MCO information for PCA agencies

Website: www.bluecrossmn.com
Provider customer service: 866--518-8448
Provider contracting: 800-262-0820
Assessment and authorization for seniors: Contact member’s care coordinator
Fraud hotline: 651-662-8363 or 800-382-2000 ext. 28363

Blue Plus communicates provider requirements or changes through a Provider Bulletin or a Provider Quick Points.

Find information in the Provider Policy and Procedure Manual, the Blue Plus Manual or on the DHS website.

QPs must enroll with Blue Plus before billing for services they provide. Blue Plus will assign an individual Internal Reference Number to the QP. The QP must use this number when billing for services he or she provides.

Register for the PCA Steps for Success training through DHS. Find the training information on the home and community-based services page under Personal care assistant (PCA).

Although we have an extensive network of PCA providers and rarely add any additional agencies, we do assess the network needs with each contract request that we receive to determine if we will extend a contract offer. 

Website: www.healthpartners.com  
Claims customer service: 952-883-7699 or 888-663-6464
Member services (HPCare): 952-967-7998 or 866-885-8880 
Member services (MSHO): 952-967-7029 or 888-820-4285 
Provider contracting: 952-883-5607 
Authorization medical management triage line: 952-883-6333   
PCA questions: Email: pcaquestions@healthpartners.com
Fraud hotline: 952-883-5099 or 855-332-7194 or email reportfraud@healthpartners.com

Contracted agencies may receive a letter or can refer to Fast Facts articles.

Bill QP services using the agency number.

Agency must contact quality utilization improvement (QUI) and provide PCA information by the start date. Call 952-883-6333 or fax 952-853-8712.

Submit all claims within 180 days of first date of service. Provider has 60 days from the remit date of the original timely filing denial to submit an appeal.  If appeal is received after the 60 days, a letter is sent to provider stating that the appeal was not accepted.

The PCA network is closed.

Website: www.imcare.org
Provider customer service: 800-843-9536
Provider contracting: 800-843-9536
Assessment and authorization:

• For seniors or those receiving PCA services through the Elderly Waiver (EW) or another waiver, contact the member's county case manager or IMCare Senior Care Coordinators at 800-843-9536. Fax homecare authorization requests to 218-327-5545. 
• For all others, contact social service intake at 218-327-2941. Itasca County public health nurses (PHNs) perform the PCA assessments.

Provider numbers: IMCare does not assign individual PCA numbers. Your NPI or UMPI number assigned by NPI registry or by DHS is the number IMCare uses to identify you.
Fraud hotline: 866-269-0584

IMCare communicates through provider updates, IMCare's Provider Newsletter or the IMCare website: www.imcare.org.

Bill QP services through the PCA provider agency.

IMCare expects provider agencies to take the DHS PCA Steps for Success training. Find the training information on the home and community-based services page under Personal care assistant (PCA).

PCA authorizations are handled by the Quality Improvement/Utilization Management (QI/UM) department.

The following forms are required for an authorization to be approved:

• PCA assessment, Home Care Services Plan and Flexible Use Agreement for county public health nurse (PHN)
• Level 1 behavior documentation if warranted

PCA provider agencies submit a request for a six-month service agreement by fax using IMCare's Homecare authorization request form, based on PHN recommendations. The medical director reviews the request. If the request meets the DHS homecare rating or unit determination, authorization is approved. When the six-month time frame is completed, agencies submit a request for second half of service agreement.

Submit claims within 180 days from the last date of service.

Call IMCare for more information.

Website: www.medica.com
Provider customer service: 800-458-5512
Provider contracting: 800-458-5512
Assessment and authorization:

• Seniors: Call the assigned care coordinator. To find care coordinator contact information, contact provider services at 800-458-5512.
• All others: Contact Care Management at 800-458-5512, option 1, option 4, option 3.

Fraud hotline: 866-821-1331

Medica communicates changes to its provider network as follows:

• Medica sends communications that affect all providers through Connections, our provider newsletter. Participating agencies, subscribe to Connections.
• Medica sends communications that are specific to agencies providing PCA services either by letter or an email distribution list Medica has created for participating home care agencies and personal care provider organizations (PCPOs).

