Medicare Provider FAQs
To become a Provider with Umbra, you need to sign a Contract. Based on the state in which your license is active, you will be asked to sign an Agreement with Consumer Health Advocacy DBA Umbra Health Advocacy and/or with East Harbor Partners, our affiliated Professional Corporation. (The difference has to do with differences in state rules about who can own a medical practice.)
After the Agreement is signed, we will need you to reassign your benefits so we can bill Medicare on your behalf and add you to our CMS enrollment.
Once registered, we will onboard you and begin scheduling patients based on your availability.
Providers must have an active medical, nurse practitioner, or physician assistant license. We will need to verify your license status and your NPI number must be re-assigned to Umbra to begin billing for services. Providers must also complete onboarding, which includes training and setting up availability on the Umbra Platform.
Yes, you can perform Provider services and initiating visits in states where you're licensed, and you can act as Auxiliary Personnel to provide PIN and CHI services under the supervision of another Provider in states where you are not licensed. Based on your license, we will still pay you the MD or NP/PA hourly rate for these services.
Providers must document the time spent on patient visits, including assessment and follow-up time; documentation must include Service dates, patient identifier, start time, end time, and brief activity description. The Umbra Platform will help track time and streamline the process.
We will remit payment for validated Service Units within thirty (30) days after the corresponding CMS remittance advice is received. If CMS denies or recoups payment for any Service Unit, we may offset or reclaim the proportional compensation previously paid for that Service Unit.
|
Code |
Performed by Supervising Provider |
Performed by Auxiliary Personnel/Clinical Staff & Supervised by Provider |
|
Initiating Visits |
||
|
99202/99212 - Short visit, low complexity - 10-19 min |
✅ |
❌ |
|
99203/99213 - Moderate complexity - 20-29 min |
✅ |
❌ |
|
99204/99214 - Moderate to high complexity - 30-39 min |
✅ |
❌ |
|
99205/99215 - High complexity - >40 min |
✅ |
❌ |
|
Annual Wellness Visit (AWV) |
||
|
G0438 - Personalize Prevention Plan of Service (PPPS) |
✅ |
❌ |
|
G0439 - PPPS, subsequent visit |
✅ |
❌ |
|
Transitional Care Management (TCM) |
||
|
99495 - Transj care mgmt mod f2f, 14d |
✅ |
❌ |
|
99496 - Transj care mgmt high frf, 7d |
✅ |
❌ |
|
Social Determinants of Health Assessments |
||
|
G0136 - One stand-alone SDOH risk assessment performed no more often than every 6 months, lasting 5-15 minutes |
✅ |
✅ |
|
Principal Illness Navigation |
||
|
G0023 - 60 minutes/calendar month |
✅ |
|
|
G0024 - Additional 30 minutes/calendar month |
✅ |
|
|
G0140 - 60 minutes/calendar month |
✅ |
|
|
G0146 - Additional 30 minutes/calendar month |
✅ |
|
|
Community Health Integration |
||
|
G0019 - First 60 minutes |
✅ |
|
|
G0022 - Additional 30 minutes after initial 60 |
✅ |
|
|
Chronic Care Management |
||
|
99437 - Each additional 30 minutes of chronic care management services by physician or other professional, per calendar month |
✅ |
❌ |
|
99439 - Each additional 20 minutes of clinical staff time directed by a physician or other professional, per calendar month |
✅* |
|
|
99487 - First 60 minutes of clinical staff time, per calendar month |
✅* |
|
|
99489 - Each additional 30 minutes of clinical staff time, per calendar month |
✅* |
|
|
99490 - First 20 minutes of clinical staff time, per calendar month |
✅* |
|
|
99491 - First 30 minutes provided personally by a physician or other qualified professional, per calendar month |
✅ |
❌ |
|
G3002, G3003 - First 30 minutes face-to-face chronic pain management and treatment services provided by physician, additional 15 minutes chronic pain management and treatment by physician or other professional, per calendar month |
✅ |
❌ |
|
99424 - Principal Care Management services for patients with one chronic condition expected to last at least 6-12 months - initial 30 min provided personally by physician or other QHP |
✅ |
❌ |
|
99425 - Principal Care Management services for patients with one chronic condition expected to last at least 6-12 months - additional 30 min provider personally by physician or QHP |
✅ |
❌ |
|
99426 - Initial 30 minutes of Principal Care Management services provided by clinical staff under the direction of a physician or QHP, per calendar month. |
✅* |
|
|
99427 - Each additional 30 minutes of Principal Care Management services provided by clinical staff under the direction of a physician or QHP, per calendar month. |
✅* |
|
*Auxiliary provider must be clinical staff, including nurses, medical assistants, and pharmacists for these services.
“Service Units” are defined as completed blocks of time and services furnished according to CMS Services specified below and for which CMS issues final payment.
“Qualified Time” is defined as minutes personally furnished by Provider or by Auxiliary Personnel under Provider’s General Supervision that satisfies the CMS requirements and regulations for applicable Services and are documented as a time entry with Service dates, patient identifier, start time, end time, and brief activity description.
Qualified Minutes may be aggregated across Provider and Auxiliary Personnel; partial blocks (<60 minutes for 60-minute Services and <30 minutes for 30-minute Services) are non-compensable. General Supervision is not billable.
Yes, non-face-to-face activities, such as documenting patient visits and updating care plans, are billable as part of the service. The Umbra Platform will support tracking this, and the system is designed to streamline your documentation process.
“General Supervision” means providing overall direction and control, periodically reviewing documentation and confirming that billed activities match the patient’s needs and CMS requirements, and reviewing and adjusting care plans, as needed. Provider presence is not required during the performance of the Services.