Page 61 - R2P Front Desk Manual v1

○ 3-digit benefit code for PT is 500
● Authorization Note: If the ID starts with “MYY” an OPAP authorization will need to be
submitted through Carefirst Direct web Portal HERE. Always call to receive benefits
because auth for MYY plans is required after the patient’s 6th LIFETIME visit, so
clinic must know how many lifetime visits the patient has had. *It is very important to flag
and note in the patient’s chart that auth is needed and after which number visit!!* Add an
authorization to the patient’s case to alert the Coordinator and PT when auth must begin.
○ When submitting an OPAP request through the portal, please note that the # of
units requested per code = # of visits when approved (i.e. if 2 codes are
requested at 2 units each and approved, 4 visits have auth)
○ Auth requests through the portal can only be backdated three days. If beyond
three days, make sure to note in “Additional Comments” the start date you are
requesting.

Cigna / American Specialty Health (ASH):

● For patients with Cigna insurance, you must input “ASH - Cigna” as their insurance
carrier in WebPT in order for claims to be billed correctly (effective 8/1/18).
○ Any returning patients who were previously under the “Cigna” insurance carrier
will need to be fixed to Ash - Cigna.
● When verifying, call both Cigna and ASH to obtain benefits. Cigna will provide
information regarding all benefits except for authorization; ASH will provide information
regarding any requirement for authorization.
○ Authorization Note: Most plans require an online Medical Necessity Review
(MNR) submitted through ASH after the patient’s 5th visit.
■ Need to call ASH and check if auth is required for every Cigna patient
because R2P is in the ASH service area for zip code 21701, but not all
Cigna plans will require auth (depends on their individual plan).
● Cigna Portal
○ Provider Services:
■ If ID # starts with the letter U: 800-882-4462
■ If ID # starts with the number 1: 866-494-2111
● ASH Portal
○ Eligibility: 800-972-4226, option 1

Medicare:

● Verify benefits via interactive voice response (IVR) system: 877-235-8073
● Medicare policy numbers are 11 characters comprised of numbers and uppercase letters
(does not use letters S, L, O, I, B, and Z; does not have any special characters)
○ Old Medicare card numbers were the patient’s SSN followed by a letter; all old
Medicare cards should have been replaced in early 2019.
● Plan Part B must be effective.
● Most plans will have a secondary insurance that must also be added to the patient’s
chart and attached to their case.

Last Update: 7/9/19