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AppendicesAppendicesStandard Client SurveysPhysicians Buying GroupsStandard Cost AnalysisPiloted Billing Models Contact InformationMissouri Private Health Insurance Company ContactsLPHA Identified Barriers and SolutionsBilling Plan Toolkit for Local Public Health Agencies33

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Standard Client Survey (Pilot Phase)Billing Plan Toolkit for Local Public Health Agencies35

Standard Client Survey (Pilot Phase) continued36Bureau of Immunizations

Standard Client Survey (Implementation Phase)Billing Plan Toolkit for Local Public Health Agencies37

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Physicians Buying GroupsGroup Purchasing Contact InformationCompanyContact NameContact InformationSanofi and MerckConnie Antalconniea@slmg.netGlaxoSmithKline (GSK)Michelle .923.2233www.pedspal.orgPedsPal Group PurchasingMoore Medical LLCAurora Tomlin800.234.1464, Ext. 5413atomlin@mooremedical.comBilling Plan Toolkit for Local Public Health Agencies39

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Standard Cost AnalysisBilling Plan Toolkit for Local Public Health Agencies41

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Piloted Billing Models Contact InformationAvaility/HeW10752 Deerwood Park Blvd, Suite 110Jacksonville, FL 32255Contact: Inside Sales Team1.877.732.5633, Option 2insidesales@availity.comEmdeon One (Purchased by Change Healthcare)3055 Lebanon Pike, Suite 100Nashville, TN 37214Contact: Tim Gallaher, Sales mTransactRx5146 W. Whispering Wind DrivePhoenix, AZ 85310Contact: Fabi Carmona, Customer Care Supervisor866.522.3386623.806.8829 (direct line)fcarmona@transactrx.comContact: Andrea Seratte, Executive Vice President866.522.3386623.434.4628, Extension s Public Health Solutions (Formerly Upp Technology)Mitchell & McCormic, Inc2165 West Park Court, Suite GStone Mountain, GA 30087Contact: Aymsley Upp, Director, Revenue Cycle re4401 S. Orange Avenue, Suite 117Orlando, FL 32806Contact: Brian Oestreich, Regional Marketing are.comBilling Plan Toolkit for Local Public Health Agencies43

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Missouri Private Health Insurance Company ContactsPlease note this directory is a culmination of contacts received from multiple sources. The individualslisted have been contacted by the BI, LPHAs or billing models to obtain contracts for private / commercialinsurance billing.Insurance CompanyContact Name and TitleAetnaCheryl Danforth, ProviderRelations RepresentativeAnthem Blue Cross and Blue ShieldHeather Burch, Provider RelationsRepresentativeBlue Cross and Blue Shield ofKansas CityMarsha Yarnell, Provider RelationsRepresentative(Eastern Jackson County)Dena Roberts, Provider RelationsRepresentative(Andrew, Atchison, Buchanan,Caldwell, Clinton, Daviess,DeKalb, Gentry, Grundy, Harrison,Holt, Livingston, Mercer, Nodawayand Worth counties)Carla Jensen, Provider RelationsRepresentative(Clay and Ray counties)Jennifer Reese, Provider RelationsRepresentative(Platte and Western JacksonCounty)Katrina Taggart, Provider RelationsRepresentative(Cass, Johnson and Lafayettecounties)Deb Armenta, Provider RelationsRepresentative(Bates, Benton, Carroll, Henry,Pettis, Saline, St. Clair and Vernoncounties)Blue Cross and Blue Shield ofMissouri (Wellpoint/Anthem)Cigna (Kansas City Area)Cigna (St. Louis & Central Area)Core SourceContact eKC.comSandra Volner, Provider cbsmo.comJennifer Crader, Provider RelationsRepresentativeDaniel Brawley, Provider ider RelationsRepresenttive800.990.9058Billing Plan Toolkit for Local Public Health Agencies45

