Letter to Providers: Healthy Rewards Card Billing Guide
Aug. 20, 2009 | Author: MHSWe recently mailed the following letter and billing guide to providers regarding our new incentive program, the CentAccount™ Healthy Rewards card:
Provider Letter (PDF)
Healthy Rewards Billing Guide (PDF)
Dear MHS Provider:
In a dual effort to increase member’s participation in preventive care and in the support of HEDIS measures, Managed Health Services’ new CentAccount™ Healthy Rewards program gives members a monetary incentive through a flexible spending account for completing annual well-care / well-child visits and health screenings.
Members will receive their monetary reward loaded on a Debit MasterCard® that is sent to the member only after the first eligible PMP visit or screening has been completed. The CentAccount MasterCard will be accepted at participating groceries and pharmacies, and is restricted to the purchase of health-related items, such as over-the-counter medicine. The CentAccount can also be used at www.diapers.com to purchase items such as diapers and bottles, and at doctor offices that accept Debit MasterCard® for the payment of co-pays.
The following chart shows the HEDIS status of the eligible medical visits:
| Type of Medical Visit | HEDIS Measure |
| PMP and / or Well-child visit w/in first 90 days One reward for each visit |
No |
| Well-child visit 0-15mo (W15) Up to 6 visits rewarded |
Yes |
| Well-child visit, 16mo-2y | No |
| Well-child visit, 3y-6y (W34) | Yes |
| Well-child visit, 7y-11y | No |
| Adolescent Well-Care Visits (AWC) 12y-20y | Yes |
| Annual Well-Care Visits Adult Annual Check-Up 21+ |
No |
| Diabetes LDL-C Test | Yes |
| Chlamydia CHL-C Screening | Yes |
| Cervical Cancer CCS-A Screening | Yes |
| Breast Cancer BCS-A Screening | Yes |
Your help with this initiative is crucial to ensure members are rewarded for the completion of their eligible medical visits. In order to confirm completion of an eligible visit, we ask that you use the appropriate billing and diagnosis codes. Only claims that are paid will be eligible for claims-based rewards.
The following chart displays the appropriate billing and diagnosis codes to use in order for the member to be rewarded for their eligible medical visit:
| Type of Medical Visit | Billing Code (at least one) | Diagnosis Code (at least one) |
| PMP and/or well-child visit w/in first 90 days | Any CPT code except Annual Visit codes | n/a |
| Well-child visit, 0-15mo (W15) Up to 6 visits rewarded |
99381, 99382, 99391, 99392, 99460 | V20.2, V70.0, V70.9 |
| Well-child visit, 16mo-2y | 99382, 99392 | V20.2, V70.0, V70.9 |
| Well-child visit, 3y-6y (W34) | 99382, 99383, 99392, 99393 | V20.2, V70.0, V70.9 |
| Well-child visit, 7y-11y | 99382, 99383, 99395 | V20.2, V70.0, V70.9 |
| Adolescent Well-Care visits (AWC) 12y-20y |
99384, 99385, 99394, 99395 | V20.2, V70.0, V70.9 |
| Annual well-care visits Adult annual check up 21+ |
99385, 99395 | n/a |
| Diabetes LDL-C test | 80061, 83700, 83701, 83704, 83721 | n/a |
| Chlamydia CHL-C Screening | 87110, 87270, 87320, 87490, 87491, 87492, 87810 | n/a |
| Cervical Cancer CCS-A Screening | 88141, 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88155, 88164, 88165, 88166, 88167, 88174, 88175 | V72.32, V72.31 |
| Breast Cancer BCS-A Screening | 76090, 76092, 77055, 77056, 77057 CPT II: G0202, G0204, G0206 |
V76.11, V76.12 |
For your convenience, we have created a quick reference billing guide with the above billing information. You can download a copy of this guide at the top of this post, or you can request copies by calling Provider Services at (877) 647-4848.
If a MHS member has any questions about their CentAccount Healthy Rewards card, please direct them to our Member Services department at 1-877-MHS-4U4U (647-4848).
