In-Network Providers

In-Network Providers2020-05-11T04:12:17+00:00

Heroes on the front lines of in-home care. Thank you!

Thank you for ALL that you do!

  • Your caring and your kindness transforms someone’s dark moment with a ray of light EACH and EVERY day.
Ricki Wilkey, Program Manager, CENTIPEDE
Get HOPE from your past resilience.
  • Remind yourself of your resilience on a regular basis.
  • You made it through and you are stronger because of it.
Know that you will get through this!
Sofi McCormick, Manager of Customer Engagement, CENTIPEDE

We appreciate you. Keep on keeping on!

M. Scott Vaughn, CAPM, Manager of Data Analytics, CENTIPEDE

I am so grateful for hope…without it, times of trial can be unbearable.

  • Remain focused on the GREAT work you are doing.
  • We will get through this together, one day at a time!
Peter J. Kapolas, BSN, CPHQ, SVP Program Operations and Quality, CENTIPEDE

Look for opportunities during this time of change and challenge.

Daniel Van Der Werken, Jr., Sr. Software Engineer, CENTIPEDE

Thank you for the kindness you bring to the world.

  • Sending love light and healing to your soul.
Nicole S Bond, PMP, VP Project Operations, CENTIPEDE

You are truly appreciated by your patients and by us for your servant hearts.
Thank you for being a light.

Shine on!

Sarah G Pitts, CAPM, Digital Communications and Project Support Specialist, CENTIPEDE

In times of adversity leaders lead.
Thank you for stepping up and leading for your team and your members.

Together we will prevail! Keep the faith.

Nancy C Everitt CEO Centipede Care SolutionsNancy C Everitt, PMP, Founder and CentEO, CENTIPEDE

Frequently Asked Questions…

3 Key Reasons Your Claims Get Denied2020-05-11T02:28:45+00:00

Let’s all agree that claim denials are frustrating.

Often the reasons for claims denials are relatively simple.

Below are the top 3 reasons we see denied claims and how you can easily fix these errors.

1. NPI and TAX ID: Start at the beginning with your own NPI and TAX ID. If these key numbers are not on file with CENTIPEDE and your health plan then… bingo your claim won’t match the system and you’ll receive a denial as an out of network provider.

Do not use an NPI or TAX ID that was not used in your Credentialed file.

Tip: Ensure your NPI and or TAX ID change are on file with CENTIPEDE and we will notify all health plan’s accessing CENTIPEDE.

2. MEMBER NAME: Next, ensure that you have the correct and EXACT Name, Address and Date of Birth for your member that is on their ID Card.

Jack Smith is not the same as John B Smith.

Member names must be exact, take a moment to validate the name, address and date of birth on your authorization or Member ID Card.

3. DIAGNOSIS CODE: Last but not least, ensure that you have a valid Diagnosis Code with the correct number of digits. A helpful link to locate valid diagnosis is https://www.icd10data.com .

The key to clean claims starts with accurate data.

Develop a checklist and ensure that the basics are right on all of your claims.

Browser: Clearing Your Cookies and Cache2020-06-01T10:38:19+00:00

Your browser Chrome, Internet Explorer, Firefox, Safari etc all store cookies and cache (store) pages or elements of pages to help speed up the page load process.

That’s good for speed but bad if there have been changes to a page or a site. Good practice is to clear your cookies and cache weekly just like cleaning house. Below we’ll show you how to clear cookie and cache on Chome and Internet Explorer.

CHROME: First open Chrome as your browser.

How to Clear Chrome Cookies and Cache
How to Clear Chrome Cookies and Cache
  1. At the top right, click More.
  2. Click More tools   Clear browsing data.
  3. At the top, choose a time range. To delete everything, select All time.
  4. Next to “Cookies and other site data” and “Cached images and files,” check the boxes.
  5. Click Clear data.
Boxes to check to clear Chrome cookies and Cache.
Select Time Range of All Time and Check boxes to clear data. The press Clear Data.

INTERNET EXPLORER: Now Open Internet Explorer

In the upper right-hand corner of the webpage, you will see a gear button. Press this button this is your settings button.

  1. Next, you will have a menu of options drop down. Select INTERNET OPTIONS from that menu.
  2. Next, the INTERNET OPTIONS box is going to pop up. You are going to see 7 tabs at the top.
Select General Tab then Browsing History

3. Select General Tab and then you will see Browsing history.In Browsing history, you will see a button DELETE.

4. Select the DELETE button and a new box is going to pop up. You will notice all of the boxes except for one of them are checked. Leave them checked and press the DELETE button.

5. Next, you will be brought back to the main internet options screen. Press OK and close INTERNET EXPLORER.

6. Start a NEW Session and your Cookies and Cache will be clear! 

COVID-19 Telehealth Billing2020-05-11T02:02:56+00:00

New flexibilities have been granted by CMS and on a state-by-state basis to allow for Telehealth Billing during COVID-19 to reduce face to face interaction.

