news—june 2015 provider memos released in may · beginning on august 3, 2015, illinois will begin...
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NEWS—June 2015
Provider Memos Released in MayMolina Healthcare (Molina) frequently sends Provider Memoshighlighting Health Plan and State process changes andrequirements. In May, the following Memos were released.
APL Billing Requirements—in an attempt to provide furtherclarification, Molina provided explicit billing guidelines forProviders to follow to ensure payment.
Changes to Member Assessment Process in NursingHomes—Molina is taking the face to face assessment pro-cess for its Members in house and will contract with a newvendor, MedXM to provide the Annual ComprehensiveExam for selected Members.
Rate Reduction—Molina will not be implementing the ratereduction recently imposed by the State of Illinois for any ofits programs.
IMPACT Memos—The State of Illinois’ official notice onlaunching their new enrollment system and the temporarysuspension of processing new medical provider applica-tions and paper-based updates effective May 29.
For more information, the corresponding Provider Memos areattached.
ICD-10 ImplementationThe deadline for ICD-10 implementation is October 1, 2015. Toensure Providers are ready, Molina will be offering ICD-10testing. As a reminder:
ICD-10 implementation is a federal mandate – testing givesyou the opportunity to ensure compliance
ICD-10 testing can improve your revenue cycle, ensuringyour claims will process correctly
If you’re interested in testing, please contact your ProviderServices Representative. For a list of common FAQ, refer to thelink on our provider site at: www.molinahealthcare.com/providers/common/PDF/ICD-FAQ.pdf
HCC Pearls
Molina is introducing a new programfocusing on the coding and documenta-tion rules (Hierarchical Condition Cate-gory — HCC) applied by the Centersfor Medicare and Medicaid Services(CMS). HCC Pearls are concise tips foreffectively and easily identifying, cod-ing, and documenting your patient’shealth status. Included in this month’spacket are:
Cerebrovascular Accident (CVA)
Chronic Kidney Disease
Additional HCC Pearls can be found at:
http://www.molinahealthcare.com/providers/il/duals/pages/home.aspx
Pharmacy Update
Molina Healthcare recently updated itslist of physician administered medica-tions requiring prior authorization.Changes include:
Addition of Ixinity (J7195 andJ7200)
Reclast is now J3489
For a complete formulary, please visit:http://www.molinahealthcare.com/providers/il/medicaid/drug/Pages/formulary.aspx
June National Health Observances
National Safety Month
Cataract Awareness Month
National Cancer Survivors Day(June 7)
Men’s Health Week (June 15 – 21)
For additional information, please contact yourProvider Services Representative or call (855) 866-5462.
Provider Memorandum
REMINDER: Ambulatory Procedure Listing Procedure Codes Billing Requirements
The Illinois Department of Healthcare and Family Services (HFS) has provided further clarification to its
December 17, 2014 memo, “Clarification on MCO Hospital Encounter Claims Submittal” (found at:
http://www.hfs.illinois.gov/assets/121714n1.pdf). The additional clarification provides explicit billing
guidelines for Ambulatory Procedure Listing (APL) procedure codes and providers must follow the direc-
tions described below to ensure payment.
All outpatient APL services must be billed on an institutional claim form - UB04
Only one date of service per claim, with the exception of series billable (claims spanning a
“series” of dates) and ER-Observation services.
Any date(s) of service without an APL service, must be billed on a professional claim form
(HCFA1500) as fee for service.
Any claims received not following these guidelines may be denied.
We understand there has been uncertainty among providers and health plans regarding the billing pro-
cedures for APL codes. While this may seem a departure from current practices, after consultation with
HFS, it has been concluded that these guidelines reflect the correct billing methodology for hospital out-
patient services.
If you have questions or concerns, please feel free to contact Provider Services at (855) 866-5462.
May 1, 2015
PS1504.2
E-mail: [email protected] Internet: http://www.hfs.illinois.gov
Pat Quinn, GovernorJulie Hamos, Director
201 South Grand Avenue East Telephone: 1-877-782-5565 Springfield, Illinois 62763-0002 TTY: (800) 526-5812
Informational Notice
Date: December 17, 2014
To: Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers
Re: Clarification on MCO Hospital Encounter Claim Submittal
This notice is to inform Institutional providers about specific encounter submission formatting for ancillary services.
