Hometown Health has created new email addresses to help you contact the appropriate team members on our Network Services Team. Please see the descriptions below explaining where to send specific types of inquiries. Sending inquiries to the correct email will allow for the quickest response time.
Provider Updates: ProviderUpdates@hometownhealth.com
Use the forms located here for the below updates and email them to the address above once complete:
Credentialing (Status Update Request Only): HTHcredentialing@hometownhealth.com – Please use this email address for the below topics:
Contracting: HTHcontracting@hometownhealth.com – Please use this email address for the below topics:
Provider Relations: HTHProviderRelations@hometownhealth.com
Providers who utilized Change Healthcare to submit claims can now utilize Optum iEDI instead. Note, if you previously submitted claims through a system other than Change Healthcare, you should continue to do so and need not complete this form.
Hometown Health’s alternative claim submission solution, Optum Intelligent EDI, also called Optum iEDI, is set to go live on Wednesday, March 13, 2023. Providers are encouraged to work with their practice management system or vendor to establish the necessary connections for claims submission using Payer ID 88023. For assistance, providers can call the Optum Support Team at 1-866-OptumGo or email them at NTW@optum.com. You can learn more about Optum Intelligent EDI here.
Late Thursday, March 7, United Health Group released a statement regarding the Change Healthcare cyberattack. In it they noted the following:
You can read UnitedHealth Group’s Full Statement Here
If you are a provider who utilizes Change Healthcare and you are experiencing issues submitting prior authorization requests, please email provider relations at HTHProviderRelations@hometownhealth.com and they can assist.
Change Healthcare is still working to implement an alternate gateway for claims processing. We are in contact with Change Healthcare and will continue to communicate updates to providers and all stakeholders as we receive more information.
Paper claim submission is available. Providers can fax claims to the fax line 775-982-3751 or mail to 10315 Professional Circle, Reno NV 89521
Hometown Health’s has updated its Administrative Guidelines and they will become effective on April 1, 2024. You can view the updated Administrative Guidelines and Requirements here.
We would like to share the following updates to keep Hometown Health’s provider partners informed about the steps we are taking to mitigate the claim processing challenges brought about by the cyber attack on Change Healthcare:
Hometown Health is committed to processing and paying provider claims in a timely and accurate fashion, and we appreciate your patience and partnership as we address these issues.
Hometown Health is in communication with Change Healthcare as they work through issues with their claims processing system. At this time, Change Healthcare systems remain offline. Change Healthcare is investigating the possibility of setting up an alternate gateway for claims processing. We will continue to communicate to providers and all stakeholders.
Hometown Health is aware of the cyber security incident affecting Change Healthcare. We have created a Frequently Asked Questions webpage for our members. We also wanted to address the question below for providers:
Is Hometown Health accepting and processing claims?
Hometown Health will continue to process claims received in a timely manner. We recognize that many of our provider’s claims are processed through Change Healthcare as the EDI (Electronic Data Interchange) intermediary. For those provider’s impacted, we are continuing to work with Change Healthcare to monitor status updates and their ability to bring services back online. Our expectation is that when services resume, we will work diligently to process claims quickly to restore timely payments. As we continue to evaluate the length of the downtime, we will assess alternate means by which we can accept claims. If alternative means are needed we will communicate those through our provider webpage and provider email blasts.
To ensure plans and fee schedules process accurately for the new year, Hometown Health is undergoing an annual audit for 2024 fee schedules and plans. As such, your office may experience a slightly longer claims turn-around time for dates of service after January 1, 2024. We do not anticipate claims holding for longer than 30 days. We ask that you be patient during this audit process and not call Customer Service for claim status updates until at least 30 days after Hometown Health received the claim. The fastest way to see the status of a claim is by using the Provider Portal LINK. We appreciate your patience as we complete the auditing work; last year the audit helped reduce claim reconsiderations by 60%.
Please be aware authorization requirements may have changed for 2024. It is important the prior authorization matrix for each plan is reviewed prior to rendering care. For example, Caesars now requires a prior authorization for any lab or certain imaging that is not part of an annual exam, diabetic diagnosis, or ER/Urgent care visit. You can find all 2024 prior authorization on our Authorization Matrix page here.
Hometown Health has updated its Provider Administrative Guidelines for 2024. Changes to to the Current Administrative Guidelines will be in effect on January 5, 2024.
You can view the 2024 Administrative Guidelines here.
See Hometown Health 2023 Provider Updates here.
Senior Care Plus has developed training materials for providers who care for Senior Care Plus members with special needs. The Senior Care Plus D-SNIP Model of Care training materials are now available. The training materials included a description of the D-SNP population, Care Coordination. the Provider Network, and the Model of Care Quality Measurement and Performance Improvement Initiatives. View the D-SNP Model of Care Training document here.
