July 21, 2010
Service Plan Protocol
Per the AAU Update sent on June 17th, new service codes and uniform rates for incontinence supplies became effective July 1, 2010. However, as this is a significant change to member service plan records, the following protocol has been established to minimize the effort required by Case Management agencies to update service codes and rates.
FIRST: The AAU will administratively adjust existing service plans by ending the existing Prior Authorization and entering the new correlated information. Both the Case Management and the DME provider will receive the Adv6g listing the new service code, number of units, rate, and prior authorization.
SECOND: All New Member plans and annual Reassessment service plans received at the AAU on or after Monday, Aug. 9, 2010 will need to list new incontinence supply services codes and rates. Any incontinence supply requests using former service codes and rates will not be authorized and will receive an SPR requesting the correct information.
THIRD: All Addendums received on or after Monday, Aug. 9, 2010 requesting any change in incontinence supplies or a change in incontinence supply provider need to list new incontinence supply services codes and rates. Addendum requests using former codes and rates will not be authorized and an SPR will be sent requesting correct information.
Please reference the attached list of new service codes and rates when preparing to submit service plan documents. If you are not sure about what code and rate to list, please work with your local Durable Medical Equipment company(s) to determine which new codes should be applied to specific products. Also remember that new rates reflect individual units of product (not cases) and should be listed accordingly on the service plan.
If you have any questions or concerns regarding the information provided above, please feel free to contact us via e-mail at Provider Questions.