United Healthcare Community Plan of Tennessee Updates Billing Requirements for Allied Health Professionals
To facilitate the process of claims and ensure correct reimbursement, the United Healthcare Community Plan of Tennessee has made amendments to the billing criterion regarding the allied health professionals who render services to TennCare members. As the adjustments to the legislation require, the following principles must be followed to claim a service:
- Individual NPI Number Required: AHP/mid-level healthcare professionals must bill using their own NPI number and not one of the healthcare professionals they work under.
- Active Medicaid ID: AHP/mid-level healthcare professional has to be registered in the State Medicaid agency with an active Medicaid ID on the date of the service.
- Claims for Shared Services: When AHP and a healthcare professional rendered their services on the same occasion, only one party can bill for their work, and the choice depends upon the number of reimbursement policies that were utilized.
This update emphasizes the importance of accurate provider identification on claims. By billing under their NPI number, AHPs ensure proper recognition of their services and facilitate smoother claims processing. Additionally, the requirement for an active Medicaid ID reinforces the importance of maintaining updated credentials within the state’s Medicaid system.
Resources:
UnitedHealthcare Community Plan of Tennessee encourages providers to review the following resources for more information:
- Your TennCare contract
- The UnitedHealthcare Community Plan of Tennessee Provider Manual
This requirement is consistent with the general trend prevailing in the industry because the UnitedHealthcare Community Plan of Tennessee seeks to recognize the valuable input of the AHPs by allowing them to bill under their NPI number. Proper billing has always ensured adequate reimbursement for the providers on the one hand and promoted systemic efficiency on the other.
The former is now facilitated by the updated requirements that the providers will have to follow, which means reduced denial rates and decreased periods before claims are processed. The latter is associated with the provider-centric approach that the UnitedHealthcare Community Plan of Tennessee has adopted, meaning that the billing changes will impact the consistency and quality of healthcare delivered to TennCare members.
About UnitedHealthcare Community Plan of Tennessee:
UnitedHealthcare Community Plan of Tennessee is dedicated to ensuring access to high-quality healthcare for all TennCare members. The organization collaborates with health providers and local communities to create conditions for a healthier nation.
Extensive improvements have been implemented lately to make the provision of health services more efficient. The program emphasizes its interest in developing partnerships to advance and enhance service delivery.
Source: https://www.uhcprovider.com/en/resource-library/news/2024/tn-medicaid-npi-required-for-billing.html