June 9, 2023
The Centers for Medicare and Medicaid (CMS) released several billing changes and updates for various Medicare services that took effect on January 1, 2022. As a valued Wellcare Health Plan provider partner, we want to remind you of how these changes impact your billing activities with us:
Effective January 1, 2022, CMS requires home health providers to submit one NOA via a type of bill (TOB) 32A form as an initial bill for home health services. This NOA covers contiguous 30-day periods of care, beginning with admission and ending with patient discharge.
Providers must then submit a TOB 0329 for the periods of care following the submission of the NOA. The NOA is not separately reimbursable but is required to process and calculate the reimbursement payment via the final bill submission of TOB 0329.
Per CMS regulation, providers must submit a NOA within the first five (5) calendar days of a period of care using TOB 32A. Penalty or Reduction applied to late submission of the NOA. If the NOA is not received within 5 days of the admit date, 1/30 penalty/reduction will be applied to the final bill starting on the first date of admission.
If this is not submitted within 5 days, penalty will be applied following CMS methodology.
For more information, please see Replacing Home Health Requests (PDF)
Thank you for continuing to provide our Medicare members with high quality and compassionate care. If you have questions about any of these billing changes, please contact Provider Services.