• General administrative requirements for all health care providers are found online in the Administrative Manual.
• Specific administrative requirements for participating agencies are on the website under the Provision of Personal Care Assistance Services for PCA Agencies.

Services are billed with an agency NPI or UMPI. It is not necessary to enroll qualified professionals with Medica.

Medica offers classes to contracted providers through its Medica Provider College. Occasionally, Medica offers classes specific to PCA services. These classes are announced in Connections, the provider newsletter. For PCPOs, good classes to start with include, “The Life of a Claim” and “Minnesota Health Care Programs.” Home care agencies may also want to consider “Medica Products” training.

Medica is not accepting applications for new PCA providers. However, Medica may consider extending a contract offer if a PCA agency is providing a unique service or in a specific geographic region to meet network needs..

Medica coordinates client services through the client’s assigned care coordinator. The care coordinator is the first point of contact for any issues relating to the client’s medical care and authorizations. It is important that the staff from your agency work closely with the assigned care coordinator on the client’s care.

Website: www.primewest.org      
Provider customer service: 866-431-0802
Provider contracting: 866-431-0802 select option 2
Assessment and authorization:

• Seniors: Call their assigned case manager at the county
• All others: Contact local Public Health department for a PCA assessment
  

Provider numbers: PrimeWest does not assign individual provider numbers. Your NPI or UMPI number assigned by NPI registry or by DHS is the number PrimeWest uses to identify you. 

Fraud hotline: 320-335-5240 or 866-763-2952

PrimeWest Health communicates changes to its provider network as follows:

• Communications that affect all providers are sent through PrimePointers, our provider newsletter. Participating agencies can access PrimePointers at www.primewest.org.
• Communications that are specific to agencies providing PCA services are by letter.

• General administrative requirements are found online at www.primewest.org/providers-partners.
• Specific administrative requirements for PCA Agencies are found in the Provider Manual, PCA Chapter.

Bill services with an agency number. It is not necessary to enroll qualified professionals.

PrimeWest Health expects contracted PCA agencies to attend the DHS PCA Steps for Success training. Find the training information on the home and community-based services page under Personal care assistant (PCA).

Call PrimeWest for more information. 

Website: mnscha.org
Provider customer service: 888-633-4055
Provider contracting: 507-444-7770 or 866-722-7770
Assessment and authorization:

• Direct requests for initial assessments and reassessments to the local Public Health Office in the county in which the member resides.
• For Senior Care Complete and Minnesota Senior Care Plus (MSC+) members open to EW, contact the local county care coordinator or case manager for the member to request assessment and authorization.

Provider numbers: South Country does not assign individual provider numbers. Your NPI or UMPI number assigned by NPI registry or by DHS is the number South Country uses to identify you.
Fraud hotline: 877-778-5463 or email www.reportit.net (log in as user SCHA and password Owatonna)

Bill QP services with the agency number.

South Country provides billing procedures and training as necessary. South Country expects contracted PCA agencies to attend the DHS PCA Steps for Success training.

See South Country’s Provider Manaual or Authorization section on our website, www.mnscha.org

Submit claims within six months from date of service.

South Country will contract with PCA agencies that our members or counties are using.

Website: www.ucare.org    
Provider customer service: 888-531-1493
Provider contracting: 888-531-1493
Assessment and authorization: 612-676-6705, 877-447-4384 or see UCare Provider Manual (PDF) (PCA authorization process)
Fraud hotline: 877-826-6847

Changes are communicated on the provider page of the UCare website, the UCare Provider Manual or Provider Newsletter.

Bill with the agency NPI.

Newly contracted PCA agencies receive individual training before the contract effective date.

Fax request to UCare Clinical Services at 612 884-2094 or 866 610-7215. Allow 10-14 business days for UCare to process your request. For more details, refer to the UCare Provider Manual (PDF).

Submit claims within one year from the date of service and adjustments within one year from the date the claim originally paid or denied.

UCare is closed to new agencies.