UCP Surcharge - Unmatched Payers Report

UCP Surcharge - Quarterly Surcharge Payers Report

 

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UCP Surcharge - Unmatched Payers Report

General Instructions

The UCP Surcharge - Unmatched Payer Report will be used by Hospitals and Ambulatory Surgical Centers (ASCs) to identify and report payments received from Unmatched Surcharge Payers.

The governing regulation for the Uncompensated Care Pool is 114.6 CMR 11.00. For information about the UC Pool reporting requirements, see section 114.6 CMR 11.03.

The purpose of the Unmatched Payers Report is to identify payer that are not registered with the Uncompensated Care Pool Surcharge.

The Unmatched Payers Report is due 45 days after the end of each quarter. The quarters correspond to the UC Pool Fiscal Year (Qtr 1: October 1 - December 31, Qtr 2: January 1 - March 31, Qtr 3: April 1 - June 30, Qtr 4: July 1 - September 30).

Providers shall report the names of entities that make payments to acute hospitals for the purchase of acute hospital services and ambulatory surgical centers for the purchase of ambulatory surgical center service that are not registered with the Division as a surcharge payer.

Application Instructions


Clicking 'Home' on the left menu will display the Provider selection page. From the Provider drop-down list select an organization. Users will only be able to select organization names that are present in the drop-down list. 
Select provider, payment year and payment period. The report end date will display automatically after selecting the reporting quarter.

If you have questions about a specific facility that is not listed in the name drop-down list, contact the Division of Health Care Finance and Policy at 1-800-888-2250 and press 2 for the UCP hotline. You can also email the Division at pool.help@state.ma.us.

New Unmatched Payer Payments - To file new Unmatched Payer Payments click 'Filing / New Unmatched Payer Payments' from the left side navigation pane.

Providers shall report on the 'Unmatched Payer Payments' screen - the name, address, payment amount, check date and check number for all payers that do not appear on the registered payers and affiliates (search known payers) list in the application. Also, enter the information for all payers whose status you are unsure of. The Division will investigate and make a final determination of each payer status that is reported in the Unmatched Payers Report.

When a Payer name is entered in the 'Payer' field and the user moves to another field, the application will search the registered surcharge payer list for any payer whose name ' is similar to' the name entered in the 'Payer' field.

Unmatched Payer Search - The application will allow users to determine if an unmatched surcharge payer is already registered with the Division for the surcharge. Users will be able to search the registered surcharge payer list within the application. If a match does not exist between the registered surcharge payer list and an unmatched surcharge payer, information will be entered directly in the application for reporting back to the Division.

To search click 'Filing / Unmatched Payer Search' from the left side navigation pane.
The known payers screen provides you with a list of registered payers, affiliates and exempt payers. It is designed to be a quick reference tool for you to find matches for unrecognized payers. You can search the list by entering an unrecognized payer's name and click 'Search' button. The application returns all payers whose name is ' like' the name entered. In the event you are unable to make a match against the known payers list, select add Unmatched Payments button and click continue. Clicking continue transfers everything you have entered directly to the Unmatched Payer screen. Complete the additional information requested on the Unmatched Payer screen.

Unmatched Payer's File Upload - The Unmatched Payer's File Upload option is an alternative to manual data entry for companies that have payment information in another system. This will allow you to upload payment information from currently used data sources. Once Payment information has been uploaded you can preview information and print reports using the same process as described above. This should be done to verify that payment information has been uploaded correctly.

To upload data click 'Filing / Unmatched Payer's File Upload' link from the left side navigation pane and follow instructions displayed on the main screen and click 'Upload' on the floating tool bar to complete the upload process.

View or Update All Payments - To view or update payments information for unmatched payers click 'Filing / View or Update All Payments' link from the left side navigation pane.

Save - Click 'save' button on the floating toolbar menu to save the data entered.

Submit Unmatched Payer Payments - Click ' submit' button on the left side menu and follow instructions displayed on the main screen.

