Waiver Provider News & Updates
Welcome to our Waiver Provider website page. As those servicing some of our most vulnerable Ohioan’s, Buckeye is committed to engaging in meaningful and effective ways to strengthen our partnership in service to these individuals. This page aims to present news, updates and specialty content that is unique and impactful to you. Be sure to bookmark this page to ensure easy future access.
Click on the link below to view our May 29, 2024, Waiver Provider Townhall. (video may begin as soon as the web page opens - if needed, scroll video back to hear from the beginning)
Thank you to those who joined Buckeye’s Waiver Townhall this summer. We’ve compiled the most frequently asked questions from the discussion. For additional questions or more information, please contact Provider Services.
Service Definitions
Q: What is the difference between a Home Care Attendant, Homemaker Service, and Personal Care Attendant?
- Home Care Attendants provide health-related support.
- Personal Care Attendants assist with activities of daily living, such as:
- Dressing
- Grooming
- Bathing and showering
- Toileting and incontinence care
- Homemaker Services focus on helping maintain the member’s home and organize daily activities to support personal wellness. These services include:
- Meal preparation, grocery shopping, meal planning, and storing meals
- Light housekeeping
- Laundry services
- Transportation for social gatherings
- Scheduling appointments and transportation services
Prior Authorization and Billing
Q: What is the turnaround time for chemotherapy prior authorizations?
- Medicare prior authorizations for Part B drugs, like chemotherapy, are processed within 72 hours for standard requests and 24 hours for expedited requests.
Q: What is the Prior Authorization Check Tool and where can I find it?
- To check if a PA is required:
- You can submit a PA request and check on the status on the portal found at: Buckeyehealthplan.com/providers.html
Q: How do we bill for Home Delivered Meals—should we create a service line for each day or enter the total units on the delivery date?
- Please bill by the Date of Service (DOS) for the day each meal is intended to be consumed, not the delivery date.
Q: How are retro authorizations approved? What can we do to support the approval process?
- Buckeye does not process retro authorizations. However, retro services or authorizations are sometimes completed through an update to the Service Plan for waiver services.
Q: Should providers use the G0156 code for both State plan Medicaid and Waiver services, or is it specific to one?
- The G0156 code is specific to State plan Medicaid and should not be used for Waiver services.
Claims & Reimbursement
Q: How do we handle denied claims for Home Delivered Meals due to “exceeding units”?
- Waiver authorizations are based on day-by-day service consumption. For accurate billing, use the Date of Service rather than the delivery date.
Q: How can I get assistance with a denied claim?
- Contact Provider Services at 1-866-296-8731. If further assistance is needed, follow the claims escalation and research process on Buckeye’s website.
Q: How do I submit a corrected claim if the original lacked an authorization?
- Re-submit the claim as corrected with the authorization indicated on the claim itself, not as an attachment.
Q: How do we bill for reimbursement differences between new and old rates?
- Once Buckeye’s system is updated, claims will reprocess automatically, and the new reimbursement amount will be issued.
Q: If a provider is facing issues with Part B claims payments, who can they contact for assistance?
- Providers should initially contact Provider Services at 1-866-296-8731 for claims payment issues. If further support is needed, follow the claims escalation and research process on Buckeye’s website.
Service & Delivery
Q: Can you tell me if state hours are more skilled nursing than home health care?
- State hours are provided through the state and require a doctor’s order as well as monitoring by a registered nurse (RN).
Q: Is a provider given specific consumers for repeat services to maintain comfort and familiarity for the consumer?
- Members may request a change in providers. Otherwise, they will generally continue with the same provider.
Provider Contracting and Credentialing
Q: My agency has submitted an application to become a network provider. Is there a number I can call for credentialing inquiries? Also, what is the turnaround time if we submit a claim via mail, and is there an alternative for out-of-network providers?
- Please reach out to your designated contact for contract status inquiries. Unfortunately, until you’re contracted, you’ll need to submit claims by mail, with a 30-day turnaround time from receipt.
Q: We are a waiver provider. How can we get approved to offer state hours as well?
- You must first be credentialed as a Medicaid Home Health Agency (HHA) through Medicaid. Once credentialed, you can apply for a contract addendum via the “Join Our Network” page on Buckeye’s website.
Q: Once a provider signs a contract with an effective date set 30 days in the future, must we wait until that effective date to start providing services? Will the provider receive next steps or a contact person?
- Services must start on or after the contract’s effective date. For continuity of care services, confirm if you have a NON-PAR affiliation and an authorization that starts before the contract effective date. For further support, please visit Buckeye’s Provider Engagement Administrators Page to find your Provider Engagement Administrator.
Additional Questions, Contacts and Resources
Q: Where can I find the live-in exception waiver form for Passport Providers?
- Visit the Ohio Department of Aging’s Passport services website.
Q: How do I locate the Waiver Service Coordinators’ contact information?
- The Care Manager or Waiver Service Coordinator is listed on the member’s Waiver Service Plan, viewable in the provider portal at buckeyehealthplan.com/providers.html or by calling Member Services at 1-866-549-8289. Buckeye Care Management is exploring additional ways to make this information more accessible.
