Conduent Incorporated · NASDAQ:CNDT
Conduent — Investor Presentation (2017)
20 slides from Conduent's investor presentation, 2017
Slide 1: Wyoming Medicaid Vision Services 2017
WYOMING MEDICAID VISION SERVICES 2017 April Wickham- Medicaid Vision Services Manager Elisa Mauch- Provider Relations Supervisor
Slide 2: Chapter 24.22 Vision Services
Chapter 24.22 Vision Services • Vision and dispensing services are benefits for client’s ages 0- 20. • Vision services for clients 21 and older are only reimbursable for the treatment of eye disease or eye injury based on the appropriate ICD diagnosis code and client records must support billing of
Slide 3: Eye Exams
EYE EXAMS For children, ages 0-20: Eye exams determine visual acuity and refraction, binocular vision, and eye health. 92002-92004 - New patient eye exams are a covered benefit for clients who are new to the provider’s practice. 92012-92015 - Established patient eye exams are a covered benefit once
Slide 4: Eye Exams
EYE EXAMS For adults, 21 years and older: Eye exams to diagnose an eye disease or eye injury ONLY. 92002-92004 - New patient eye exams are a covered benefit for clients who are new to the provider’s practice. 92012-92014 - Established patient eye exams are a covered benefit once in a 365 day period
Slide 5: Eye Exams
EYE EXAMS Office visits for the treatment of eye disease or eye injury. 99201-99215 – May be billed by ophthalmologists for office exams. Documentation: Eye care provider records must reflect medical necessity and include interpretation and report, as appropriate, of the procedure. 92018-92065, 9208
Slide 6: Eyeglasses/Materials
EYEGLASSES/MATERIALS For Children ages 0-20: • One (1) pair of eyeglasses is covered per 365 days • V2020 – Standard frames are covered up to $73.49. The provider may not “balance bill” the client for frames that cost more than the allowable amount. NOTE: Balancing billing example – When the client
Slide 7: Covered Lenses
COVERED LENSES • V2100-V2121 (V2199 requires prior authorization) – Single lenses • V2200-V2221 (V2299 requires prior authorization) – Bifocal lenses • V2300-V2321 (V2399 requires prior authorization) – Trifocal lenses • V2410-V2430 (V2499 requires prior authorization) –High Index Aspheric lenses •
Slide 8: High Index Aspheric Lenses
HIGH INDEX ASPHERIC LENSES Aspheric lenses will only be covered when medically necessary and when they meet the following guidelines listed below: • When the power in the highest meridian is - (minus) 6 diopters or more. For example: A spectacle prescription of -2.00 -4.00 x 180 -4.00 + -2.00 = -6.0
Slide 9: Replacements
REPLACEMENTS Medicaid will allow one (1) replacement of lenses and frames within the 12 month period if: • There is a change in the prescription for the lenses, (please use the existing frames if possible). • Eyeglasses are lost or broken beyond repair – This will require documentation stating it wa
Slide 10: Reimbursement
REIMBURSEMENT Obtain eligibility information from Medicaid prior to placing order for eyewear • Verify with client and Provider Relations (1-800-251-1268) if the benefit has been used in the past year • Deliver glasses in a reasonable amount of time (typically within a week or two from the order dat
Slide 11: Order vs Delivery Date Exception Form (Effective 4/1/17)
ORDER VS DELIVERY DATE EXCEPTION FORM (EFFECTIVE 4/1/17) Wyoming Medicaid will allow a provider to bill using the order date of glasses only if one of the following conditions are present: 1. Client is not eligible on the delivery date but were eligible on the order date 2. Client does not return to
Slide 12: Contact Lenses
CONTACT LENSES For Children, ages 0-20: • V2500-V2599 – Contact lenses require prior authorization (PA) and documentation provided must show medical necessity and state why the client’s vision cannot be corrected with eyeglasses. (6.14 Prior Authorizations) • Contact lenses will be reimbursed at the
Slide 13: PA Form
'™™ Enter Date of ith [""" Enter Age |! STAY Y entered | SIGNATURE OF PROVIDER: Fr FENCING AUTHORIZATION GEST [Enter Who Provided Pending PA Number | COMMENTS EXPLANATION WYONRNONEDICAD Ame MEDIC. POLICY «FO ROK re CHEYEIOS, WY 00-561
Slide 14: Vision Therapy
VISION THERAPY Procedure Code: 92065, 99070 Vision therapy is a sequence of activities individually prescribed and monitored by the doctor to develop efficient visual skills and processing. It is prescribed after a comprehensive eye examination has been performed and has indicated that vision therap
Slide 15: Vision Therapy
VISION THERAPY 92065 – Vision Therapy can be billed for clients under the age of 21 and clients eligible for the Acquired Brain Injury Waiver benefit plan with a qualifying medical diagnosis (See manual for diagnosis codes) • When administered in the office under the guidance of a practitioner. • It
Slide 16: Additional Services
ADDITIONAL SERVICES • V2627 – Scleral cover shell requires prior authorization all ages(6.14 Prior Authorizations) • V2623, V2629 - Prosthetic eye requires prior authorization all ages (6.14 Prior Authorizations)
Slide 17: Resources
RESOURCES Provider Manuals and Bulletins • Click on Provider / Provider Manuals and Bulletins / Select Provider Type Fee Schedule • Click on Provider / Fee Schedules / Accept / Procedure Code Search Page CMS NCCI Tables Procedure Code Searches Dental Fee Schedule OPPS/APC-Base Fee Schedu
Slide 18: Resources Continued
RESOURCES CONTINUED IVR Functionality Verify client eligibility •Client ID or client SSN and date of service is required •Benefit plan Covered Services Limitations •Cap Limits •Lock-in •TPL / Medicare Buy-in Verify claim status Verify payment Opt out to agent Provider Relations 1.800.251.1268
Slide 19: Resources Continued
RESOURCES CONTINUED Fax Number 307.772.8405 EDI Services 1.800.672.4959 (Option 3) 9-5 MST Monday – Friday EDI Enrollment Form Trading Partner Agreement WINASAP Software & Technical Support for WINASAP Technical Support for Vendors, Billing Agents, and Clearinghouses Provider Web Portal Regis
Slide 20: Questions?
QUESTIONS?