One of the new flexibilities is to allow the use of audio only for telehealth as opposed to audio and video.

For CENTIPEDE providers billing for Telehealth during COVID-19 its important to use the Place of Service Code 02.

POS 02 indicates that services were provided through a telehealth platform.

Remember to bill only those codes that are appropriate for your specialty or for which you have been granted SPECIAL flexibility.

COVID-19: HCBS Appendix K Waivers2020-05-11T03:17:57+00:00

CMS has approved changes to State 1915(c) HCBS Waivers also referred to as Appendix K.

Click here to see the latest changes to APPENDIX K by state.

Disclosure of Ownership (DOO) Form2020-05-10T19:06:28+00:00

CENTIPEDE is required to validate Ownership and Interest for any provider that participates in networks for Medicare, Medicaid or any federal product. Rather than have different levels of Credentialing CENTIPEDE applies this same standard to ALL products and providers to ensure the highest level of quality.

This Disclosure of Ownership is required to finalize your participation for CENTIPEDE.

I don’t want to share my information especially a SSN

  • Unfortunately many of our names are not 100% unique.
  • When we search providers, owners and or Board Members by name there are matches. When we have a name match a Credentialing Specialist then performs a secure manual search using SSN as a rule out. If we match on SSN, then CENTIPEDE notifies you and we reality test the exclusion.

What’s an Excluded Provider?

  • You may or may not be aware that by federal law, the U.S. Department of Health and Human Services’ Office of Inspector
    General (HHS-OIG) can exclude individuals and entities from participating in federal health care programs – including Medicaid
    and Medicare.
  • If the HHS-OIG excludes a health care provider under a federal health care program, the U.S. Department of
    Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) policy also prohibits the reimbursement of any
    items or services furnished, ordered or prescribed by that provider.

Where can I find out more?

Link to OIG:  OIG Excluded Providers look up

Link to CFR:  Feel free to review the full requirement at  42 CFR 455.106. In addition to identifying excluded providers there is also a requirement to disclose the identity of any excluded individuals/entities with ownership or control interest in the provider of 5% or greater.

EVV: Using Modifier 76 For Another Service on the Same Day2020-05-11T02:11:54+00:00

When submitting the same HCPCS/CPT code on the same day of service for a second EVV visit, you must add Modifier 76 to the second visit.

Modifier 76 is widely used to indicate that another procedure or service was performed after the original procedure or service.

Remember each line of billing can have up to four modifiers if there is a need to add another modifier.

How to Obtain a National Provider Identifier (NPI)2020-05-18T14:47:07+00:00

A National Provider Identifier (NPI) is a required element for participating in the CENTIPEDE Health Network. There is no cost to obtain an NPI and you will generally receive your NPI number in approximately 1 business day after applying.

Before you get started, ensure that you know the name utilized for filing your taxes. You want to create a consistent name tying your legal name to your NPI.

Most CENTIPEDE Providers are Organizations. Organizations obtain an Entity Type 2 NPI and not an Entity Type 1 NPI.

Time needed: 5 minutes.

Instructions: Use the following links and guidance to obtain your NPI.

  1. Go to the NPI website https://nppes.cms.hhs.gov/#/

    Create an Account
    NPPES website create an account

  2. Next enter the Correct Information for an Entity Type 2 for your Organization.

    Tip: A Type 1 NPI is for licensed individuals who render direct care to patients; e.g., physicians, dentists, nurses, chiropractors, pharmacists,physical therapists, etc.

  3. Choosing Your Taxonomy is Important. Taxonomy describes the services you provide.

    Accuracy is important and can be a little confusing. You can look-up taxonomy using the following link https://nex12.org/images/PDF/Taxonomy_20_0.pdf

    TIP: Taxonomy codes are ten characters in length, alphanumeric in nature and always end with the letter X. The first four characters of a taxonomy code indicate its Level 2 Classification. The middle five characters vary depending on the Level 3 Area of Specialization.

    For simplicity, we’ve also compiled the most frequent taxonomy codes used for CENTIPEDE Providers:

    Adult Day Health: 261QA0600X
    Assistive Technology Supplier: 225CA2500X
    Case Manager/Care Coordinator: 171M00000X
    Case Management: 251B00000X
    Chore Provider: 372500000X
    Home Health: 251E00000X
    Home Delivered Meals: 332U00000X
    Homemaker: 376J00000X
    Contractor: 171W00000X
    Contractor-Home Modification: 171WH0202X
    Contractor-Vehicle Modification: 171WV0202X
    Personal Care: 3747P1801X
    Respite Care: 385H00000X
    Pest Control: 171W00000X

  4. Complete and Submit.

    Well done! You will receive a registration notification once the NPI submission is approved. Save this documentation and keep your address and contact information current.

  5. Updates

    If your Organization adds additional services you can add NEW Taxonomies to your existing NPI. You do not need to request a new NPI unless you wish to bill these services separately.