For small-group, association health plans and large-group HMO plans, PCP referrals will no longer be required for a patient to see a specialist. You should be prepared to see patients from these plans without the need for referrals.
Specialist Referrals May Still Apply:
If there are services a member needs that cannot be performed in Hometown Health’s direct network in Nevada or at the University of Utah, and you need to refer a member to a Center of Excellence such as Stanford or UC Davis, the service will only process at the member’s in network benefit cost share if authorized as in-network by Hometown Health. If not authorized as in-network, the member will be liable for the out of network cost share.
On June 12, 2023, the Eighth Judicial District Court of Nevada ordered Friday Health Plans of Nevada (FHP-N) into receivership. Receivership is the first step toward liquidating the company’s assets.
August 31, 2023 was the last operating day for FHP-NV. If you performed services for Friday Health Plan members on or before that date and have not yet submitted a claim, you are strongly encouraged to do so AS SOON AS POSSIBLE.
Friday Health Plans of Nevada is a former Hometown Health leased-network client. Hometown Health wants to protect provider partners from the uncertainties that come with receivership – and we believe the prompt filing of all FHP-NV claims gives our provider partners the best opportunity to be properly and promptly reimbursed.
The state of Nevada has set up a website for more information at fridayhealthplansofnevada.com
View the DOI’s Press Release regarding Friday Health Plans titled: “Important Information for Members on Friday Health Plans of Nevada Members Special Enrollment Period Offered to Find New Coverage.”
Hometown Health has partnered with Better Doctor to fulfill the regulatory requirements of the No Surprises Act to ensure providers are attesting to their directory information on a quarterly basis. Your office will receive quarterly requests directly from Better Doctor to complete attestations. Providers with outdate information may be dropped from our provider directories. We appreciate your collaboration in keeping our directories up to date for our members.
Hometown Health has invested in an outside auditing firm to review and ensure our 2023 plans and contract fee schedule builds are accurate. As such, your office may experience a slightly longer claims turn-around time for dates of service after January 1, 2023. We do not anticipate claims holding for longer than 30 days. We ask that you be patient during this audit process and ask that you not call Customer Service for claim status updates until at least 30 days after Hometown Health received the claim. We appreciate your patience as we complete the auditing work to ensure you are paid accurately throughout 2023.
This is to inform you that Hometown Health is in compliance with the Consolidated Appropriations Act (CAA) which was signed into law on December 27, 2020. The CAA includes a new prescription drug reporting requirement.
Hometown Health is pleased to announce a new partnership with the University of Utah effective Aug. 1, 2022. As our new preferred partner, this grants in-network access to members of Hometown Health’s Commercial, TPA and Senior Care Plus plans for all University of Utah services, including but not limited to cancer care, neurology and cardiology. Out-of-state referrals may now be directed to the University of Utah. To learn more about University of Utah, click on the “University of Utah” link at the top of the Hometown Health Provider Directory page here.
Senior Care Plus is pleased to announce we have added new Durable Medical Equipment (DME) Providers to our network to better serve our members. See our updated Durable Medical Equipment page on the Senior Care Plus website to learn more.
To support membership growth, better serve our current members and partners, and fulfill our mission of making a genuine difference in the health and well-being of the people and communities we serve, Hometown Health will be going live with Link on Jan. 1, 2022.
With the implementation, there are a few important things to call out as we transition systems.
First and foremost, we are asking for your assistance to make sure members get the care and customer service they need. Please do not turn patients away. Members may contact you with concerning medical care, labs, imaging or prescription medications. Please take all reasonable steps outlined to assist our members before contacting the Customer Engagement Center.
We greatly appreciate your support as we work through this transition period. If you have any questions, please reach out to Hometown Health Customer Service at 775-982-3232.
Download these tips for your office here.
Medical Claims for health care services provided to inmates of the Nevada Department of Corrections (NDOC) may be submitted in two different ways:
1. Inpatient Services – For inpatient stays in medical facilities that last longer than 24 hours, inmates are eligible for Medicaid. This includes observation care exceeding 48 hours, claims for those stays should be submitted to Medicaid for reimbursement. Claims will be noted by NDOC as “Medicaid Pending”. If Medicaid denies the claim, NDOC will provide an authorization number for services. Send Medicaid denied claims to:
Nevada Department of Corrections
C/O Hometown Health
PO Box 981703
El Paso, TX 79998-1703
EDI Payer ID: 88023
800-336-0123
2. Outpatient Services – For all outpatient services, send claims to:
Nevada Department of Corrections
C/O Hometown Health
PO Box 981703
El Paso, TX 79998-1703
EDI Payer ID: 88023
800-336-0123
All claims sent to Hometown Health for processing must include: inmate name, inmate ID number, date of birth and NDOC authorization number. NDOC authorization numbers may be obtained from NDOC by calling 775-887-3226 or 775-887-3209. Claims denied for no authorization number: providers need to reach out to NDOC Medical Administration at 775-887-3226 or 775-887-3209 to obtain authorization codes.
