EDI/IT BH Redesign Workgroup May 10, 2017
Agenda Welcome Practitioner enrollment and affiliation Trading Partner Testing IT Document Updates Q&A Document
Practitioner Enrollment Enrollment status as of May 10th: Enrollments Applications Total Applications Provider Total enrolled as Total enrolled as Oldest dated Applications in enrolled as Returned to Types of 4/26/2017 of 5/10/2017 application “Submit Status” Provider of 04/10/17 LISW (Type 115 1,887 1,982 2,059 4/20/2017 12 37) 2/27/2017 LPCC (Type 119 1,973 2,108 2,207 4/20/2017 30 47) 01/09/2017 IMFT (Type 1 44 51 52 N/A 0 52) 04/17/2017 LICDC (Type 29 296 336 344 4/26/2017 25 54) 02/13/2017 Nurses 175 897 915 1,018 4/3/2017 68 (Type 38) 03/22/2017 5,097 5,392 5,680 135 439 * Provider enrollment concentrating efforts on getting RTP and Nurse applications processed
Agency Affiliations • Count of agencies with at least one affiliated practitioner: Provider type As of 4/10/2017 As of 4/17/2017 As of 4/24/2017 As of 5-08-2017 84 (MH) 223 233 241 254 95 (SUD) 133 147 155 171 Total: 356 380 396 425
Agency Affiliations • Agencies with NO affiliated practitioners: Provider type As of 4/10/2017 As of 4/17/2017 As of 4/24/2017 As of 5/08/2017 84 (MH) 106 85 90 77 95 (SUD) 154 142 134 119 Total: 260 227 224 196
Trading Partner Testing – Fee For Service
Trading Partner Testing • MITS Bits • http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/May- 1-17.pdf?ver=2017-05-05-100421-610 • Testing : • Begins May 10 • Dates of service : • Use DOS from January 1, 2017 – March 31, 2017 • HPE will “forward” these dates to July 1 and later http://medicaid.ohio.gov/PROVIDERS/Billing/TradingPartners.aspx
Trading Partner Testing • “Rapid Response” Team A • May – June • Respond to trading partner-identified issues • Communicate ODM-identified issues on weekly basis • Communication • BH-Enroll@medicaid.ohio.gov • ODM has dedicated phone option for trading partners on Provider Hotline – 800-686-1516, option 9 • Rapid Response Team availability: • Monday-Friday 7:30am-7pm • Saturday 8am-1pm http://medicaid.ohio.gov/PROVIDERS/Billing/TradingPartners.aspx
Trading Partner Testing – EDI Meetings • Maintain bi-weekly meetings • ODM to provide weekly status report of known issues with MITS • First report due May 19th • Next scheduled meetings: • May 24, 2017 11:30 – 12:30 • June 7, 2017 12:30 – 1:30 following Benefits and Service Development Workgroup • June 21, 2017 11:30 – 12:30 • July 5, 2017 11:30 – 12:30
Support for July 1 st and beyond • “Rapid Response” Team B • July - end date determined based on need • Respond to provider-identified issues regarding claims processing • Communication • BH-Enroll@medicaid.ohio.gov • ODM to provide dedicated phone option on Provider Hotline – 800-686-1516, option 9 • Rapid Response Team availability: • Monday-Friday 7:30am-7pm • Saturday 8am-1pm http://medicaid.ohio.gov/PROVIDERS/Billing/TradingPartners.aspx
Q & A Document • Last updated 5/1/2017 • http://bh.medicaid.ohio.gov/manuals • Will continue to add questions as we receive them.
