Clarifications on the CareCentrix home health care program for Medicare Advantage members

CareCentrix^® has managed authorizations for home health care services for Medicare Plus Blue^SM and BCN Advantage^SM members since June 2021.

Based on feedback CareCentrix has received, we've added information about the following to the Home health care: Frequently asked questions for providers (PDF) document.

When to notify CareCentrix that a member has stopped receiving services prior to the end date on their authorization

Because CareCentrix can't approve a new prior authorization request for a member who has an active authorization for home health services, you need to notify CareCentrix when:

• The member is discharged from a home health agency's care, is readmitted to an inpatient setting and then requires additional home health services following discharge
• A member changes home health agencies during a 30-day authorization duration
• A member’s health care coverage is terminated during a 30-day authorization duration

To notify CareCentrix, call 1-833-409-1280. Once CareCentrix modifies the authorization end date, they will make determinations on new prior authorizations you submit for the member.

How to search for members by last name in the HomeBridge^® portal

To search for members by last name in the HomeBridge portal:

1. Complete all required fields other than the Last Name Search field.
2. In the Last Name Search field, do one of the following:
   • If the member's last name DOESN'T include spaces or special characters: Enter the member’s full last name.
   • If the member's last name includes spaces or special characters (such as hyphens, apostrophes or periods): Enter only the first alphabetic character of the member's last name.

     If you enter a space or special character in the Last Name Search field, you’ll receive an error message that reads “Patient last name cannot have characters other than alpha numeric.”

3. Click Continue.

How to confirm the CareCentrix-generated HIPPS code to include on claims for services provided to members with Medicare Plus Blue plans

CareCentrix assigns HIPPS codes to authorizations for home health services received by Medicare Plus Blue members within Michigan. The HIPPS code that you submit on the claim must match the CareCentrix-generated HIPPS code that appears on the Service Registration Form, or SRF, or on the Authorization Status screen in the HomeBridge portal.

If you don't provide a HIPPS code or complete the HIPPS questionnaire when you submit the prior authorization request, CareCentrix will proceed with making a determination on the request. If they approve the request, they'll send a SRF form that doesn't include a HIPPS code. Once they've processed the approval, CareCentrix will assign a HIPPS code and send an updated SRF that includes the HIPPS code.

If you don’t receive an updated SRF, you can find the CareCentrix-assigned HIPPS code by checking the Authorization Status screen in the HomeBridge portal or by calling CareCentrix at 1-833-409-1280 from 8 a.m. to 11 p.m. Eastern time any day, excluding holidays.

CareCentrix is an independent company that manages the authorization of home health care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans.

Posted: November 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network