Reopen Requests - After a web application submission has been completed and closed a user may recognize that adjustments or corrections are needed. Through the same web application the user can create a request to reopen a closed submission. Reopen requests must be reviewed and will be approved or rejected by internal staff. To help ensure a timely review an email notification is automatically generated and sent to the appropriate Division staff. If the request is accepted, the submission is reopened for edit and the quarterly report must be resubmitted to the Division after modifications are made. 'Reopen Requests' menu will appear on the left pane after the payments are submitted.

Printing - Select 'Reports/Unmatched Payer Payments' from the left side navigation pane. This will open pdf report and display all Unmatched Payers entered for the reporting year and quarter. You can always view the pdf report by clicking on Filing and selecting View or Update All Payments or clicking on Browsing and selecting Show All Payments.

 
UCP Surcharge - Quarterly Surcharge Payers Report
 

General Instructions

The UCP Surcharge - Quarterly Surcharge Payers Report will be used by Hospitals and Ambulatory Surgical Centers (ASCs) to identify and report payments received from Quarterly Surcharge Payers.

The governing regulation for the Uncompensated Care Pool is 114.6 CMR 11.00. For information about the UC Pool reporting requirements, see section 114.6 CMR 11.03. The Quarterly Report for Private Sector Payments is due 45 days after the end of each quarter. The quarters correspond to the UC Pool Fiscal Year (Qtr 1: October 1 - December 31, Qtr 2: January 1 - March 31, Qtr 3: April 1 - June 30, Qtr 4: July 1 - September 30).

Report Information

Providers shall report private sector payments received from the top surcharge payers as designated. All amounts reported should reflect payments received during the respective quarter regardless of the date services were rendered. On Line 25, providers should report the sum of payments received from all other private payers not listed, including third party administrators who make payments on behalf of one or more insurance carriers or businesses.

Providers shall separate private sector payments into Total, Medicare Managed Care, Medicaid Managed Care and Other Exempt payments. Providers are asked to indicate the names of the "Other Exempt categories represented in the amounts entered. Other Exempt categories include Workers Compensation, Federal Employee Program claims, Property and Casualty claims and any Other Exempt category not mentioned.

Definitions

1. Total Private Sector Payments - All payments received from Private Sector payers less any payments from a supplemental Medigap plan (e.g., Medex). This column does not include payments from Title XVIII, Title XIX or other governmental programs of public assistance. Total Private Sector Payments, however, does include Private Sector Payments that are exempt from the surcharge. These payments include those from Medicare Managed Care plans, Medicaid Managed Care plans, Federal Employee Benefit Programs, Workers' Compensation and Property and Casualty payments. Private Sector Payments that are exempt from the surcharge should be included in this line and also reported separately in the Medicare, Medicaid Managed Care Payments and Other Exempt Payments lines as appropriate. For example, payments from Tufts Secure Horizons plan should be included in the total line and separated out in Medicare Managed Care Payments line. Other Exempt payments, such as Workers' Compensation payments, should be included in the total line and also included in other exempt payment line with the description entered on the line denoted Description of Other Exempt Payments.

2. Medicare Managed Care - Payments made on behalf of Medicare beneficiaries for services covered under Medicare Managed Care programs including but not limited to:
Medicare MC-Enhance (Pilgrim Product)
Medicare MC-Health New England Medicare Wrap
Medicare MC-HMO Blue for Seniors
Medicare MC-Kaiser Medicare Plus Plan
Medicare MC-Mathew Thornton Senior Plan
Medicare MC-Tufts Medicare Supplement (TMS)
Medicare MC-Fallon Senior Plan
Medicare MC-HPHC 1st Seniority
Medicare MC-Seniorcare Direct/Plus
Note: Do not include Medex or other Medigap payments in this column. 

