater impact our team can have as part of Humana.”
This partnership upholds the continuity of Inclusa’s culture and locally-rooted legacy, while expanding its contribution within Humana’s national Medicaid platform. Thank you for joining us in this exciting opportunity.
Press Release: Humana Inc. – Humana to Expand Medicaid Services in Wisconsin with Acquisition of Inclusa, Inc.
We will share more information as it becomes available.