Missouri Private Health Insurance Company ContactsInsurance CompanyCoventry Health Care of Missouri(Merged with Aetna) – EasternMissouriCoventry Health Care of Missouri(Merged with Aetna) – WesternMissouriContact Name and TitlecontinuedContact InformationProvider Relations Representative800.755.3901Leon Nelson, Provider omKelley Bolton, Provider oxhealth.comAmanda Rash, Provider health.comProvider Relations der Relations Representative402.494.2411800.228.8602Provider Relations Representative800.608.8158Use website for questions orassistanceHealthLinkProvider Relations Representative314.925.6000 or 800.624.2356www.healthlink.comHome State HealthDawn Lukacina, Provider Relations h.comHumanaDenise Doering, Provider Relations ain HealthProvider Relations RepresentativeMissouri Care/WellCareProvider Relations RepresentativeCox Health CenterFirst Health (Coventry/Aetna)Golden Rule (Now UnitedHealthcare)Great West Casualty CompanyGroup Health Plan (Now CoventryHealth Care of Missouri)Harmony/WellCareHealthcare USA (Now Aetna)46Bureau of

Missouri Private Health Insurance Company ContactsInsurance CompanySecure Horizons (Now UnitedHealthcare of Midwest)Contact Name and TitlecontinuedContact InformationTriCareYvonne Dawson, ProviderRelations Representative314.592.7334Yvonne T Dawson@uhc.com913.802.5633877.842.3210Patty Snider@uhc.comTriCare (Northwest Missouri)Patty Snider, Provider RelationsRepresentativeUnited Healthcare of the Midwest(Includes UMR)Traci Leathers, Provider RelationsRepresentative800.627.0687Traci Leathers@uhc.comUnited Mine Workers Health &Retirement FundsDavid Gildart, Provider nds.orgBilling Plan Toolkit for Local Public Health Agencies47

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LPHA Identified Barriers and SolutionsThrough monthly conference calls and/or routine communication with the pilot agencies, the BI collectedbarriers (along with available solutions) that were encountered during the projects. Below is a summary ofthe primary barriers and the recommended solutions identified through the LPHA Billing Pilot Projects.Barrier: Convincing a private/commercial insurance carrier to contract with an LPHA.Solution: The Department of Insurance, Financial Institutions and Professional Registration (DIFP)recommends that LPHAs gather data on the number of individuals served in the community and the numberof employers that use their coverage (if available). Approach insurance carriers with this data and theconcept and benefits of “one-stop shopping.” Many times with insurance companies it requires education,persistence and talking to the right person. If you serve a rural area with limited health care resources,provide data relating to physician-to-population ratio, and the lack of or limited number of hospitals,Federally Qualified Health Centers, and Rural Health Clinics available. If LPHAs are unsuccessful with theperson they initially speak with, ask who else in the chain of command you can speak with to sell your cause.Work your way up the chain of command, if necessary.Barrier: Many of the pilot agencies without a physician on staff encountered difficulties when settingup contracts with private insurance companies.Solution: An Insurance Summit was held in July 2013, through which the BI and the LPHAs were able tonetwork with Missouri insurance companies. Some of the insurance companies have modified their contractsin order to better serve the LPHAs who do not have a physician on staff. In an effort to avoid wasted LPHAstaff time and frustration, the BI provided the pilot LPHAs with a listing of insurance company contacts sothat they may begin contract discussions with the proper insurance company staff. This Missouri insurancecompany contact listing is included in the Appendices of this toolkit. Some of the pilot agencies who werehaving trouble getting contracts in place also contacted other LPHAs who already had established contracts.The agencies with contracts in place were able to provide those without contracts with contact informationand tips on how to successfully obtain contracts. Many of the pilot agencies who needed insurance companycontracts were able to get them in place prior to the end of the pilot projects.Barrier: Under certain billing models, some of the LPHAs were unable to bill all local insurancecompanies.Solution: Research the various billing models that are available to determine which one will work the mosteffectively for your agency. Some of the pilots were able to contact the billing model and encourage them toadd certain carriers that were not available through their system.Barrier: Some of the LPHAs reported that they lack funds for the up-front cost of vaccines.Solution: Research various funding opportunities available in your specific area. Conduct a cost analysisto ensure that billing third-party payers will result in a profit for the agency. Research what options areavailable through the individual vaccine companies, as some companies have a payment schedule thatis public health agency friendly. Also, consider obtaining group purchasing discounts offered throughPhysicians Buying Groups. Explore the possibility of sharing vaccine with a neighboring county to helpoffset the vaccine cost. (Note: LPHA’s insurance policies may only cover refrigeration equipment and not thecontents. An endorsement to your policy may need to be added to cover your vaccine inventory.)Disclaimer:This section contains information that was originally submittedby pilot LPHAs and has been summarized by the BI for relative context.Billing Plan Toolkit for Local Public Health Agencies49

