Unfair Billing Practices - Some Medicaid Manaaged Care Companies - Including Buckeye
OAAPN continues to pursue fair and equitable reimbursement for Ohio's APRNs. At this time, we need your help in order to address reimbursement issues concerning a few of the Medicaid Managed Care Companies. We have recently heard complaints regarding Buckeye health plan's refusal to credential or contract with some APRNs.
Please take a moment to confirm with your billing personnel if this is a problem in your practice. If you can confirm that Buckeye, or any of the other four Medicaid Managed Care Companies listed below, are not credentialing, contracting or reimbursing you appropriately or fairly, please contact us immediatelyby responding to OAAPN legal counsel, Jeana Singleton with the requested information per below.
In order to address APRN reimbursement concerns properly, we will need any documentation you may have. It would be most helpful to have copies of all communications including denial letters you receive from these companies. Be sure to include the following information:
Name of Insurance Company:
Type of practitioner (specialty)
Address and location of practice
¨ Refusal to credential you as an independent billing provider;
¨ mandated billing under the physician's billing number;
¨ refusal to credential you because the "network is full";
¨ less than 100% reimbursement;
¨ refusal to reimburse you at all;
¨ refusal to recognize you as a PCP, etc.;
-- requiring that your collaborator be enrolled as a network provider with that company
-- any other questions or concerns affecting your practice.
Thank you for responding to our requests in the past year. Because of you, OAAPN has been very successful in securing unencumbered reimbursement policies from many of Ohio's insurance companies.
Please do not reply to this e-mail - forward all information to OAAPN legal counsel:
Jeana M. Singleton, Esq.
BRENNAN, MANNA & DIAMOND, LLC
75 E. Market Street
Akron, Ohio 44308
Effective July 1, 2013, the Ohio Medicaid managed care program, which serves more than 1.6 million residents across Ohio, has chosen five managed care plans. The five managed care plans awarded contracts to serve Ohio’s Medicaid population are:
- Buckeye Community Health Plan
- Molina Healthcare of Ohio
- Paramount Advantage
- UnitedHealthcare Community Plan of Ohio
Medicaid managed care plans provide coverage to Covered Children and Families (CFC) and Aged, Blind, and Disabled (ABD) populations, as well as approximately 37,000 children with special health care needs who are currently eligible for Medicaid due to a disability.
Any questions or concerns, please contact:
Christine Williams, MSN, CNP, FAANP, OAAPN Reimbursement Chair