PCH PORTAL: Browser Troubleshooting2020-05-18T14:52:05+00:00

Software is both a magical and confounding invention. You are likely reading this because you are having problems with the PCH Portal.

So let’s get started and begin at the beginning. The key to successful PCH Portal access is ensuring you are on a SUPPORTED and CURRENT web browser.

Important Note: The PCH Portal online billing software is provided by OPTIMA Health to contracted providers free of charge for single claim billing. Excela is the software developer for the PCH Portal. CENTIPEDE simply provides support and troubleshooting for the CENTIPEDE-OPTIMA providers who need help.

If you are experiencing any of the following issues the issue is likely related to your browser:

  • Slow Speed
  • Elements or tabs not present
  • Buttons not working
  • Changes aren’t showing up

Time needed: 2 minutes.

Browser Troubleshooting: Use the steps below to troubleshoot your browser.

  1. Use the correct browser. The PCH Portal plays well with Internet Explorer and Chrome. If you are using Firefox or Safari the software will not operate as expected.

    PCH Portal Supported Browsers

  2. Ensure that you are using Chrome or Internet Explorer.
    Now check your version by clicking on the following link https://www.whatismybrowser.com.

    This site will tell you if you are on a current version of your browser. If your browser version is too old, that too can cause problems with software and also creates security issues.

    If your browser is not current or not supported take a moment and update your browser.

    Remember its important to use ONLY the supported browsers Chrome and Internet Explorer AND ensure you are using a current version of the browser.
    Use only Chrome and Internet Explorer

PCH PORTAL: How to Reset Your Password2020-05-18T01:47:34+00:00

Yikes you’ve been locked out of the PCH Portal, it’s after hours and need to submit claims. Not a problem, take a deep breath and follow these instructions to reset your password by yourself.

First enter the email address you used to create your PCH Account. You must use the same email address that is tied to the account.

If you correctly enter your email address you will receive the image below and a Reset email will be sent to your email from Pchglobal.Support@exelaonline.com in a minute or less. If you don’t receive an email its likely held up in your spam filter.

Good job you entered a correct email. Now check your email to reset your password.

Now – its time for a reset! A web browser should open taking you to the PCH portal. Your user name should already be filled in on the login page.

Click on the RESET button in the email.

Select a password and enter in the Password field. Your password must be at least 7 characters. Re-enter your selected password in the Confirm Password field.

If your passwords match you will receive the Success screen below.

Congrats! Your password is reset – now login.

Make a note of your username and password for future use. Bookmark this page so that you can easily return to it for future login.

TIP: Also save the link elsewhere on your computer in case the bookmark does not work.

Now click the Login button to login to the system. Ta Da! You are in business. The Screen will open to the dashboard page below.

You are ready to roll!

Fear not, if you encounter problems you can always reach out to the CENTIPEDE Team at joincentipede@heops.com or call CENTIPEDE at 855-359-5391.

Virginia COVID-19 FAQ and Links2020-05-11T03:07:03+00:00

OPTIMA Health: Click here to locate the most recent OPTIMA Health FAQ for COVID-19. Sign-in will be required.

DMAS: Click here to access the most recent DMAS information for COVID-19 and the emergency waiver.

W-9: Tips and Common Errors2020-05-11T01:12:15+00:00

The contracting process starts with your W-9 form. Getting this right helps ensure your entire provider file is correct, which means faster payment and access to more members. Below is a guide on how to complete a W-9 right the first time.

Line 1 and Line 2: Business Name

Line 1 is the name used for filing Business taxes. Line 2 is your DBA or “doing business as name”.

Example: Line 1: Jane Smith Line 2: Supreme Home Health LLC

Sample W9 Name, Tax Class and Address
Sample W9 Name, Tax Class and Address

Next… Choose your TAX Classification.

In the above example, Jane Smith dba Supreme Home Health LLC is an LLC structured as a Partnership (two people). In this scenario, you would check LLC AND insert P for Partnership. An LLC always has a Tax Classification and is either a C Corporation, an S Corporation or a Partnership.

TIP: If the LLC is only one person it’s a “Solo” LLC and you would check the first box for Individual/sole proprietor or single-member LLC and leave the LLC line blank. If you are uncertain, consult your accountant.

Next… Enter your address. This will be the address where PAYMENTS are sent.

PART 1: Taxpayer Identification Number (TIN)

Enter the number used for BUSINESS Taxes. Enter only 1 number.
DO NOT enter both your SSN AND EIN.

PART II: Certification (Signature and Date

Remember to sign AND Date your W9. Best practice is to keep a current W9 ready at all times. Do not send in a W9 that is over 180 days (6 months) old.

Good job! That’s it.

TIP: Any time your organization name changes, your TAX ID Number changes or you move send CENTIPEDE a new W9 before the event occurs so that we can start the change process.

If your W9 is not accurate… your payments will be impacted.

May the force be with you.