How to Become A 3rd Party Provider

Video 2How to Become A3rd Party ProviderAddressing:Preparation for enrolling with a 3rd Party Contact information for 3rd Parties in Nebraska

DisclaimersThis information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD. To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free. It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.

Disclaimer The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services. The Nebraska Optometric Association, and its presenters, agents, consultants and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.

4Enrolling as a ProviderMultiple page application forms with considerable documentation: copies ofNPI (National Provider Identifier) Optometry DiplomaState License DEA Registration (need it)Proof of Malpractice InsurancePhoto IDplus more in some casesTurn-around time: weeks to months

45NPI (National Provider Identifier)Need before enrolling as any providerNeed a separate NPI for Each doctor (only one NPI for any doctor), Each office location, Each separate business entity (optical dispensary may need separate NPI if has a separate tax ID number)http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPageEnrolling as a Provider

56NPI (National Provider Identifier)Exception: Sole Proprietor (Not a PC or partnership, etc.)Only one NPI total (represents both doctor and her/his practice). Get specifics at http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPageEnrolling as a Provider

67Enrolling as a ProviderNPI enrollment information found atNational Plan and Provider Enumeration System (NPPES)https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

78NPI (National Provider Identifier)Information on NPI application must match information onMedicare B application (855i and 855b)Medicare DME application (855s)IRS information (Employer ID number, etc)

Enrolling as a Provider

89Contacts to Become a ProviderRoutine Care ExamplesAvesis http://www.avesis.com/provider_benefits.htmlEyeMed (Eyecare Plan of America) http://portal.eyemedvisioncare.com/wps/portal/emweb/providers/become_a_provider Optum (Spectera) https://www.optumhealthvision.com/providers/OH_Vision_Provider.jsp Vision Service Plan (VSP) https://vspglobal.com/cms/doctors/be-a-vsp-doctor.html

910Contacts to Become a ProviderStandard Medicaid Via Nebraska Dept. of Health & Human Services Both Routine & Medical Patients age 65+ &/or in nursing home

http://dhhs.ne.gov/medicaid/Pages/med_providerenrollment.aspx

1011Contacts to Become a ProviderMedicaid Managed Care Organizations (MCOs)MCOs cover all Medicaid patients that are not also covered by Medicare. MCOs coverMedical DiagnosesRoutine Care (sub-contracted)

1112Contacts to Become a ProviderMedicaid Managed Care Organizations (MCOs)State divided into two parts, each having two MCOsMCOs for Eastern 10 counties: UnitedHealthCare Community Plan (United HealthCare)Routine Vision Care: Marilyn Brittingham, Sr. Network Development Specialist @ 1-800-243-1401 x2097. Her email address is mbrittingham@superiorvision.comAetna Better Health of Nebraska (Aetna, formerly Coventry)Routine Vision Care: Marilyn Brittingham, Sr. Network Development Specialist @ 1-800-243-1401 x2097. Her email address is mbrittingham@superiorvision.com

Seward Washington Otoe Sarpy Saunders

Cass Dodge Douglas Gage Lancaster

1213Contacts to Become a ProviderMedicaid Managed Care Organizations (MCOs)State divided into two parts, each having two MCOsMCOs for Other 83 Counties: Aetna Better Health of Nebraska (Aetna, formerly Coventry)Routine Vision Care: Marilyn Brittingham, Sr. Network Development Specialist @ 1-800-243-1401 x2097. Her email address is mbrittingham@superiorvision.comArbor Health (AmeriHealth Nebraska via BCBS)Routine and Medical Care: Avesis subcontracts routine and medical

1314Contacts to Become a Provider Medical CoverageBlue Cross Blue Shield of Nebraska http://www.bcbsne.com/Providers/Library/Credentialing.aspxApparently BCBS will pay claims retroactive to the date of applicationfor enrollment, but only when their special form is completed. This needs to be confirmed with BCBS.Midlands Choice https://www.midlandschoice.com/Healthcare-Providers/Credentialing/Join-Our-NetworkAetnahttp://www.aetnabetterhealth.com/nebraska/providers/join-our-network/criteria

1415Contacts to Become a Provider Medical Coverage

United HealthCare, 877/842-3210, then using a fake tax ID # 471234567, follow their phone voice response. When given the choice, sayFirst choice, Press 5 or say OtherNext choice Press 1 or say CredentialingNext choice Press 2 say MedicalNext choice Press 2 or say Join networkUHC convoluted web site found at: http://www.uhc.com/physicians/join_our_network.htm

1516Contacts to Become a Provider Medical Coverage

Medicare Medicare Part B http://www.wpsmedicare.com/j5macpartb/departments/enrollment/

Rail Road Medicare Part B 877/288-7600http://www.palmettogba.com/palmetto/Providers.nsf/docsCat/Providers~Railroad%20Medicare~Resources~Provider%20Enrollment?open

Medicare Durable Medical EquipmentDurable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Brochure [PDF,87KB]

https://www.noridianmedicare.com/dme/enroll/

1617Becoming a ProviderOnce Approved you will be givenProvider number Manuals &/or other (Web) resourcesClaim requirementsExplanation of various plansOther important dataBe sure to read these resourcesignorance is not an excuse for incorrect claims! Fraudulent filing is a Federal crime.

17Thank You for ListeningWe hope this information has been helpful.Thank you for listening!See our NOA Website for more 3rd Party Educational Videos.

3rd Party ServicesNebraska Optometric Association