3. Medicaid Managed Care -
Payments made on behalf of Medicaid recipients for services covered under Medicaid Managed Care programs including:
Current Medicaid Managed Care plans:
Medicaid MC-Boston HealthNet (Boston Medical Center Health Plan)
Medicaid MC-Fallon Community Health Plan
Medicaid MC-Neighborhood Health Plan
Medicaid MC-Network Health (Cambridge Health Alliance)
Recently terminated plans:
Medicaid MC-Community Health Plan (term. 2/99)
Medicaid MC-HMO Blue (term. 12/98)
Medicaid MC-Kaiser Foundation Plan (term. (2/99)
Medicaid MC-Tufts Associated Health Plan (term. 12/98)
Medicaid MC-Harvard Pilgrim Health Care (term. 2/99)
Medicaid MC-Mass Behavioral Health Partnership

4. Other Exempt Payments -
All other exempt private sector payments pursuant to 114.6 CMR (1) (a) and 114.6 CMR (1) (b).

Workers Compensation - Payments under the Workers Compensation program (established pursuant to M.G.L. c. 152).


Federal Employee Program (FEP) - Payments for individuals covered under the Federal Employees Health Benefits Act (refer to the Guide to Federal Employees Health Benefits Plans for Federal Civilian Employees, which is available on their web site at http://www.opm.gov/insure.


The Guide can also be obtained by calling (888) 275-7585.


Property and Casualty Payments - payments, settlements and judgments arising out of third party liability claims for bodily injury paid under the terms of property or casualty insurance policies. 

5. Description of Other Exempt Payment -
Using the exempt payment categories listed in (4) above, or add a description that describes the payments entered on other exempt payment line.

Line Instructions

1. Aetna, Inc. - is a holding company (not an insurance company or TPA). See list below for the Aetna U. S. Healthcare affiliated health plans, insurers and TPAs whose payments should be included on this line.

Note: Effective June 1999, the following Prudential HMOs became subsidiaries of Aetna and should be included on the Aetna line:
Prudential Health Care Plan, Inc.
Prudential Health Care Plan of Georgia, Inc.
Prudential Health Care Plan of Connecticut, Inc.
Prudential Health Care Plan of New York, Inc.
Prudential Health Care Plan of California, Inc.



 

Corporation

Federal Tax I.D.

NAIC NO.