The Department of Healthcare and Family Services (HFS) mandates Managed Care Organizations (MCOs) to submit outpatient encounters via an HFS 837I (pdf) and shall include one of the following:
• Ambulatory Procedure Listing (APL) procedure code, • Emergency room revenue code, or • Observation revenue code
In all cases where one of these three criteria is not met, MCOs must submit the encounters to HFS via an HFS 837P (pdf). The Medicaid Management Information System (MMIS) system will reject these types of encounters if the above protocol is not followed.
Dan Jenkins, Chief Bureau of Rate Development and Analysis Division of Medical Programs
Changes to Member Assessment Process in Nursing Homes
Per its contractual agreement with the State of Illinois, Molina Healthcare (Molina) is required to
conduct face to face assessments for its Members residing in skilled nursing facilities (SNF). Pre-
viously, Molina partnered with a vendor, General Medicine, to complete face to face assessments
and provide SNFist services for Members in skilled nursing facilities. Molina has now taken the
face to face assessment process in house.
Going forward, a Molina Case Manager (CM) will visit Members residing in skilled nursing facilities
to complete these face to face assessments. The skilled nursing facilities’ point of contact for Moli-
na Members will be the CM. The CM will request a copy of a skilled nursing facility’s personalized
care plan for each Member. Additionally, the CM will attend care plan meetings for Molina Mem-
bers, as required by the contract. The Molina CM will introduce themselves when entering a
skilled nursing facility to complete assessments. Case Managers will not write orders or pro-
vide primary care services for Molina Members.
Additionally, effective June 01, 2015, MedXM, a contracted vendor with Molina, will be sending
Nurse Practitioners into the skilled nursing facilities to complete an Annual Comprehensive Ex-
amination (ACE), on selected Molina Members. These risk assessments are completed through a
compilation of health-based questions in an effort improve the quality and efficiency of care to
Members residing in skilled nursing facilities.
If you have any questions, please contact Provider Services at (855) 866-5462. Representatives
are available Monday through Friday, 8 a.m. to 5 p.m. You may also visit our website at
www.MolinaHealthcare.com to learn more about Molina Healthcare.
May 22, 2015
PS1505.01
Provider Memorandum
REIMBURSEMENT RATES—NO RATE REDUCTIONS FOR MOLINA PROVIDERS
Per the Illinois Department of Healthcare and Family Services (HFS) Information Notices dated
May 1, 2015, HFS is required to reduce reimbursement rates for certain services rendered on
or after May 1, 2015 through June 30, 2015.
The rate reduction is the result of Public Act 099-0002. Copies of the HFS notices can be
found at: http://www2.illinois.gov/hfs/MedicalProvider/ProviderReleases/Pages/default.aspx.
Services exempt from the rate reduction include hospital and mental health services, services
mandated by a court order and services prohibited from a reduction under federal laws and
guidelines.
While Molina Healthcare of Illinois (Molina) follows the State of Illinois billing and reimburse-
ment guidelines, Molina will NOT be implementing the rate reduction at this time for any
of its programs (Family Health Plan, Integrated Care Plan, Medicare Medicaid
Plan). There are no changes in the procedures for billing. Providers should continue to bill
their usual and customary Medicaid and Medicare charges for medically necessary covered
benefits. Molina will revisit reimbursement updates provided by HFS in July and implement
any changes at that time.
If you have any questions, please contact Provider Services at (855) 866-5462. Representa-
tives are available Monday through Friday, 8 a.m. to 5 p.m. You may also visit our website at
www.MolinaHealthcare.com to learn more about Molina Healthcare.