Q: Who should I contact if we haven’t received a service plan update from Utilization Management within 20 days?
- Contact Provider Services at 1-866-296-8731 or Shawnda Noble, Waiver UM Supervisor, at shawnda.r.noble@centene.com.
Q: Who should I contact to correct errors in a service plan?
- Reach out to the Waiver Service Coordinator (WSC) or Care Manager (CM) listed on the Service Plan for corrections.
Q: Is there a contact for contracting updates?
- Please reach out to OhioContracting@centene.com For contract status updates.
Q: Where can I find the Authorization Acknowledgement section in the provider portal?
- For assistance with signing the electronic Service Plan, request portal training via your Provider Engagement Administrator.
Q: How do we access authorizations online instead of by fax?
- Authorizations are available on the Provider Portal in each member’s individual chart.
Q: Is Buckeye’s reimbursement for services negotiable?
- Contact OhioContracting@centene.com to discuss possible contract changes.
Q: How do we get on the list to receive referrals?
- Send your information to Ellen LaSalvia at elasalvia@centene.com.
Q: Agencies and facilities often experience delays or issues receiving care plans. Who should we contact if a care plan is missing?
- For missing Service Plans, please reach out to the Program Coordinator listed on the authorization form.
Thank you to those who joined Buckeye’s Waiver Townhall this summer. We’ve compiled the most frequently asked questions from the discussion. For additional questions or more information, please contact Provider Services.
Service Definitions
Q: What is the difference between a Home Care Attendant, Homemaker Service, and Personal Care Attendant?
■ Home Care Attendants provide health-related support.
■ Personal Care Attendants assist with activities of daily living, such as:
• Dressing
• Grooming
• Bathing and showering
• Toileting and incontinence care
■ Homemaker Services focus on helping maintain the member’s home and organize daily activities to support personal wellness. These services include:
• Meal preparation, grocery shopping, meal planning, and storing meals
• Light housekeeping
• Laundry services
• Transportation for social gatherings
• Scheduling appointments and transportation services
Prior Authorization and Billing
Q: What is the turnaround time for chemotherapy prior authorizations?
■ Medicare prior authorizations for Part B drugs, like chemotherapy, are processed within 72 hours for standard requests and 24 hours for expedited requests.
Q: What is the Prior Authorization Check Tool and where can I find it?
■ To check if a PA is required:
Buckeyehealthplan.com/providers/
prior-authorization/preauth-check.html
■ You can submit a PA request and check on the status on the portal found at: Buckeyehealthplan.com/providers.html
Q: How do we bill for Home Delivered Meals—should we create a service line for each day or enter the total units on the delivery date?
■ Please bill by the Date of Service (DOS) for the day each meal is intended to be consumed, not the delivery date.
Q: How are retro authorizations approved?
What can we do to support the approval process?
■ Buckeye does not process retro authorizations. However, retro services or authorizations are sometimes completed through an update to the Service Plan for waiver services.
Q: Should providers use the G0156 code for
both State plan Medicaid and Waiver services, or is it specific to one?
■ The G0156 code is specific to State plan Medicaid and should not be used for Waiver services.
Claims & Reimbursement
Q: How do we handle denied claims for Home Delivered Meals due to “exceeding units”?
■ Waiver authorizations are based on day-by-day service consumption. For accurate billing, use the Date of Service rather than the delivery date.
Q: How can I get assistance with a denied claim?
■ Contact Provider Services at 1-866-296-8731. If further assistance is needed, follow the claims escalation and research process on Buckeye’s website.
Q: How do I submit a corrected claim if the original lacked an authorization?
■ Re-submit the claim as corrected with the authorization indicated on the claim itself, not as an attachment.
Q: How do we bill for reimbursement differences between new and old rates?
■ Once Buckeye’s system is updated, claims will reprocess automatically, and the new reimbursement amount will be issued.
Q: If a provider is facing issues with Part B claims payments, who can they contact for assistance?
■ Providers should initially contact Provider Services
at 1-866-296-8731 for claims payment issues. If further support is needed, follow the claims escalation
and research process on Buckeye’s website.
Service & Delivery
Q: Can you tell me if state hours are more skilled nursing than home health care?
■ State hours are provided through the state
and require a doctor’s order as well as monitoring by a registered nurse (RN).
Q: Is a provider given specific consumers for repeat services to maintain comfort and familiarity for the consumer?
■ Members may request a change in providers. Otherwise, they will generally continue with the same provider.
Provider Contracting and Credentialing
Q: My agency has submitted an application to become a network provider. Is there a number I can call for credentialing inquiries? Also, what is the turnaround time if we submit a claim via mail, and is there
an alternative for out-of-network providers?
■ Please reach out to your designated contact for contract status inquiries. Unfortunately, until you’re contracted, you’ll need to submit claims by mail, with a 30-day turnaround time from receipt.
Q: We are a waiver provider. How can we get approved to offer state hours as well?