LPHA Identified Barriers and Solutions continuedBarrier: Privacy for clients when explaining possible charges to health insurance.Solution: Pilot agencies found that working in a separate clinic room is the best solution to this barrier.Barrier: System issues when checking patient eligibility (VaxCare).Solution: Contact the insurance company by phone using the phone number on the individual company’s website, which will direct the call to an operator who will be able to check eligibility. Do not use the 800 numberon insurance cards.Barrier: Determining which insurance companies to contract with.Solution: Conduct research within the agency’s jurisdiction to determine the most popular insurancecompanies being used by residents. One way to collect the information is through a survey of clients.Barrier: Time consuming city and/or county legal department review of insurance contracts.Solution: If this is a required process, the agency should follow up with the city and/or county officefrequently regarding the status of the contract. Ensure the legal department knows that the contract mustbe in place before billing can begin and any delays in the contract review will cause delays in the LPHA’sability to bill private / commercial health insurance.Barrier: Agency staff’s lack of knowledge of billing process.Solution: Utilize training offered by the selected billing model. Contact other LPHAs to discuss proceduresand best practices. Refer to the DHSS “Billing Plan Toolkit for Local Public Health Agencies” for generalprocess guidance and resources.Barrier: Additional time needed for patient intake.Solution: Develop protocols that will assist staff in streamlining the patient intake process. Examine thepossibility of collecting insurance information when appointments are scheduled.Barrier: VaxCare does not offer a specific vaccine.Solution: Contact VaxCare and request they begin offering the vaccine. They will review whether or notthere is a sufficient need for the vaccine and may or may not add it to their list of available vaccines.Barrier: Resolving payment disputes when a client is both Medicaid and Medicare eligible. Bothprograms deny payment claiming the other provider is responsible for payment.Solution: Claims should be filed with Medicare first. If Medicare denies the claim, then submit the claim toMedicaid with the Medicare explanation of why the benefits were denied. If the Medicaid claim is denied,contact their Provider Relations office at 573-751-2896 to clarify why the denial occurred, and how it canbe resolved. Utilize the Medicare Advantage program and/or the Centers for Medicare and Medicaid (CMS)Secure Net Access Portal (C-SNAP) to verify Medicare information. You must be a Medicare provider toregister and receive information from C-SNAP. The link is Another link helping with Medicare denials is stools/rejected-claim-tool.shtml.Disclaimer:This section contains information that was originally submittedby pilot LPHAs and has been summarized by the BI for relative context.50Bureau of Immunizations

Additional Internet ResourcesThere are many resources available to LPHAs who are interested in billing Medicaid, Medicare andprivate / commercial insurance. Below are links to various web sites and documents that may be helpfulwhen developing and implementing a medical billing system within an LPHA.Resources for Vaccine Coding and Billing, National Adult and Influenza Immunization Top Questions on Coding and Billing for Vaccines: Avoiding Common Errors, National Adult InfluenzaImmunization Summit, tional InternetResourcesEasy guide to coding to collect what you are owed Modern Medicine Network, Medical al-economics/news/keys-codingIllinois Public Health Association’s Billing Best Practices White Papers and Training Webinars, ingImmunization Credentialing and Contracting for Public Health Departments and-contracting-forpublic-health-departmentsImpact of HIPAA on Public Health – Now hipaaon-public-health-part-1-and-2Gearing up for Meaningful Use – A Public Health Perspective c-health-perspectiveImmunization Billing for Public Health blichealth-white-paper-releasedCommon Medical Billing Mistakes and Solutions: A Local Health Department Perspective lutionsMedical Billing Audits for LPHAs %20White%20Paper.pdfAmerican Academy of Pediatrics – contains information regarding immunizations for both parents andhealth care providers. The health care provider information includes resources on vaccine financing that mayprovide guidance during the development stages of a billing for Disease Control and Prevention (CDC) Immunization Billables Project – offers informationregarding the CDC Billables Project and provides additional billing resources for index.htmlBilling Plan Toolkit for Local Public Health Agencies51

