CareCentrix^®-assigned HIPPS codes for home health services for Medicare Plus Blue^SM members who receive services in Michigan

As we communicated previously, you must include the health insurance prospective payment system, or HIPPS, code CareCentrix assigned when submitting claims for home health care services for Medicare Plus Blue members who receive services in Michigan.

Notes:

• For Medicare Plus Blue members who receive services outside of Michigan, follow the reimbursement guidelines for the local Blue Cross plan.
• This requirement doesn't apply to BCN Advantage^SM members.

Preferred methods to obtain a CareCentrix-assigned HIPPS code

These are the preferred methods:

• When possible, complete the HIPPS questionnaire within the CareCentrix HomeBridge^® portal when you submit the prior authorization request. If you do this, you will find the HIPPS code for the approved authorization in the following locations:
  • The Authorization Status screen in the HomeBridge portal.
  • The Service Registration Form, or SRF, that CareCentrix sends via fax.

  Refer to your Outcome and Assessment Information Set, or OASIS, assessment to complete the HIPPS questionnaire.

• If the OASIS isn't available when you submit the authorization request, fax it to CareCentrix at 1-877-414-1087 as soon as it's available. CareCentrix will assign a HIPPS code, which you can find on the Authorization Status screen in the HomeBridge portal.

  If you submitted an OASIS and haven't received a HIPPS code, call CareCentrix at 1-833-409-1280 to request the code prior to submitting the claim or check the Authorization Status screen in the HomeBridge portal.

CareCentrix monitors authorizations for missing HIPPS codes

If you don't obtain the HIPPS code using one of the preferred methods by day 25 of the episode of care, CareCentrix will make two attempts to call you.

• When CareCentrix contacts you and you supply the information needed to assign the HIPPS code, CareCentrix will update the authorization to include the HIPPS code.
• If you contact CareCentrix to obtain a HIPPS code after the 30-day episode of care has ended and you provide the necessary information, CareCentrix will update the authorization to include the CareCentrix-assigned HIPPS code.

In both cases, you'll be able to find the CareCentrix-assigned HIPPS code on the Authorization Status screen in the HomeBridge portal.

Additional information

For more information about the CareCentrix home health care program, see the document titled Home health care: Frequently asked questions for providers.

As a reminder, CareCentrix manages prior authorizations for home health care services for Medicare Plus Blue and BCN Advantage members as follows:

• For episodes of care that start on or after June 1, 2021
• For episodes of care that started prior to June 1, 2021, when one of the following occurs on or after June 1: recertification is needed, resumption of care is needed or there's a significant change in condition

Posted: July 2021
Line of business: Blue Cross Blue Shield of Michigan