Document 6526551

Fax
Telephone
855-454-5584
502-719-8600
9900 Corporate Campus Dr.
Ste. 1000
Louisville, Ky. 40223
FAX
To:
From:
<<Physician>>
CoventryCares of Kentucky
Fax:
<<Location_Fax>>
Date:
December 9, 2013
Pages:
5 pages with cover
Provider Relations
Re:
Updates
Taxonomy Update
Updated Provider Relations
Representative Listing
 Urgent
 For Review
 Please Comment
 Please Reply
 Please Recycle
Notes:
We appreciate your participation in the CoventryCares of Kentucky provider network and hope you find
the enclosed information helpful.
IMPORTANT WARNING: This message is intended for the use of the person or entity to which
it is addressed and may contain information that is privileged and confidential, the disclosure of
which is governed by applicable law. If the reader of this message is not the intended recipient,
or the employee or agent responsible to deliver it to the intended recipient, you are hereby
notified that any dissemination, distribution, or copying of this information is STRICTLY
PROHIBITED. If you have received this message by error, please notify us immediately and
destroy the related message.
To:
From:
Date:
RE:
CoventryCares of Kentucky Providers
CoventryCares of Kentucky Provider Relations
December 9, 2013
Updates
1.
Taxonomy Requirement
******************** ATTENTION PAPER UB04 CLAIM SUBMITTERS *********************
Coventry Cares of Kentucky has received numerous UB04 paper claims this past week with the
taxonomy code submitted in the wrong field. Institutional claims will reject for missing taxonomy code
when the value is submitted in Field 57 on the UB04 form, which is titled “other ID”. The correct location
for billing provider taxonomy code is Field 81 with a qualifier of B3. Please see the chart below for key
fields on institutional paper claims.
Data Element
Billing Provider NPI
Billing Provider TIN
Billing Health Care Provider Taxonomy
Attending Provider NPI
Operating Physician NPI
Other Provider NPI
UB04 Field Locator
Field 56
Field 05
Field 81 (Qualifier B3)
Field 76
Field 77
Field 78-79 (With Qualifier: DN Referring, ZZ Other
Operating Physician, 82 Rendering and NPI)
If your claims are submitted on paper or being dropped to paper by your clearinghouse, please verify
the correct placement of your taxonomy code.
If you have submitted electronic claims without taxonomy numbers, you should have received the
rejections through your clearinghouse. Paper claims and Medicare crossover claims submitted without
taxonomy numbers will be denied.
The following is a recap by type of claim and the rejection or denial that you will receive for the incorrect
claim submission:
Coventry Cares of Kentucky Reject Messages

EDI Claims
When a rendering provider’s taxonomy code is missing from professional claims, a provider will
receive back through their clearinghouse a Payer/Level 2 Reject messages that states:
Rendering Taxonomy Missing/Invalid
When a billing provider’s taxonomy code is missing from institutional claims, a provider will
receive back through their clearinghouse a Payer/Level 2 Reject messages that states:
Billing Taxonomy Missing/Invalid

Paper Claims
When a rendering provider taxonomy is missing from paper professional claims, the claim will
be denied for missing taxonomy number if the NPI is populated on the claim.
When a billing provider taxonomy is missing from paper institutional claims, the claim will be
denied for the missing taxonomy number.
Again, if you need assistance with this change, please contact your Provider Relations Representative by
dialing 1-855-454-0061.
Thanks for your prompt attention to this matter.
2.
Benefit and Co-Pay Change Notice
The Kentucky Department for Medicaid Services is implementing new and modified “essential benefits”
for the Kentucky Medicaid program effective January 1, 2014 to comply with the Affordable Care Act. In
addition, member co-pays will be modified. CoventryCares of Kentucky intends to adopt the co-pays
being implemented in the Kentucky Medicaid Fee-For-Service program. We will modify our coverage to
include the revised benefits. Highlights of the changes follow. More detailed information will be sent
out upon approval of the benefit changes by the Centers for Medicare & Medicaid Services.
Benefits changes include:
 Increased visit limits for physical therapy, occupational therapy and speech therapy
 Expansion of allergy testing and shots to include all ages
 Expanded substance use and behavioral health benefits


Addition of private duty nursing benefits
Expanded preventative health services
Co-pays will be:
 $4
 $3
 $3
 $3
 $4
 $50
 $1
 $4
 $8
 $8
3.
outpatient hospital or surgery
office visits (medical, dental, vision)
therapy visits (PT, OT , ST)
lab, diagnostics and radiology
durable medical equipment
inpatient stay
generic drugs
preferred drug list drugs
non-preferred drug list drugs
non-emergency us of ER
Provider Representative Listing Update
Providers in Region 5 – please see the attached update to the provider representative list.
Who is my Provider Relations Representative?
Region 1
Region 2
Region 3
Region 4
Ballard
Christian
Breckinridge
Adair
Anderson
Region 5
Region 6
Region 7
Boyle
Boone
Bath
Bell
Region 8
Leslie
Caldwell
Daviess
Bullitt
Allen
Bourbon
Estill
Campbell
Boyd
Breathitt
Letcher
Calloway
Hancock
Carroll
Barren
Clark
Fayette
Gallatin
Bracken
Clay
Magoffin
Carlisle
Henderson
Grayson
Butler
Franklin
Garrard
Grant
Carter
Floyd
Martin
Crittenden
Hopkins
Hardin
Clinton
Harrison
Jackson
Kenton
Elliot
Harlan
Owsley
Fulton
McLean
Henry
Cumberland
Montgomery
Jessamine
Pendleton
Fleming
Johnson
Perry
Graves
Muhlenberg
Jefferson
Edmonson
Nicholas
Lincoln
Greenup
Knott
Pike
Hickman
Ohio
Larue
Hart
Owen
Madison
Lawrence
Knox
Whitley
Livingston
Todd
Marion
Logan
Scott
Mercer
Lewis
Laurel
Wolfe
Lyon
Trigg
Meade
Metcalfe
Woodford
Powell
Mason
Lee
Rockcastle
Menifee
Marshall
Union
Nelson
Monroe
McCracken
Webster
Oldham
Pulaski
Shelby
Russell
REGION 4
Robertson
Spencer
Simpson
Casey
Rowan
Morgan
Trimble
Taylor
Green
Washington
Warren
McCreary
Wayne
Illinois
Indiana
All Other States
Tennessee
Central Nashville
Missouri
North Carolina
Ohio
W. Virginia
Pennsylvania
Virginia
Knoxville - TN
Regina Gullo
Kimberly Berry
Lesley Lewis
Phillip Kemper
Sherri Briscoe
Sherri Briscoe
Jennie Cahill
Donna Moor
Jacqulyne Pack
Jacqulyne Pack
(502) 612-9958
(812) 660-1394
(502) 719-8743
(502) 719-8604
(502) 719-8764
(502) 719-8764
(859) 412-0052
(502) 689-3629
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
(606) 331-1075
(606) 331-1075
[email protected]
[email protected]
**FOR INITIAL OR GENERAL INQUIRIES CALL CUSTOMER SERVICE AT 1-855-300-5528**
Revised 12.09.13 T Koreck