Michigan Rehab Service Provider Manual

Transcription

1 Michigan Rehab Service Provider Manual (800)

2 Table of Contents INTRODUCTION... 3 PARTICIPATING PROVIDERS... 3 NEW HEARING INSTRUMENT(S)... 3 Coverage... 3 Authorization... 4 Ordering... 4 Billing Requirements... 4 Claims Information... 4 CROS/BICROS INFORMATION... 4 BATTERIES... 4 REPAIRS... 5 In-Warranty Repairs... 5 Out-of-Warranty Repairs... 5 LOSS AND DAMAGE... 5 REPLACEMENT EARMOLDS... 5 SERVICES AFTER SIX MONTHS... 5 RETURN FOR CREDIT American Hearing Benefits. All rights reserved. DOCS ; Version 2.0; Page 2

3 INTRODUCTION American Hearing Benefits is proud to make our provider network, services and Starkey Hearing Technologies products available to AudioNet America for the Michigan Rehabilitation Service (MRS). PARTICIPATING PROVIDERS All credentialed audiologists and ENTs in the AHB provider network can participate in this program.* If your facility is not currently enrolled with AHB, you will need to submit a completed AHB credentialing form. For more information on how to become an AHB provider, please contact the AHB credentialing team: AHBcredentialing@starkey.com If you have questions regarding AudioNet s policies or procedures, please call our designated insurance customer service line: *AudioNet requires that all audiological evaluations, hearing aid selections, fittings and adjustments be conducted by a licensed audiologist or ENT employed by the dispensing facility. NEW HEARING INSTRUMENT(S) Coverage Starkey Hearing Technologies and its subsidiary companies (Starkey, Audibel and NuEar ) products have been approved for AudioNet network use. All options such as directional microphones, telecoils, and multimemory can be added at no additional charge. All hearing instruments are issued with a full two-year repair warranty, including loss and damage. For a complete list of available products, please visit AudioNet s website: MRS members are covered in full for the Mid-Level Standard Digital Hearing Aids. All other levels could have a member co-payment that is payable to the provider office by the member. The full patient responsibility will be determined by MRS at the time of the second authorization and will be reviewed on a case by case basis American Hearing Benefits. All rights reserved. DOCS ; Version 2.0; Page 3

4 Authorization MRS will issue 2 separate authorization numbers. The first authorization number will be given for the Evaluation (S0618) and the Assessment (V5010). The second authorization number will be given for the Conformity (V5020), dispensing fee and hearing aids. Authorizations are obtained by calling AudioNet at: AudioNet requires that services are rendered within 6 months of the authorization date. If the timeframe exceeds 6 months, a new authorization must be obtained. Ordering In order for a claim to be processed and paid, the following materials must be submitted to AHB: 1. Hearing aid order form and ear impressions (when necessary) 2. A fully completed MRS claim worksheet available on our website at: 3. Copies of the PCI-1001 forms available from AudioNet. Two (2) forms will be required showing information for the 2 authorizations. 4. Copy of Audiogram legibly signed by the authorized audiologist, ENT or otolaryngologist & dated within the last 6 months. Patient s name must be printed on the audiogram to be accepted. Billing Requirements 1. Confirmation of Delivery Document, (signed by authorized provider and patient at the time of fitting.) Must be submitted within 24 hours of fitting. 2. Conformity Form available from AudioNet (signed by authorized provider and patient at follow up visit.) This form is to be completed and returned AudioNet and AHB after the conformity evaluation is completed. Claims are not processed until both the Confirmation of Delivery and the Conformity Form are received. Claims Information Two separate claims will be filed. The first claim will be filed using the first authorization number received. This will be for the evaluation and assessment. The second claim will be filed using the second authorization number when the fitting confirmation form and conformity form has been received. CROS/BICROS INFORMATION Please take note of the V Codes above for the CROS and BICROS. CROS fittings are reimbursed at the monaural rates. BICROS fittings are reimbursed at the binaural rates. It is very important for the worksheet to contain correct coding for the CROS or BICROS dispensing fee and hearing aid codes. This will assist AHB in building the claim correctly. CROS is only available in the Mid-High technology level no upgrades permitted. BATTERIES MRS does not cover replacement batteries. Patients are responsible for purchase American Hearing Benefits. All rights reserved. DOCS ; Version 2.0; Page 4

5 REPAIRS In-Warranty Repairs Hearing instruments covered under warranty will be sent directly to Starkey for repair. Repairs are processed under your commercial account number with Starkey Hearing Technologies. Out-of-Warranty Repairs Hearing instruments out of warranty will be sent directly to Starkey for repair. Out of warranty repairs are processed under your commercial account number and the patient is responsible for any associated charges. Providers may charge their usual and customary rates. LOSS AND DAMAGE All hearing aids carry a minimum of a two-year repair warranty including two years of Loss and Damage (L&D) coverage. Our flagship level hearing aids carry a three-year repair and L&D warranty. L&D coverage allows for a one-time replacement of a lost or irreparably damaged hearing aid. Hearing instruments are covered in full for a one-time replacement through the manufacturer. Loss and damage claims will be processed under your AHB account at no charge. The patient may be charged $150 for one hearing aid or $250 for two hearing aids. REPLACEMENT EARMOLDS Replacement earmold orders will be sent directly to Starkey. Replacement earmolds are processed under your commercial account. Providers may charge $40 to the patient for each replaced earmold. SERVICES AFTER SIX MONTHS Office visits occurring after the initial post fitting six-month period may be billed to the member at $20 per visit. RETURN FOR CREDIT In the event of a return for credit, the provider is authorized to keep fees collected for S0618, V5010, and V5020. Payment for dispensing fees (ex: V5160) must be returned to AHB at the following address: American Hearing Benefits Attn: AHB Administration PO Box 9457 Minneapolis, MN Please make checks payable to American Hearing Benefits American Hearing Benefits. All rights reserved. DOCS ; Version 2.0; Page 5