Over the past few months Hometown Health has been negotiating with Carson Tahoe Hospital and its related entities for a new contract. We are pleased to announce we have successfully negotiated a new contract resulting in Carson Tahoe Regional Medical Center, Carson Tahoe Medical Group, and Carson Tahoe Continuing Care Hospital remaining in-network for Hometown Health.
We are appreciative of the partnership with Carson Tahoe Hospital and its related entities and their collaboration to come to an agreement that enables us to keep health costs affordable for our members and the community.
The following Carson Tahoe Hospital entities will remain in network for Hometown Health and Senior Care Plus members on July, 1 2021:
In recent negotiations, Carson Tahoe Hospital has demanded an 84% percent price hike on inpatient hospital services that will drive up the cost of health care for the members and customers we serve. In addition, Carson Tahoe is asking for 55% percent price hikes on long-term care, and a 20% percent increase on primary and specialty care.
While negotiations continue, the distance between Carson Tahoe Hospital’s demand and Hometown Health’s offer of continual increases over the next three years appears unsurmountable. As a result, and in order to help minimize disruption in care, we are providing early notice that all Carson Tahoe Hospital services and facilities will be out of network for Hometown Health and Senior Care Plus members effective July 1, 2021.
If an agreement is not reached by Wednesday, June 30, 2021, all services for Carson Tahoe Regional Medical Center, Carson Tahoe Medical Group, and Carson Tahoe Continuing Care Hospital will transition to other in-network providers to help minimize disruption in care and to help keep healthcare costs affordable.
Also on that date, any Hometown Health and Senior Care Plus members currently under the care of Carson Tahoe Medical Group providers will be contacted and offered a selection of an in-network provider. We are committed to the health of our community. While we continue to negotiate in good faith, and hope to come to a mutually beneficial agreement in the next 30 days, our top priority is ensuring members have immediate access to care they need. We will continue to keep you informed as negotiations continue.
Read the Termination Notification Letter here.
The Public Employees’ Benefits Program’s (PEBP’s) PPO network contract with SHO and Hometown Health (HTH) will terminate effective June 30, 2021. On July 1, 2021, PEBP will transition to the Aetna Signature Administrators (ASA) network. Claims will continue to be handled through HealthSCOPE Benefits.
To ensure PEBP members are not unexpectedly billed for out-of-network coverage, PEBP is requesting all providers who do not participate in the ASA network to inform their PEBP (HealthSCOPE) patients of this change prior to providing any services on or after July 1, 2021.
IMPORTANT: Claims for dates of service prior to July 1, 2021 must be submitted to HealthSCOPE Benefits for processing no later than September 30, 2021.
For questions, contact HealthSCOPE Benefits at 1-888-763-8232.
View the official termination letter from PEBP and HealthSCOPE.
Please be advised beginning May 1st, 2021 Hometown Health will no longer be responsible for payment of inpatient admissions when timely notification is not received as described in the 2021 Administrative Guidelines. Please review this and other important changes in the updated Administrative Guidelines which are effective May 1st, 2021.
Renown Health will implement Open Notes via MyChart effective Mar. 17 in compliance with the 21st Century Cures Act. Please join one of two provider meetings for more information on how this impacts you and your practice:
Please email terri.lightfoot@renown.org for the video link and supporting documents.
Due to the ongoing COVID-19 state of emergency, members of the Hometown Health Signature HMO plan will not be required to get referrals from Primary Care Providers to receive specialty care. This COVID-19 policy is effective April 1, 2020 and will expire no later than September 30, 2020, unless otherwise extended by Hometown Health.
The above temporary COVID-19 no-referral policy does not change the requirement to obtain prior authorization from Hometown Health for services as listed in the plan document for any Hometown Health product. Services related to COVID-19 never require prior authorization for any Hometown Health product.
Hometown Health Office Hours:
Monday – Friday, 8 a.m. to 5 p.m.
Live Person Telephone Hours:
Monday – Friday, 7 a.m. to 8 p.m.
24 Hour Recorded Assistance:
Toll Free 800-336-0123
Hometown Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.