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Provider News

Change in Reimbursement and Billing Practices for Pediatric Shift Care

Effective February 15, 2022, HPP will only reimburse providers 150% of contracted rate for multiple members who receive Home Health Aide (S9122) or Skilled Nursing (S9123/S9124) services in the same household by the same provider of care. Providers will be required to submit the correct modifier on all claims to reflect the number of members receiving care on any given date of service.   

  • Two (2) members receiving care – UN Modifier - 75% reimbursement of contracted rate on each claim
  • Three (3) members receiving care – UP Modifier - 50% reimbursement of contracted rate on each claim

HPP will update any current authorization that reflects the above scenario. Billing claims with dates of service after February 15, 2022 will require the correct modifier.

If you have any questions, please contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m.