Submitting Medicare Plus Blue post‑service claims for home health care

For home health care services received in Michigan by Medicare Plus Blue℠ members:

• Post‑service claims must include the CareCentrix^®-assigned health insurance prospective payment system, or HIPPS, code.

• The HIPPS code on the post-service claim must match the HIPPS code on the Request for Anticipated Payment, or RAP, claim.

This doesn’t affect home health care claims for BCN Advantage℠ members.

Keep reading to learn more.

CareCentrix‑assigned HIPPS code required when submitting post‑service claims

You must include the CareCentrix‑assigned HIPPS code when you submit post‑service claims for home health care for Medicare Plus Blue members to Blue Cross Blue Shield of Michigan. Otherwise, claims will be rejected.

CareCentrix assigns the Health Insurance Prospective Payment System code in alignment with guidelines from the Centers for Medicare & Medicaid Services.

Obtaining the HIPPS code

• If the Outcome and Assessment Information Set, or OASIS, assessment is available: Complete the HIPPS questionnaire when you submit the prior authorization request. You’ll find the HIPPS code for the approved authorization on the Authorization Status screen in the CareCentrix HomeBridge^® portal.
  
  The HIPPS questionnaire is available in the HomeBridge portal. Refer to your OASIS assessment to complete the questionnaire.

• If the OASIS assessment isn’t available when you submit the authorization request: Fax it to CareCentrix at 1‑877‑414‑1087 as soon as possible. CareCentrix will assign a HIPPS code, which you can find on the Authorization Status screen in the HomeBridge portal.



If you submitted an OASIS assessment and haven’t received an HIPPS code, call CareCentrix at 1‑833‑409‑1280 to request the code — or check the Authorization Status screen in the HomeBridge portal for the code — before you submit the post‑service claim to Blue Cross.

Submitting the OASIS assessment
The steps to submit the OASIS assessment vary based on when you submit it:

• When submitting the assessment with the prior authorization request: Upload the assessment as a separate document. Don’t include it within the medical record.
• When submitting the assessment after submitting the prior authorization request: Fax the assessment to CareCentrix at 1‑877‑414‑1087.

Note: You must submit the OASIS assessment before the end of each episode of care. We recommend you submit it as soon as it’s available.

CareCentrix‑assigned HIPPS codes on post‑service claims must match the HIPPS codes on RAP claims

When you submit a Medicare Plus Blue post-service claim for home health care, the CareCentrix‑assigned HIPPS code must match the HIPPS code on the RAP claim. Blue Cross will deny Medicare Plus Blue claims for home health care services when the CareCentrix‑assigned HIPPS code doesn’t match the HIPPS code on the RAP claim.

If the HIPPS code on the post-service claim doesn’t match the HIPPS code on the RAP claim that you submitted prior to providing services, submit a corrected RAP claim with the post‑service claim.

This requirement is in keeping with standard billing processes and is in alignment with the Centers for Medicare & Medicaid Services requirements. For more information, see the following resources:

• Medicare Claims Processing Manual Chapter 10 – Home Health Agency Billing**

• The “Claims Submission Data Elements” section of the Submitting a Final Claim under the Home Health Patient‑Driven Groupings Model** page on the cgsmedicare.com website

Additional information

For more information about the CareCentrix home health care program, see the document titled Home health care: Frequently asked questions for providers.

As a reminder, CareCentrix manages prior authorizations for home health care services for Medicare Plus Blue and BCN Advantage members as follows:

• For episodes of care that start on or after June 1, 2021
• For episodes of care that started before June 1, 2021, when one of the following occurs on or after June 1: Recertification is needed, resumption of care is needed or there’s a significant change in condition

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.