Northeast Region HMOs  
Aetna U.S. Healthcare Inc.01-050425295517
Aetna U.S. Healthcare Inc.23-244204895935
Aetna Health Plans of Southern New England, Inc.22-285557195658
NYLCare Health Plans of Connecticut, Inc.06-144754695457
Prudential Health Plans of Connecticut, Inc.22-292671195960
Aetna U.S. Healthcare Inc.52-152424995236
Aetna U.S. Healthcare Inc.23-26729695237
U.S. Healthcare, Inc.**22-266362395234
NYLCare Health Plans of New York, Inc.13-335463795607
Prudential Health Plans of New York, Inc.22-279326995041
Mid-Atlantic Region HMOs  
United States Health Care Systems of Pennsylvania, Inc.23-216974595109
Aetna U.S. Healthcare Inc.52-127092195287
NYLCare Health Plans of New Jersey, Inc.22-270989895720
Aetna U.S. Healthcare Inc. (DE)23-247057595245
Capital Region HMOs  
Aetna U.S. Healthcare Inc.52-135380295590
Aetna U.S. Healthcare of the Carolinas Inc.56-194161395343
Southeast Region HMOs  
Aetna U.S. Healthcare of Georgia, Inc.58-164956895094
Prudential Health Care of Georgia, Inc.22-317512895043
Aetna U.S. Healthcare Inc.59-241158495088
Aetna U.S. Healthcare Inc.72-110014395002
Aetna U.S. Healthcare of Alabama Inc.*68-0326121N/A
Mid-West Region HMOs  
Aetna U.S. Healthcare Inc.34-139973696518
Aetna U.S. Healthcare of Illinois Inc.06-105595595397
Aetna U.S. Healthcare Inc.62-132718195006
Aetna U.S. Healthcare, Inc.23-286156595756
Southwest Region HMOs  
Prudential Health Plans, Inc.74-184433595040
Aetna U.S. Healthcare Inc.76-018968095490
Aetna U.S. Healthcare of North Texas Inc.75-199686095328
NYLCare Health Plans of the Gulf Coast, Inc.76-002526295030
NYLCare Health Plans of the Southwest, Inc.75-191002295029
West-Central Region HMOs  
Aetna U.S. Healthcare Inc.84-131279395256
U.S. Healthcare, Inc.23-286156895810
Aetna U.S. Healthcare, Inc.23-286156395757
Aetna U.S. Healthcare, Inc.06-134543695003
Pacific Coast Region HMOs  
Aetna U.S. Healthcare of California Inc.95-3402799N/A
Prudential Health Plans of California, Inc.22-2793278N/A
VivaHealth, Incorporated95-4110760N/A
Aetna U.S. Healthcare Inc.91-1315815 
Aetna U.S. Healthcare of Washington Inc.91-166240647060
Insurance Companies  
Aetna Life Insurance Company06-603349260054
Aetna Insurance Company of Connecticut, Inc.06-128627636153
Aetna Health and Life Insurance Company06-087683678700
U.S. Health Insurance Company36-328143465200
U.S. Health Insurance Company57-080512684450
Corporate Health Insurance Company23-271021072052
New York Life and Health Insurance Company13-313950097705
Corporate Health Administrators23-2505210 
Aetna Life Insurance and Annuity Company71-0294708 
Southwest Physicians Life Insurance Company72-097687166176
Dental Companies  
Aetna U.S. Healthcare Dental Plan Inc.23-257061647039
U.S. Healthcare Dental Plan, Inc. **23-257061947007
Aetna U.S. Healthcare Dental Plan, Inc.22-2990909N/A
Aetna Dental Care of Kentucky, Inc. **06-140762952026
Aetna U.S. Healthcare Dental Plan of California Inc.06-1160812N/A
Aetna U.S. Healthcare Dental Plan Inc.06-117753195910
Prudential Dental Maintenance Organization, Inc.22-272505195035
NYLCare Dental Plans of the Southwest, Inc.74-245810595027

2. Blue Cross and Blue Shield of MA - including but not limited to the following Massachusetts products: HMO Blue, Blue Choice, Blue Care 65, HMO Blue for Seniors, Blue Care Elect, Indemnity and Comp. Major Medical, Blue Choice New England (BCBSMA), HMO Blue New England (BCBSMA).

3. Blue Cross and Blue Shield of Rhode Island - the only product line.

4. Blue Cross and Blue Shield - Other States - include Blue Cross and Blue Shield payers from states other than Massachusetts or Rhode Island. If Blue Cross Blue Shield of Rhode Island cannot be identified separately, include BCBS-RI payments on this line and indicate in a footnote that these payments are included on this line.

5. CIGNA Health Care of Massachusetts, Inc. (the HMO) - as of June 1999, also includes:
Healthsource Massachusetts, Inc.
Note: Do not include any non-Massachusetts CIGNA or Healthsource plans on this line.

6. Benefit Plan Management:

7. Connecticut General Life Insurance Company (CGLIC) - also includes:
Healthsource Provident Administrators

8. Fallon Community Health Plan, Inc. - the only product line.
Note: Do not include Fallon Health and Life Assurance Co. on this line.

9. The Guardian Life Insurance Company of America - the only product line.

10. Harvard Pilgrim Health Care - includes:
Harvard Pilgrim Health Care of New England
Harvard Pilgrim Insurance Company
Pilgrim Health Care
Pilgrim Health Care Insurance Company
Note: Do not include Neighborhood Health Plan on this line.

11. Health New England, Inc - also includes:
HNE Advisory Services, Inc.
HNE Select

12. Health Plans, Inc. - also includes:
Freedom Care

13. Massachusetts Laborers' Health and Welfare Fund

14. Neighborhood Health Plan

15. Tufts plans: Lines 16, 17, and 18 denote specific Tufts Health Plans and should be used if they can be identified. All other Tufts Health Plans should be reported on line 19, Tufts-Other.
Note: Tufts Benefit Administrators, Inc. should be reported on line 18.

