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Winnolas™ simplifies the transition from your current software provider by seamlessly incorporating existing data and user information, eliminating the stress of switching software..
HHAs are encouraged to use the pre-claim review request checklist provided by the Palmetto GBA portal to ensure the submission requests are complete.
Palmetto GBA will send notification of the decision to the submitter and the beneficiary within 10 business days (excluding federal holidays) for an initial request.
A resubmitted request is a request submitted with additional documentation after the initial pre-claim review request receives a non-affirmed decision. Palmetto GBA will send notification of the decision of these requests to the HHA and the beneficiary within 20 business days (excluding federal holidays).
The HHA receives the letter which contains either the Provisional Affirmative or Non-Affirmed Decision and a Unique Tracking Number (UTN).
Submit the final claim with the UTN on the claim. If all requirements are met, the claim will be paid absent evidence of possible fraud or gaming and be excluded from future medical review.
HHAs will receive non-affirmed decisions for not meeting Medicare coverage requirements. Claims submitted with non-affirmed decisions will be denied. The submitter may resubmit another complete package with all documentation required as noted in the decision letter. Resubmissions using the denied UTN should be repeated until a Provisional Affirmative Decision letter is received with the UTN status affirmed.
The UTN is provided on the decision letter of the initial pre-claim review request. Each 30-day request will generate a separate UTN. Claims submitted with non-affirmed decisions will be denied. Final claim submission should ONLY be done using the UTN located on a Provisional Affirmative Decision letter.
Real-time electronic final claim submission is built-in to Winnolas and provides the real-time status of the claim through the entire process from submission to payment.
The primary reason for the denial of a claim is the failure of the submitted documentation to establish homebound status of the beneficiary. Winnolas provides a Pre-Claim Review: Additional Eligibility Requirements checklist at the end of the OASIS that must be filled out and signed by the visiting clinician. When the physician reviews and signs the plan of care, all the requirements for homebound status are contained in the supporting documentation.
Real-time electronic final claim submission is built-in to Winnolas and provides the real-time status of the claim through the entire process from submission to payment.
Winnolas™ simplifies the transition from your current software provider by seamlessly incorporating existing data and user information, eliminating the stress of switching software..