May 18, 2015
PS1505.02
Provider Memorandum
E-mail: [email protected] Internet: http://www.hfs.illinois.gov/
Bruce Rauner, Governor 201 South Grand Avenue East Website: http://IMPACTinfo.illinois.gov Springfield, Illinois 62763-0002 Telephone: (877) 782-5565
TTY: (800) 526-5812 Email: [email protected]
Informational Notice
Date: May 8, 2015 To: Participating Medical Assistance Providers Re: Enrollment Timeline and Deadlines for the Illinois Medical Assistance Program -
Illinois Medicaid Program Advanced Cloud Technology (IMPACT)
This notice provides information on the timeframes and requirements for launching the new computer-based enrollment system, called Illinois Medicaid Program Advanced Cloud Technology (IMPACT). Illinois will temporarily suspend processing applications from providers seeking to participate in the Medical Assistance Program, as well as update requests from currently enrolled providers. Beginning on August 3, 2015, Illinois will begin enrolling and revalidating Medicaid-funded providers through the new IMPACT web portal. While billing/claiming processes will remain unchanged in 2015 and 2016, failure to enroll or revalidate on time may lead to payment delays. This notice also includes several important dates related to IMPACT implementation for providers and administrative staff. See the IMPACT Provider Enrollment Timeline (http://www.illinois.gov/hfs/impact/Documents/IMPACTProviderEnrollmentTimeline.pdf) for more information. The dates below apply only to the types of providers that currently enroll in the provider enrollment system. Waiver program providers that enroll in systems other than with the current Medicaid system will not be affected by the activities listed below.
Cut Off for Provider Applications & Paper Updates (May 29, 2015) – Illinois will suspend processing provider applications and paper-based updates for the Medical Assistance Program on May 29, 2015 until the IMPACT system comes online August 3, 2015. Applications for providers seeking to participate in the Medical Assistance Program may be submitted through IMPACT once the system comes online.
Cut Off for Electronic Updates (June 24, 2015) - Illinois will suspend electronic updates for the Medical Assistance Program on June 24, 2015 until the IMPACT system comes online. If necessary, providers are encouraged to update their information through the current process before June 24, 2015. All currently-enrolled
E-mail: [email protected] Internet: http://www.hfs.illinois.gov/
providers will be required to revalidate or update their information within 6 months of the IMPACT system coming online.
Revalidation Period for Currently-Enrolled Providers (August through December, 2015) - The types of providers that are currently enrolled in the provider enrollment system will need to revalidate their information before the end of 2015. This applies to entities and individuals seeking to become Illinois Medical Assistance providers, including those working under Waiver Programs administered by agencies other than the Department of Healthcare and Family Services. Additionally, revalidation must occur in a particular sequence so that associations may occur between entities and individual providers. Facilities, Agencies and Organizations (FAOs) must revalidate first, before any individuals (Sole Proprietors or Rendering/Servicing) can associate with these entities.
More information is available at the IMPACT website (http://www.illinois.gov/hfs/impact/Pages/default.aspx). Additional details will be posted as new information becomes available. Please check the IMPACT website periodically for updates, and contact the IMPACT Help Desk ([email protected]) with questions.
E-mail: [email protected] Internet: http://www.hfs.illinois.gov/
Bruce Rauner, Governor
201 South Grand Avenue East Website: http://IMPACTinfo.illinois.govSpringfield, Illinois 62763-0002 Telephone: (877) 782-5565
TTY: (800) 526-5812Email: [email protected]
Informational NoticeDate: May 21, 2015
To: Medical Assistance Providers
Re: Temporary Suspension of Medicaid Provider Applications; May 29 – August 3, 2015
The purpose of this notice is to inform you that the State will temporarily suspend processing newmedical provider applications and paper-based updates on May 29 until the grand opening of theIMPACT system on August 3, 2015. Applications should be received by HFS no later than May 29.
The State may make special exceptions to accommodate urgent needs or high-priority issues.Additionally, most providers will be able to request a retroactive enrollment effective date once theIMPACT system is live.
More information about the temporarily suspension of provider applications is available on theIMPACT website (http://IMPACTinfo.illinois.gov), including:
A PowerPoint slide deck A recording of the May 13 webinar for providers A list of Frequently Asked Questions
Providers are invited to register for a webinar on June 10, 1pm to get additional information. Afterregistering, you will receive a confirmation email with information on how to participate, which youcan add to your Outlook calendar.
If you have questions, please contact the IMPACT Help Desk at [email protected] and ask tospeak with the Communication Liaison from your funding agency, listed on slide 7.
About IMPACT
The Illinois Medicaid Program Advanced Cloud Technology (IMPACT) is a multi-agency effort toreplace Illinois’ legacy Medicaid Management Information System (MMIS) with a web-based systemto give providers a more convenient and consistent user experience, and to ensure clients receivetimely and high-quality Medicaid services.
The current phase of IMPACT focuses on enrolling and revalidating all Medicaid providers in the newsystem. Billing/claiming processes will remain unchanged in 2015 and 2016.