Upcoming Training Opportunities • BH Redesign “401” Training – May 22 nd • https://register.gotowebinar.com/#register/4952243634902258434 • Prior Authorization Training – May 23 rd • https://register.gotowebinar.com/register/8342927488327893763 • Basic Billing for PT 84/95 Agency Billing Staff • Wednesday, June 14 th • Thursday, June 27 th • Register here: http://medicaid.ohio.gov/PROVIDERS/Training/BasicBilling/TrainingCalendar/ tabid/502/Default.aspx?SearchEvent=%7Cbehavioral%20health%7C
Questions
Appendix
New MITS Bits Encouraging Practitioner Affiliation • Released on 4/11/2017 • As of 4/24/2017: 224 agencies had no affiliated practitioners • ODM and Ohio MHAS working on other avenues to reach these agencies • Remittance advice includes a message for all 84s and 95s • The MITS Bits may be found on the BH Redesign website: • http://mha.ohio.gov/Portals/0/assets/Funding/MACSIS/MITS-BITS/BH-MITS- Bits-BH-Redesign-Update_4-11-17.pdf • Report of Affiliated Practitioners by agency posted on the BH Redesign website: • http://bh.medicaid.ohio.gov/Portals/0/Providers/20170410-Affiliated- 84_95-Practitioners.pdf?ver=2017-04-11-114357-233
Trading Partner Testing Trading partners will be unable to test prior authorization scenarios. ODM will include all prior authorization testing in its UAT work. Suggested Testing Scenarios What is being tested? Submit clean claims for services without service limits (audits, PA) or provider Coverage and pricing restrictions Submit clean claims for services without service limits (audits, PA) that require Coverage, pricing and provider the NPI of the rendering provider requirements Submit clean claims for services without service limits (audits, PA) that require a Coverage, pricing and provider modifier for a non-enrolled rendering provider and the NPI of a supervising requirements provider Submit clean claims for services without service limits (audits, PA) that require a Coverage, pricing and provider modifier for a non-enrolled rendering provider requirements Submit clean claims for services without service limits (audits, PA) that require Coverage, pricing and provider the NPI of the rendering provider and the NPI of the ordering provider requirements Submit clean claims for services with service limits (audits) up to the limit; then Coverage, pricing and service submit claims that will exceed the limit to test the audit restrictions
Supervisor and the 837 ODM guidance at this time: • Report supervising practitioner at the header level only: Loop 2310D • Do not report supervisor at the detail level (2420D) • Report only one supervisor per claim • Do not report supervised services with services that do not require supervision – this could result in incorrect adjudication
Billing Example: Correct Reporting of Supervisor Supervisor reported at header applies to all detail lines • Claim will pay based on the supervisor’s rate • Header Level Supervisor Rendering Billing Provider Supervisor NPI - Agency NPI Detail Level Line #: DOS Code Units Modifiers Rendering Supv Ordering Prior Authorization 1 7-2-17 90839 1 U9 - - - - 2 7-2-17 90840 2 U9 - - - - 3 7-10-17 90839 1 U9 - - - -
Billing Example: Incorrect Reporting of Supervisor Supervisor reported at the header applies to all detail lines • Services that are not performed under supervision should not be reported on the • same claim – the claim may adjudicate incorrectly Header Level Supervisor Rendering Billing Provider Supervisor NPI - Agency NPI Detail Level Line #: DOS Code Units Modifiers Rendering Supv Ordering 1 7-2-17 90839 1 U9 - - - 2 7-2-17 90840 2 U9 - - - 3 7-10-17 90839 1 U9 - - - 4 7-11-17 90839 1 - LISW NPI - 5 7-12-17 90839 1 - RN NPI - Ordering NPI
Update to 837P Companion Guides • Supervisor NPI should always be reported at the header – do not report the Medicaid billing ID • Report the Supervising Provider Name (NM1) and Supervising Provider Identifier (NM109) as shown below Loop ID Reference Name Codes Notes/Comments 2310D NM1 Supervising Provider Provider must be Name enrolled with Ohio Medicaid 2310D NM109 Supervising Provider Provider NPI Identifier 2310D REF Supervising Provider ODM generally expects Secondary Identification Supervising Providers to be ‘Typical’ Providers 2310D REF01 Reference Identification G2 Provider Commercial Qualifier Number 2310D REF02 Supervising Provider Atypical Provider ID Secondary Identifier assigned by ODM (Medicaid Billing ID)
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