Notification of Change to Inpatient Claim Submission Requirements

Date: 02/18/22

Summary:

Beginning on April 4^th, 2022, Ambetter from Nebraska Total Care will be collaborating with Optum, to ensure consistency in claims review and reimbursement practices with our hospital partners by reviewing all facility claims that exceed outlier thresholds.

Effective April 4^th, 2022 Ambetter from Nebraska Total Care will require submission of itemized bills with all high dollar facility claims.   You must submit an itemized detail listing each supply and service provided to the patient, and match the billed charge amount for the underlying claim for submission of all facility outlier claims.

Itemized Bill Requirements:

• The itemized bill must list each supply and services provided to the member, match the dollar amount and date of service of the request.
• The request will apply to claims submitted with other insurance, changes in coverage, lapse in coverage, or if the member’s coverage termed during the length of stay.
• Interim billing will not require an itemized bill, however it will be requested once the final bill has been submitted.

How will Company communicate its findings?

If Optum identifies any billing issues during its review, it will send you detailed findings regarding these issues and provide you with a direct contact with whom you can discuss and resolve any issues you may have with its findings.  You can also exercise your right to formally appeal Optum’s finding.

Questions:

If you have questions about this communication, please contact your Provider Relations Representative.