unisys louisiana medicaid dhh – bureau of primary care practice management technical assistance...
TRANSCRIPT
LOUISIANA
Department ofHEALTH and
HOSPITALS
UNISYS
Louisiana Medicaid
DHH – Bureau of Primary CarePractice Management Technical Assistance Workshop
August 14th , 2008
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Billing for Independent Mental Health Providers
Independently Practicing Psychologists and Social Workers Medicaid covers services provided to
Medicare/Medicaid recipients ONLY Medicaid uses a cost-comparison methodology to
make payments up to the Medicare coinsurance/or deductible
Claims should crossover electronically from Medicare Psychological and Behavioral Services (PBS)
Must be an enrolled Psychologist participating in the PBS program
Covers recipients under the age of 21 Services covered include necessary assessments,
evaluations, individual therapy, and family therapy Reimbursement is based on fee-for-service
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Ind. Social Worker Claim Form Example
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PBS Claim Form Example
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Common Billing Errors
General Claim Form Completion Codes 003 – Recipient # invalid or less than 13 digits 028 – Invalid or missing CPT code
Recipient Eligibility Error Codes 215/216/222/223 – Recipient not on file/not eligible on one or more DOS 217 – Name/# on claim does not match file
Timely Filing Error Codes 272/371 – Claim exceeds 1 year filing limit/attachment requires review
Misc. Error Codes 433/020 – Missing/invalid diagnosis 131 – Primary diagnosis not on file 234 – P/F age restriction 739 – Recipient has exceeded maximum allowed services per year
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Timely Filing Guidelines
Initial Filing Limits
Dates of Service Past Initial Filing
Limit
Two-Year Filing Limit
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Appeals Process
Denied claims ARE NOT considered appeals and should be corrected and re-filed to Unisys
Appeals may be filed when all efforts to get the claim paid have been exhausted
Requests must be submitted in writing to DHH Bureau of Appeals P.O. Box 4183 Baton Rouge, La. 70821-4182
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CommunityCARE
Program Description
Exempt Recipients
Primary Care Physician (PCP)
Non-PCP Providers
Exempt Services
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Types of Services Covered Mental Health Rehabilitation Services
Private providers Assessment Service Planning Community Support Medication Management Individual Intervention/Supportive Counseling Group Counseling Parent/Family Intervention Counseling Psychosocial Skills Group Training
All services must be Prior Authorized through SRI
Reimbursement is based on fee-for-service
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Types of Services Covered Mental Health Clinics
Only State Operated Clinics Covered Services include:
Evaluations/Assessments Treatment Counseling Services Medication Management Injections
Reimbursement is based on fee-for-service
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MHC Claim Form Example
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Common Billing Errors General Claim Form Completion Codes
003 – Recipient # invalid or less than 13 digits 028 – Invalid or missing CPT code
Recipient Eligibility Error Codes 215/216/222/223 – Recipient not on file/not eligible on one or more DOS 217 – Name/# on claim does not match file
Timely Filing Error Codes 272/371 – Claim exceeds 1 year filing limit/attachment requires review
TPL Error Codes 273 – TPL carrier code missing 290 – No EOB from primary carrier attached
Miscellaneous Error Codes 194 – Claim exceeds prior authorized limits 191 – Procedure requires prior authorization 299/232 - Procedure not covered by Medicaid/type of service not covered
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Timely Filing Guidelines
Initial Filing Limits
Dates of Service Past Initial Filing
Limit
Two-Year Filing Limit
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Appeals Process
Denied claims ARE NOT considered appeals and should be corrected and re-filed to Unisys
Appeals may be filed when all efforts to get the claim paid have been exhausted
Requests must be submitted in writing to DHH Bureau of Appeals P.O. Box 4183 Baton Rouge, La. 70821-4182
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CommunityCARE
Program Description
Exempt Recipients
Primary Care Physician (PCP)
Non-PCP Providers
Exempt Services
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Outpatient Visit Limits
If a CommunityCare recipient has used up all visits and needs non-emergent care, the PCP
Can either treat the recipient and not bill Medicaid
Offer to see the recipient as a private pay patient (enrollee pays out of pocket)
Request an extension using the 158-A form Issue a referral to a physician who will treat the
recipient
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Provider AssistanceProvider Assistance Provider Relations Telephone Unit:Provider Relations Telephone Unit:
800-473-2783 OR 225-924-5040800-473-2783 OR 225-924-5040 Provider Enrollment Department:Provider Enrollment Department:
225-216-6370225-216-6370 Correspondence Unit:Correspondence Unit: Unisys-Provider RelationsUnisys-Provider Relations
P.O. Box 91024P.O. Box 91024 Baton Rouge, LA. 70821Baton Rouge, LA. 70821 Field Analysts Field Analysts
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For Attending This 2008 Provider
Workshop
THANK YOU!THANK YOU!