CareCentrix monitoring home health authorizations for missing HIPPS codes for Medicare Plus Blue members

When submitting claims for home health care services for Medicare Plus Blue℠ members who receive services in Michigan, you must include the Care‑Centrix^®‑assigned health insurance prospective payment system, or HIPPS, code. This is required because Blue Cross Blue Shield of Michigan will reject claims that don’t include the HIPPS code.

To ensure that you have a HIPPS code when you submit claims for these members, CareCentrix monitors home health authorizations for missing HIPPS codes.

What we communicated previously

The preferred methods for obtaining the HIPPS code are:

• Completing the HIPPS questionnaire or submitting the Outcome and Assessment Information Set, or OASIS, when you submit the prior authorization request
• Faxing the OASIS to CareCentrix at 1‑877‑414‑1087 as soon as it’s available

For detailed information about the preferred methods, see 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 for:

• Episodes of care that start on or after June 1, 2021
• 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

Here’s what’s new

If you don’t obtain the HIPPS code using one of the preferred methods by Day 25 of the episode of care, CareCentrix will make two attempts to call you. When CareCentrix contacts you and you supply the information needed to assign the HIPPS code, CareCentrix will update the authorization with the code.

• If you contact CareCentrix to obtain a HIPPS code after the 30‑day episode of care has ended and you provide the necessary information, CareCentrix will update the authorization to include the CareCentrix‑assigned HIPPS code.

In either case, you’ll be able to find the CareCentrix‑assigned HIPPS code on the Authorization Status screen in the CareCentrix HomeBridge^® portal.

Additional information

• For Medicare Plus Blue members who receive services outside of Michigan, follow the reimbursement guidelines for the local Blue Cross plan.
• HIPPS codes aren’t required on claims for BCN Advantage℠ members.
• CareCentrix assigns HIPPS codes in alignment with guidelines from the Centers for Medicare & Medicaid Services.

For more information about the CareCentrix home health care program, see the following pages on ereferrals.bcbsm.com:

• Blue Cross Home Health Care
• BCN Home Health Care