Provider Forum News – July 26

All four current MCO Provider Forums met on July 26.   Here are some of the topics discussed.   NOTE:   Next meetings for MCO Providers Forums are on Thursday, August 23.    Meetings have been scheduled on this webpage.

  • New Fee Schedule Implementation Status .  All MCO’s report that the  new any  claim  denied due to submission prior to completion of  the new fee schedule being loaded.   Providers do not need to resubmit.
  • Due to changes in personnel, Molina asks that all  inquiries from providers be sent through their automated mailboxes that are available on Mollinahealthcare.com, e.g., Credentialing.   Inquiries can be addressed more quickly using this system.  The princile Molina contact is
  • The other MCO’s, BCBS, UHC, and Pres request that the Provider’s MCO Rep be contacted directly for any issues.  All Provider Reps and contact information are listed on the meeting announcement on the NMBHA webpage.
  • UHC requests that all Falling Colors bills from the spring be submitted by end of July if not already done.
  • MAX billing units.   If you are billing a service for which MAX units are defined, contact the MCO to determine how exceeding the MAX level will be handled.  The new Fee Schedule states that ‘max units…. are not intended to be absolute limits on the service provided to a recipient”.     We raised this as a concern, and each MCO will handle it differently.

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