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New Information

Claim Submission

March 21, 2013 - Please ensure that claims are submitted in a timely manner. According to BreastCare Provider Manual (page 20), claims must be filed within 60 days from the date of service. After 120 days from the date of service, claims will be suspended for failure to submit the claim by the filing deadline. These claims will be reviewed manually and will delay reimbursement. Exceptions to this policy cannot be made. Stay current on your billing.

Virtual Training Opportunities on BreastCare Billing:

Do you or your staff have questions about BreastCare billing policy, the claim submission process, or Provider Electronic Solutions (PES) software? Are you unable to travel to BreastCare training workshops held throughout the year at various locations? Then a virtual training workshop is for you! Now you can attend a class without leaving your office. The Arkansas Department of Health and HP Enterprise Services invite you to attend useful classes in an Internet virtual classroom environment. The classes are designed to help you:

configure software for prompt and accurate billing
understand fundamentals of the claim submission process, issues surrounding claim denials and actions you can take to prevent future denials
Set-up and use PES to submit claims
register for and use WebRA
understand BreastCare billing policy

If you have any questions or would like to schedule a virtual training, please e-mail Karen Young at kareny@hp.com.

Claim Denial

If your claim is denied, verify that your claim contains correct NPI number, performing provider taxonomy (if it exists), and appropriate office visit procedure code and that the on-line BreastCare system contains the matching patient ID, date of service, exam type and procedure results (CBE, Pap test, if applicable and/or mammogram) and re-file claim. For questions contact 1-855-661-7830.

Clarification on Exam Type

Be sure and use the correct exam type in the On-Line system.

BreastCare On-line System Exam Type selection	Office Visit Procedure Code for claims	Explanation
Initial Exam	99203	Use this for BreastCare Patient first office visits
Annual Exam	99213	Use this for patient annual office visits
Follow Up Exam	99212	Use this for office visit when patient returns for repeat PAP or CBE follow up

Plan D Slots

Attention Providers, you may have noticed a Plan D has been added on your Patient Information page in the BreastCare Online System. This plan creates additional slots to serve women 50-64. No action is needed on your part, the system will assign patients to the correct funding plans. If you have questions or need assistance, please contact BreastCare at 661-2942. Thank you for enrolling and providing BreastCare services for the underserved women of Arkansas.

2012 US Preventive Services Task Force 2012 Recommendations for Routine Pap Testing

BreastCare is implementing these new recommendations effective immediately. A woman can choose to have a Pap test every 3 years or if she would like to lengthen the time between testing she can choose to have a Pap test and high-risk HPV test every 5 years. Established patients who have had normal results, are not high risk, and have a cervix are transitioned to either the 3 year (36 months) or 5 year (60 months) track based on the date of the last documented Pap test. The laboratory performs the HPV test with each Pap test on the 5 year track. The provider must mark Pap and HPV on the lab requisition. For those on the 3 year track, HPV high-risk reflex tests are performed on all ASC-US Pap results. Once a patient has selected a Pap track she must stay on that track for routine screening. She cannot alternate between tracks. It is no longer necessary to have 3 consecutive, negative Pap tests before reducing the frequency. High risk patients will continue to receive Pap tests every year. “Know Your Choices for Routine Pap Testing” is an informational sheet developed for the patient so that she can make an informed decision about her Pap frequency. You can. This informational sheet is available in English and Spanish. Call Renee House at 501-661-2018 with questions.

Abnormal Vaginal Bleeding

Symptoms of cervical cancer include:

post-menopausal bleeding
perimenopausal bleeding

Any perimenopausal vaginal bleeding after amenorrhea for six months or any post-menopausal vaginal bleeding after amenorrhea for one year must be considered a symptom of cervical cancer. This requires a Pap test and a referral for Gyn consultation, regardless of a negative Pap test.

Note: Patients with post-menopausal vaginal bleeding are referred to the Regional Care Coordinators. The duration and amount of bleeding should be documented.

Exception: Patients who have had benign hysterectomies and do not have a cervix are referred to their primary care provider. Any patient who still has a cervix receives appropriate cervical services which are reimbursable.

If			Then
No menstrual cycle for 6 months or more and vaginal bleeding occurs>			Perform a Pap test and refer for Gyn consultation with Pap report
No menstrual cycle for less than 6 months, and vaginal bleeding occurs,			Do not refer for Gyn consultation. This is not considered a symptom of cervical cancer.
Woman is only spotting			Do not refer for GYN consultation.

Provider Remittance Advice (RA) via WebRA

Arkansas BreastCare no longer prints and mails paper Remittance Advice (RAs). RAs are now provided in a PDF format, which can be viewed and downloaded from a secure website. The new RA, referred to as a WebRA, looks exactly like the paper RA, while offering the advantage of electronic search functionality.

Providers must register to have access to their WebRAs. WebRA link is available in the left-hand menu after logging in to the Arkansas Medicaid provider portal. Follow the instructions to register each of your provider’s BreastCare and National Provider Identification numbers. Providers will not have access to their WebRAs until registration is complete.

The WebRA is available for download on the Monday prior to the check being mailed. This is a week earlier than the paper RA. With WebRA, providers may share access to their RAs with other parties, which include other providers such as their affiliated group(s) or non-providers like their corporate office or accountant. Providers control security access to their information via two administrative screens that manage invitations and document access.

WebRAs will be maintained for 35 days to provide a rolling five weeks of PDF RAs online. Providers are encouraged to download and save an electronic copy to their hard drive. After the 35 days, PDF RAs will no longer be available. If you require a copy of an RA that is no longer available in PDF, call the Provider Assistance Center to obtain a paper copy. Standard fees of $.25 per page apply. Providers who currently receive an 835 Electronic Remittance Advice will continue to do so.

Providers who have extenuating circumstances, such as limited or no internet access, may opt out of WebRA by completing a Hardship Waiver application and returning it ADH BreastCare .

If you have questions regarding this notice, please contact the HP Enterprise Services Billing Call Center at -855-661-7830, or locally and Out-of-State at (501) 372-0225.

Ultrasound Required for Palpable mass

Breast ultrasound and diagnostic mammogram must be ordered per BreastCare policy in the presence of a palpable mass. These procedures should be done on the same day for the convenience of the patients and to decrease delay in diagnosis. If the ultrasound is not performed when ordered, the patient will be rescheduled at the same facility for the procedure. The patient must be referred for a surgical consultation unless the ultrasound reveals a cyst or benign abnormality.

Referrals to Arkansas Tobacco Quitline

The smoking status of all BreastCare clients must be reported to BreastCare on the Screening Form. Current smokers should be referred to 1-800-Quit-NOW (1-800-784-8669 for assistance to quit smoking.

Archived Information

Archived Provider Information