North Carolina: Avoid denials when submitting personal care services claims
As a provider offering personal care services (PCS) to UnitedHealthcare Community Plan members, there are several actions you can take to help avoid claim denials for personal care services. Remembering these key steps when submitting your claim can help you avoid the hassle of resubmission or appeals and increase the speed of claim reimbursement.
Include the correct taxonomy codes All claim submissions must include the proper taxonomy codes to be processed and approved. To ensure the claims are being submitted for PCS, use the appropriate taxonomy code: 253Z00000X.
Failure to include the proper taxonomy code may result in a denial of your claim.
Ensure compliance with EVV system requirements As of Nov. 1, 2021, the 21st Century Cures Act and Centers for Medicare & Medicaid Services (CMS) require states to use an Electronic Visit Verification System (EVV) for all personal care services. In accordance with this requirement, all visits must be timestamped using EVV tools to record the member and caregiver information, location of the service, date of the service and the type of service performed.
If you do not have an EVV solution in place, your claims may be denied.
There are 3 options for the agencies in our network:
Agencies currently using HHAeXchange will be linked with new PHP contracts
Agencies currently without an EVV solution will be set up to use the EVV tools from HHAeXchange
Agencies currently using an EVV solution from another vendor can use their existing EVV system and import visit data into HHAeXchange using Electronic Data Interchange (EDI)
If you haven’t already, complete a provider questionnaire to help ensure your agency is set up to use the HHAeXchange portal.