■ You must first be credentialed as a Medicaid
Home Health Agency (HHA) through Medicaid. Once credentialed, you can apply for a contract addendum via the “Join Our Network” page on Buckeye’s website.
Q: Once a provider signs a contract with an effective date set 30 days in the future, must we wait until that effective date to start providing services? Will the provider receive next steps or a contact person?
■ Services must start on or after the contract’s effective date. For continuity of care services, confirm if you have a NON-PAR affiliation and an authorization that starts before the contract effective date. For further support, please visit Buckeye’s Provider Engagement Administrators
Page to find your Provider Engagement Administrator.
Additional Questions, Contacts and Resources
Q: Where can I find the live-in exception waiver form for Passport Providers?
■ Visit the Ohio Department of
Aging’s Passport services website.
Q: How do I locate the Waiver Service Coordinators’ contact information?
■ The Care Manager or Waiver Service Coordinator is listed on the member’s Waiver Service Plan, viewable in the provider portal at buckeyehealthplan.com/providers.html
or by calling Member Services at 1-866-549-8289. Buckeye Care Management is exploring additional ways to make this information more accessible.
Q: Who should I contact if we haven’t received a service plan update from Utilization Management within 20 days?
■ Contact Provider Services at 1-866-296-8731
or Shawnda Noble, Waiver UM Supervisor, at shawnda.r.noble@centene.com.
Q:Who should I contact to correct errors in a service plan?
■ Reach out to the Waiver Service Coordinator (WSC) or Care Manager (CM) listed on the Service Plan for corrections.
Q: Is there a contact for contracting updates?
■ Please reach out to OhioContracting@centene.com For contract status updates.
Q: Where can I find the Authorization Acknowledgement section in the provider portal?
■ For assistance with signing the electronic Service Plan, request portal training via your Provider Engagement Administrator.
Q: How do we access authorizations online instead of by fax?
■ Authorizations are available on the Provider Portal in each member’s individual chart.
Q: Is Buckeye’s reimbursement for services negotiable?
■ Contact OhioContracting@centene.com
to discuss possible contract changes.
Q: How do we get on the list to receive referrals?
■ Send your information to Ellen LaSalvia at elasalvia@centene.com.
Q: Agencies and facilities often experience delays or issues receiving care plans. Who should we contact if a care plan is missing?
■ For missing Service Plans, please reach out to the Program Coordinator listed on the authorization form.
Buckeye Health Plan is excited to present our new provider publication Waiver Provider News (WPN). Each issue will be hot off the press information with the latest and current items you need to know. While the articles and information on this website page may change over time, the content in the newsletter will remain in this archive for future reference. We look forward to growing the WPN, and this website page, through your valuable review and input, ensuring they provide you value as a resource.
Adult Day Service Transportation
- Guidance for Adult Day Service Transportation can be found in two places in the Ohio Administrative Code.
- 173-39-02.1 ODA provider certification: adult day service which allows providers to bill for transportation separately from the bundled ADS rate.
- 5160-46-04 Ohio home care waiver: definition of the covered services and provider requirements and specifications which does not allow for transportation to be billed separately and states that transportation is included in the bundled payments received for ADS.
- Beginning April 1st, 2024 Buckeye will follow the guidance for ADS transportation outlined in OAC rule 173-39-02.1 which allows ADS providers to bill separately for ADS transportation.
- A provider may transport each individual to and from the center and be reimbursed according to OAC rule 5160-1-06.1, Adult Day Transportation Round Trip.
- If a provider choses to render ADS transportation to a Waiver member, this service must be added to the member’s service plan by the member’s Case Manager or Waiver Service Coordinator and be authorized by Waiver Utilization Management prior to delivery of service.
- The provider will receive a separate authorization for ADS transportation.
Assisted Living Memory Care
On January 2, 2024 changes were made to the tier structure in Assisted Living Waiver billing, including the addition for Assisted Living Facilities to become "certified" for memory care.
Prior billing included 3 level Tiers for rate reimbursement based upon the members needed care. Tier 1 (also U1) was the least amount of needed care and the lowest reimbursement. Level 2 (U2) and Level 3 (U3) could be used for higher care levels for members.
With the new changes that occurred January 2, 2024, there are now only 2 levels of care for billing/reimbursement. Tier 1 (U1) and Tier 3 (U3).
Tier 3 can only be used for Assisted Living facilities that have applied for Memory Care through ODA and have been approved. This certification is also to be listed on the facilities website.
Facilities which are approved for certified Memory Care through ODA, by meeting the requirements in the OAC, https://codes.ohio.gov/ohio-administrative-code/rule-173-39-02.16 , have the option to bill U1 or U3.
The additional requirement to be able to bill U3, requires the member to have a dementia diagnosis (or diagnosis under the dementia umbrella). The dementia diagnosis should be listed on the claim when facilities are billing under a U3.
Facilities that have not gone through certification and approval through ODA, are only able to bill U1. Tier 2 (U2) is no longer an option.
If you need additional information on submitting claims or reason for claims denial, Buckeye's Provider Services can be reached at 866-296-8731.