Additional Internet Resources continuedCenters for Medicare and Medicaid (CMS) – provides information regarding what immunizations arecovered for Medicare clients along with additional Medicare immunization s/Centers for Medicare and Medicaid (CMS) ICD-10 – email updates, sign up /subscriber/newAdditional InternetResourcesCMS Medicare Billing: 837P and Form CMS-1500 fact sheet – provides information regarding the 837Pstandard format for transmission of electronic claims as well as the form CMS-1500 used for paper arning-Network-MLN/MLNProducts/downloads/form cms1500 fact sheet.pdfCMS Quick Reference Information: Medicare Immunization Billing – provides information on Medicareimmunization procedure codes and descriptions as well as ing-Network-MLN/MLNProducts/downloads/qr immunbill.pdfCMS Quick Reference New Medicare Provider – provides information for new Medicare ference New Provider.pdfCMS Vaccine Payments under Medicare Part D fact sheet – provides information regarding whatimmunizations may be covered by Medicare Part Factsheet-ICN908764.pdfMO HealthNet Local Public Health Agency Billing Book – provides information to help LPHAs submitclaims correctly to MO h/healthmanual.pdfMissouri Medicaid (MO HealthNet) Provider Enrollment FAQs – provides answers to some of the mostfrequently asked questions regarding MO HealthNet provider -faqs/MO HealthNet Provider Enrollment Guide – provides information on how to become a Missouri Medicaid(MO HealthNet) ion/providerenrollmentgui/Internetman121103.htmMO HealthNet Frequetly Asked Questions for Providers – provides a list of frequently asked questions forMO HealthNet and Mo HealthNet fee-for-service reau of Immunizations

Additional Internet Resources continuedMO HealthNet Puzzled by the Terminology? A Guide for Providers – provides a quick overview of the MOHealthNet dfNational Association of County & City Health Officials’ Billing for Clinical Services – provides a largeamount of information and resources regarding LPHA medical billing including various billing toolkits fromother lroad Medicare PTAN (Provider Transaction Access Number) Request Form for electronic submittersdeveloped by Palmetto GBA. Palmetto is the Railroad Specialty Medicare Administrative Contractor thatprocesses Part B claims for Railroad Retirement beneficiaries nationwide. The electronic form can be foundat files/Railroad Medicare PTAN Request Form.pdf/ File/Railroad Medicare PTAN Request Form.pdfBilling Plan Toolkit for Local Public Health Agencies53

