May 16, 2022

Pennsylvania Medicaid: Billing updates for personal care services

Effective May 1, 2022, the Pennsylvania Department of Human Services (DHS) has updated its billing requirements for personal care services that are verified using an electronic visit verification (EVV) system. Our EVV vendor, HHAeXchange, has updated its system to reflect these changes.

What this means for you
For dates of service starting May 1, 2022, health care professionals administering personal care services to UnitedHealthcare Community Plan members in their home must use HCPCS code T1019 when submitting claims and requesting prior authorization.

Code G0156 will no longer be accepted for personal care services but may continue to be used for home nursing shift care. Please note you must bill for services using a CMS-1500 claim form or electronic data interchange (EDI) 837 transaction.

We’re updating all currently approved prior authorization records to reflect code T1019 for services rendered on or after May 1, 2022.

Health care professionals who utilize HHAeXchange for EVV should review the rate configuration for code T1019 within the HHAeXchange system to ensure it’s consistent with contracted rates.

NPI number requirement
Additionally, for dates of service starting June 1, 2022, DHS is requiring that the National Provider Identifier (NPI) number included on personal care service claims must match the NPI number in the prior authorization request. A mismatch in NPIs between the prior authorization record and the billed claim could lead to a claim denial.

Call Provider Services at 800-600-9007.