MPCA Billing Network Conference CallTuesday, June 19, 2018

Call SummaryAs follow up to our bi-monthly Billing Network call, I have provided a summary of each topic addressed; please review the document in its entirety as there are time sensitive requests throughout. If you have questions or need assistance in providing requested documentation, please email me directly and I will respond promptly.

Regards,

Charmaine

1. Physical Therapy Codes Update Effective Date

o All PT codes except one add-on code has been returned to the Qualifying Visit List

Codes are effective 1/1/2018o MDHHS will resurrect these codes from claims previously

submitted and pay the PPS retro to 1/1/2018o Keep in mind, these services (PT) fall under medical so there will

be some limitations in regards to reimbursemento MDHHS is working internally to have the process fully

implemented An official memo will be sent via MDHHS Listserv

2. Prepaid Inpatient Health Plan Encounter Update PIHPs were not listed on the distribution list MSA Policy drafted for

approval by CMS MDHHS would like to ensure PIHPs are equipped to process

claims In the meantime, MDHHS will take responsibility of processing

claims There is a soft effective date of 10/1/18 to begin processing

claims MDHHS has issued a work-around (see File Transfer dated 6/12/2018)

This will allow the state to accept PIHP claims and will pay the PPS if services qualify

Please send billing questions to MPCA by emailing Charmaine Femster at cfemster@mpca.net. You can ask questions directly to your peers in the Billing Managers Network through the listserv at billingmgrs@lyris.mpca.net.

MPCA Billing Network Conference CallTuesday, June 19, 2018

Centers were to notify Tricia Ashley of any additional PIHP’s you are contracted with other than the county you are based.

Any PIHP visits for which you do not notify MDHHS of the contract will be excluded from cost settlement.

3. Telehealth Workgroup MPCA and MDHHS have scheduled a workgroup meeting for next week;

will review policies and create a reference sheet that focuses on Telehealth scenarios; an update will be shared via the Billing Network once an official document has been created

4. Dental Claims Update on fix for retroactive claims

Delta Dental is currently working on correcting claims from 10/1/2016 thru current

Centers are advised to continue to work with Delta For those who are submitting claims via the Dental Tool Kit

1. NPI is not being captured2. MDHHS requests a list of centers who are currently

submitting via the tool kit and will work with each center until fix has been implemented

Have confirmed the following POS Codes as allowable1. POS 502. POS 113. POS 15 (confirmed with Tyler after today’s call)

5. Substance Use Disorder Claims MDHHS reports an issue with patient ID numbers that required an

internal update An internal review is currently being conducted to apply a fix on edits

Review of claims dated 8/1/2017 forward

6. MHP Update Tyler has requested guidance from the Managed Care Division and will

provide updates on outstanding issues such as OB Packages

Please send billing questions to MPCA by emailing Charmaine Femster at cfemster@mpca.net. You can ask questions directly to your peers in the Billing Managers Network through the listserv at billingmgrs@lyris.mpca.net.

MPCA Billing Network Conference CallTuesday, June 19, 2018

For services provided outside of the FQHC, a non-FQHC NPI is necessary; the hospital services would not qualify

for the PPS Access this link for additional information on POS Codes

7. Qualifying Visit List MDHHS and MPCA would like to poll the Network to find ideas on the

creation of a combined document that lists all Qualifying Services to assist with claims processing

Send ideas to Charmaine Femster

8. Center Examples Requested by MDHHS To continue the follow-up of outstanding issues, here are a few topics in which MDHHS

has requested no more than 2 examples for review: MI Health Link denial of Preventative Services Denture Takebacks Rejected Behavioral Health claims due to Provider type PA 161 recoupments

** As a reminder, when submitting examples, please redact patient identifiers to adhere to privacy policies as I am unable to submit for review if this step has not been completed

9. CHC Monthly report Due June 26th by end of business

10. Other: Topics discussed for MDHHS/MHP Feedback

Topic #1:Should services that do not qualify be submitted on the claim?

MDHHS Provider Support Response:If providers render services that don’t count for the PPS, then the providers do not have to bill those services for the $0.00 payments. The only time I suggest doing this is for these injections that the health plans might reimburse for incentives, due to rendering those services. Or services that have to be billed for special credits to keep a provider status, providers would be familiar with those services if they were eligible.

Please send billing questions to MPCA by emailing Charmaine Femster at cfemster@mpca.net. You can ask questions directly to your peers in the Billing Managers Network through the listserv at billingmgrs@lyris.mpca.net.

MPCA Billing Network Conference CallTuesday, June 19, 2018

Topic #2Behavioral Health claim denied due to Provider type listed in “Attending” field

MDHHS Provider Support Response:Providers must remember even for BH services, the attending provider must be MD/DO or NP and the provider such as therapist would then need to be reported in the rendering field.

Topic #3:How to follow up on Meridian Claim Status

Answer:Providers are able to collect statuses using our self-service phone system, and in-network providers are able to view statuses through our portal. If you feel a claim was processed incorrectly or have any additional questions, please call our Member Services department Monday – Sunday from 8 a.m. – 8 p.m. at 1-877-902-6784.

Topic #4:For MI HEALTH LINK this is a UPHP dual eligible insurance-Medicare/Medicaid-Medicare does not cover annual preventative exams but Medicaid does but when we bill MI HEALTH LINK-there is no payment at all- We are getting ABN’s signed by the patients but my question to you is can we bill the patient even if they have MI Health link? I question because typically you cannot bill a Medicaid patient but we are giving an ABN?

MDHHS Provider Support Response:ICOs may be reimbursed if the service is provided within the FQHC setting and the claim is submitted using the requirements listed in the Medicaid Provider Manual.

Topic #5:A handful of our patients have Medicare A only. They do not have Medicare B, but they do have Medicaid as their secondary. Is there a way we can still bill Medicaid? Do we not bill Medicare and put the patients on sliding fees? Can we bill the patient? It seems very tricky since they are both government programs

MDHHS Provider Support Response:

Please send billing questions to MPCA by emailing Charmaine Femster at cfemster@mpca.net. You can ask questions directly to your peers in the Billing Managers Network through the listserv at billingmgrs@lyris.mpca.net.

MPCA Billing Network Conference CallTuesday, June 19, 2018

Added to Provider Support’s tracking issue document. Provider Support or MSA Policy will follow up once they gather more information

11. Next Billing Network Call August 21, 2018 at 1pm. To join, dial 1-866-453-5550, passcode:

7478807#. Please send agenda items in advance to Charmaine Femster at cfemster@mpca.net.

12. New Billing Network Call Schedule Returning to Bi-Monthly meetings

October 16 December 18

Please send billing questions to MPCA by emailing Charmaine Femster at cfemster@mpca.net. You can ask questions directly to your peers in the Billing Managers Network through the listserv at billingmgrs@lyris.mpca.net.