August 2024 Issue
Nebraska: Billing Guidelines Updated for Members Covered Under DSNP Plans
Beginning July 1, 2024, provisionally licensed clinicians should now bill Medicare and Medicare Advantage Plans as the primary plan for UnitedHealthcare Community Plan members in Nebraska who are covered by a dual special needs plan (DSNP). After billing Medicare, claims will then automatically flow to Medicaid for secondary payer review.
This change is in addition to updated billing guidelines for master’s level clinicians that went into effect on Jan.1, 2024. Those guidelines also direct that Medicare should now be billed as the primary plan.
Here’s a quick snapshot of the details:
| Master's Level Clinicians | Provisionally Licensed Clinicians | |
| Claims for dates of service beginning Jan. 1, 2024 | Bill Medicare as primary, Medicaid as secondary | Bill Medicaid as primary |
| Reimbursement for these claims | Will be paid at the established Medicaid rate per the posted mental health and substance use disorder free schedule | |
| Claims for dates of service beginning July 1, 2024 | No change | Bill Medicare as primary, Medicaid as secondary |
| Reimbursement for these claims |
|
Claim reviews underway
UnitedHealthcare Community Plan is reprocessing claims to align with the primary/secondary billing change. They are also reviewing reimbursements that were incorrect as a result of the new guidelines.
Questions?
The new billing guidelines were initiated by Centers for Medicare & Medicaid Services (CMS) and the State of Nebraska, Division of Medicaid and Long Term Care.
See the full CMS and the State of Nebraska announcements.