Our goal is to make billing and reimbursement as efficient as possible for both You First members and providers. Here are some things to remember:
- You First members should present their member card when they check-in for their visit.
- Office staff should check their membership via Medicaid’s Eligibility Verification System (EVS). For screening and diagnostic aid category "LF". You First coverage will not appear in MMIS for members on Medicaid or Medicare.
- Bill You First for covered services. Members eligible for coverage of clinical services should not receive a bill for any covered You First services. Members with Medicare Part B are not eligible for You First coverage of clinical services.
- All Medicaid providers can bill for You First services. Others can enroll on the Vermont Medicaid Portal.
- New members can submit eligible bills up to 90 days prior to their enrollment start date. A member's card will show their enrollment date plus a 90 day retroactive coverage period.
- Contact us if you or your billing staff have any questions or concerns.
The You First program covers services in these clinical categories:
- Breast cancer screening and diagnostic tests
- Cervical cancer screening and diagnostic tests
- Cardiovascular disease screenings for members 30-64
More Billing Guidance
The status and payment information of all claims submitted for processing to Vermont Medicaid for You First members can be found in the remittance advice (RA) provided by Vermont Medicaid and accessed either electronically through the Vermont Medicaid Portal or received weekly by mail. If you have questions or need assistance in understanding the reason for a claim denial, please contact us.
The You First fee schedule is in accordance with the CDC guidelines and all fees are based on the average Medicare Part B rate. As a You First provider, you agree to write-off any remaining balances of You First covered procedures and not bill the members.
- Bill primary insurance first. You First is the payor of last resort.
- Submit billing through the Vermont Medicaid billing system with Gainwell Technologies. Or mail to Gainwell Technologies Box 888 Williston, VT 05495.
- If you have any billing questions, please contact the You First program at 800-508-2222 or email [email protected].