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References1. Freed, G. L., Cowan, A. E., & Clark, S. J. (2008, December 1). Primary Care Physician Perspectives onReimbursement for Childhood Immunizations. Pediatrics, 122(6), 1319-1324. doi: 10.1542/peds.20082033 or 6/1319.abstract.2. U.S. Department of Health and Human Services. (2009, March 2). Appendix 1: Children andAdolescents Vaccine Financing Recommendations Adopted by NVAC - September 2008 (withapproved editorial changes March 2, 2009). Accessed April 2014 at pt08.html.3. Washington State American Reinvestment & Recovery Act (ARRA) Immunization ReimbursementProject Workgroup. (2011, September). The Washington State Local Health Jurisdiction ImmunizationBilling Resource Guide. Accessed April 2014 at Billing Resource Guide.pdf.4. Missouri Department of Health and Senior Services. (2013). Missouri Health Improvement Plan 20132018. Accessed April 2014 at ship.pdf.5. Indiana Immunization Coalition. (2013). Indiana Local Health Department Billing System. DesMoines, IA: Medical Billing Services, Inc. with assistance from Medical Billing and Accounting, Inc(Indianapolis, IN).6. Centers for Medicare and Medicaid Services. (2013, April 2). Are You a Covered Entity? AccessedApril 2014 at CoveredEntity.html.References7. U.S. Department of Health and Human Services. (n.d.). Health Information Privacy. Accessed April2014 at U.S. Department of Health and Human Services. (n.d.). Understanding Health Information Privacy.Accessed April 2014 at /index.html.9. Centers for Medicare and Medicaid Services. (2012, September). The National Provider Identifier(NPI): What You Need to Know (ICN: 902603). Accessed April 2014 at klet.pdf.10. Centers for Medicare and Medicaid Services. (2012, April 25). Taxonomy. Accessed April 2014 my.html.11. Iowa Immunization Program. (2011). 2011 Iowa Local Public Health Agency Billing OperationsManual (2011 Iowa LPHA Billing Project V072011). Des Moines, IA: Medical Billing Services, Inc.12. Centers for Medicare and Medicaid Services. (2013, March). Medicare Billing: 837P and Form CMS1500. Accessed April 2014 at s-1500.pdf.Billing Plan Toolkit for Local Public Health Agencies55

References continued13. Centers for Disease Control and Prevention. (2014, June 13). CPT Codes Mapped to CVX Codes.Accessed April 2014 at cines.asp?rpt cpt.14. American Medical Association. (n.d.). About CPT. Accessed April 2014 at insurance/cpt/ U.S. Department of Health and Human Services. (2001, July 17). Credentialing and Privileging ofHealth Center Practitioners Policy Information Notice 2001-16. Accessed April 2014 at pin200116.html.16. Missouri Department of Insurance, Financial Institutions and Professional Registration. (n.d.). HMOStandardized Credentialing Form. Accessed April 2014 at dentialing.php.17. Missouri Department of Insurance, Financial Institutions and Professional Registration. (n.d.). CAQHFaxing Guidelines. Accessed April 2014 at HFaxingGuidelines.pdf.18. Council for Affordable Quality Healthcare. (n.d.). Universal Provider Datasource Provider andPractice Administrator Quick Reference Guide. Accessed April 2014 at 19. Council for Affordable Quality Healthcare. (2014). UPD Participating Organizations. Accessed April2014 at Council for Affordable Quality Healthcare. (n.d.). Getting Started. Accessed April 2014 at Centers for Medicare and Medicaid Services. (2013, December). Mass Immunizers and Roster Billing:Simplified Billing for Influenza Virus and Pneumococcal Vaccinations (ICN: 907275). Accessed April2014 at -Learning-Network-MLN/MLNProducts/downloads/Mass Immunize Roster Bill factsheet ICN907275.pdf.22. Council for Affordable Quality Healthcare. (2014). CAQH Committee on Operating Rules forInformation Exchange (CORE) FAQs Part B: ACA Section 1104 Mandate for Federal Operating Rules(Version 20140421.1001). Accessed April 2014 at Missouri Department Health and Senior Services. (2014, February). DHSS Public Health WorksOrientation Manual for Public Health Leaders. Accessed April 2014 at lthworks.pdf.56Bureau of Immunizations