16. Tufts Associated Health Maintenance Organization, Inc. - also includes:
Secure Horizons Tufts Health Plan for Seniors.

17. Total Health Plan, Inc. - also known by: Tufts Total Health Plan.

18. Tufts Benefit Administrators - the only product line.

19. Tufts---Other - include all other Tufts payers not specified on lines 16, 17, and 18.

20. Unicare Life & Health Insurance Company - also includes:
Wellpoint Health Network, Inc.
Blue Cross of California
John Hancock

21. United Healthcare plans - The next four lines (lines 22, 23, 24) denote specific United Health Care plans and should be used if they can be identified.

22. United Healthcare Insurance Company - the only product line.

23. United Healthcare Service Corporation - the only product line.

24. United Healthcare of New England - the only product line. This payer is primarily an HMO.

25. Other Private Sector Payment - Include the aggregate payments made by all other private sector payers not noted in lines 1 through 24 during the quarter regardless of date of service.

Application Instructions

Clicking 'Home' on the left menu will display the Provider selection page. From the Provider drop-down list select an organization. Users will only be able to select organization names that are present in the drop-down list. 
Select provider, payment year and payment period. The report end date will display automatically after selecting the reporting quarter.

If you have questions about a specific facility that is not listed in the name drop-down list, contact the Division of Health Care Finance and Policy at 1-800-888-2250 and press 2 for the UCP hotline. You can also email the Division at pool.help@state.ma.us.

To file new Payer Payments click 'Filing / Payer Payments' from the left side navigation pane.

The Payer Payment fields are Total Private Sector Payments, Medicare Managed Care Payments, Medicaid Managed Care Payments and Other Exempt Payments. The description checkbox only applies to entries made into the Other Exempt Payments field. If you did not receive a payment from a specific payer a zero value (0) will populate if a numeric value is not entered. 

Payer drop-down list
The Payer drop-down list provides you with the complete list of payers that the Division requires you to report payments for.

Total Private Sector Payments
Only numeric values can be entered and entries must be rounded to the nearest dollar. A zero value (0) will populate if a numeric value is not entered. The amount entered into this field must be greater than the total of the amounts entered in the remaining three payment fields.

Medicare Managed Care Payments
Only numeric values can be entered and entries must be rounded to the nearest dollar. A zero value (0) will populate if a numeric value is not entered.

Medicaid Managed Care Payments
Only numeric values can be entered and entries must be rounded to the nearest dollar. A zero value (0) will populate if a numeric value is not entered.

Other Exempt Payments
Only numeric values can be entered and entries must be rounded to the nearest dollar. A zero value (0) will populate if a numeric value is not entered. If Other Exempt Payments are entered a description of the payment is required. When an amount is entered the description of other exempt payments checkbox will become enabled.

Save - Click 'save' button on the floating toolbar menu to save the data entered.

Submit Quarterly Payer Payments - Click 'submit' button on the left side menu and follow instructions displayed on the main screen.

Reopen Requests - After a web application submission has been completed and closed a user may recognize that adjustments or corrections are needed. Through the same web application the user can create a request to reopen a closed submission. Reopen requests must be reviewed and will be approved or rejected by internal staff. To help ensure a timely review an email notification is automatically generated and sent to the appropriate Division staff. If the request is accepted, the submission is reopened for edit and the quarterly report must be resubmitted to the Division after modifications are made.

Printing - Select 'Reports/Payer Payments ' from the left side navigation pane. This will open pdf reports of all payments made to all providers for the chosen Payer, Month and Year. You can always view pdf reports for payments made to a provider by clicking on PDF button from the floating tool bar while Filing or Browsing the payment information.

View or Update All Payments - To view or update payment information click 'Filing / View or Update All Payments' or 'Filing / Payer Payments' link from the left side navigation pane.

Note: Payer Payments data is not submitted through file upload process. That data must be manually entered into the application.