June 27, 2024
As we quickly approach the July 1 integration date for My Choice Wisconsin Medicaid BadgerCare+ and SSI members to Molina, we have a few important updates regarding Home Health and Personal Care Worker Providers.
Things to Know:
- Live in Care Workers: Molina is changing our requirement for electronic visit verification (EVV) for live-in workers. Effective 7/1, you do not need to complete an associated EVV if you are a live-in worker.
- If your claims deny because of missing EVV for a live-in worker, Molina will proactively grab those claims and reprocess on a weekly basis while we work on a systemic fix. You do not need to appeal or resubmit as of today, 6/27.
- Be sure to follow DHS ForwardHealth billing guidelines for billing, coding and modifiers.
- EVV Expanded Services Soft Launch: In accordance with ForwardHealth guidelines, we are preparing for hard-launch for the additional EVV required services. Starting tomorrow, you may see warning messages on your claims if there is not an EVV on file. Your claims will not deny until hard-launch in October.
- For more information, check out ForwardHealth EVV resources.
- Atypical Provider Claims: We continue to partner with Availity on Atypical (provider without a NPI) provider claim submissions. If you choose to submit your atypical claims through Availity, there will be a delay in processing while we manually pull and process all of the impacted claims, but we will process them.
- If you submit via EDI, please continue to do so. You may also continue to submit via paper.
- If you are Medicaid certified with a NPI, you must include the NPI on your claim and verify your data on file with Molina. You can email MHWIProviderNetworkManagement@MolinaHealthcare.com.
- We will offer additional updates and training on claim submission in Availity, including Atypical claims, when our systemic fix is in place. Keep an eye out for more information!
Questions?
Please reach out to your provider relations representative or email us at:
- MHWIprovidernetworkmanagement@molinahealthcare.com(for BadgerCare Plus, Medicaid SSI, or existing Molina Medicare)
- Shfamccontracts@mychoicewi.org (for Family Care, Family Care Partnership, or existing My Choice Medicare)