AcknowledgementsThe Missouri Department of Health and Senior Services’ (DHSS) Division of Community and PublicHealth’s Bureau of Immunizations (BI) gratefully acknowledge the assistance of: Centers for Disease Control and Prevention (CDC) Missouri Department of Health and Senior Services’ Center for Local Public Health Services(CLPHS) Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) Missouri Association of Local Public Health Agencies (MOALPHA) Missouri Department of Social Services’ (DSS) MO HealthNet Division (MHD)Missouri Billing Plan Stakeholder WorkgroupAcknowledgementsJo Anderson – DHSS, CLPHSPam Bryant – Former LPHA staff of Springfield-Greene County Health DepartmentYoli Carrillo – Lafayette County Health DepartmentPaula Childs – St. Charles County Department of Community Health and the EnvironmentJulie Creach – DSS, MHDJennifer Eisenhower – Former LPHA staff of Pike County Health DepartmentEllen Fry – Phelps/Maries County Health DepartmentJudy Hale – St. Francois County Health CenterKelly Horwitz – Former LPHA staff of Jefferson County Health DepartmentBecky Hunt – Madison County Health DepartmentSally Johnson – Former LPHA staff of Clay County Public Health CenterKay Kertz – Former LPHA staff of Ste. Genevieve County Health DepartmentCindy Leuthen – Former staff of DHSS, CLPHSMary Martin – Columbia-Boone County Department of Public Health and Human ServicesSusan McKinney – Former staff of DSS, MHDAngela Nelson – DIFP, Division of Market RegulationDiane Otto – Former LPHA staff of Cole County Health DepartmentMarie Peoples – Former LPHA staff of Cole County Health DepartmentBrenda Phillips – Cape Girardeau County Public Health CenterSheila Reed – DHSS, CLPHSDella Rhoades – Former LPHA staff of Nodaway County Health CenterMahree Skala – Former staff of MOALPHAWanda Sadler – former staff of BIDileep Sarecha – former CDC Field AssigneeCathy Sullivan – former staff of BIEllen Sullivan – Lincoln County Health DepartmentDaviene Wade – Callaway County Health DepartmentCarma Wheeler – Howell County Health DepartmentBI Contributing StaffLaura Kliethermes – Former staff of BIValerie Schmidt – Former staff of BIPaula WoodsmallLynelle ParoBilling Plan Toolkit for Local Public Health Agencies57

Acknowledgements continuedBilling Plan Pilot AgenciesCallaway County Health DepartmentCape Girardeau County Public Health CenterCity of St. Joseph Health DepartmentClay County Public Health CenterCole County Health DepartmentColumbia-Boone County Department of Public Health and Human ServicesDunklin County Health DepartmentHickory County Health DepartmentHowell County Health DepartmentJasper County Health DepartmentJefferson County Health DepartmentLafayette County Health DepartmentLivingston County Health CenterMadison County Health DepartmentMcDonald County Health DepartmentNodaway County Health CenterPettis County Health CenterPike County Health DepartmentReynolds County Health CenterSt. Charles County Department of Community Health and the EnvironmentSt. Francois County Health CenterSte. Genevieve County Health DepartmentStone County Health DepartmentTri-County Health Department (Worth, Gentry, DeKalb)Vernon County Health DepartmentImplementation Project AgenciesAcknowledgementsAudrain County Health DepartmentBollinger County Health CenterCass County Health DepartmentClark County Health DepartmentClay County Public Health CenterDade County Health DepartmentDallas County Health DepartmentGasconade County Health DepartmentIron County Health DepartmentKansas City Health DepartmentKnox County Health DepartmentLafayette County Health DepartmentLawrence County Health DepartmentMadison County Health DepartmentMcDonald County Health DepartmentMississippi County Health DepartmentPemiscot County Health Department58Bureau of Immunizations

Acknowledgements continuedImplementation Project Agencies continuedPolk County Health CenterPutnam County Health DepartmentSt. Francois County Health CenterShannon County Health CenterStone County Health DepartmentTri-County Health Department (Worth, Gentry, DeKalb)Washington County Health DepartmentWayne County Health CenterWright County Health DepartmentBilling Plan Toolkit for Local Public Health Agencies59

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June 2017Missouri Department of Health and Senior ServicesBureau of Immunizations800.219.3224AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis.

Coventry Health Care of Missouri (Merged with Aetna) – Eastern Missouri Provider Relations Representative 800.755.3901 Coventry Health Care of Missouri (Merged with Aetna) – Western Missouri Leon Nelson, Provider Relations Representative 913.202.6117 Cox Health

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