Pueblo County Department of Human Services and Health Colorado - PowerPoint PPT Presentation

Pueblo County Department of Human Services and Health Colorado (Southern Colorado Medicaid) Presented by Provider Relations Department July 2019 1

Agenda 01 02 Overview Contacts and Resources Provider Credentialing & 03 04 Coding Contracting 05 06 Claims Payment Questions 2

What is the RAE or Regional Organization? Chapter Chapter In Colorado, Medicaid is called Health First Colorado. Every 01 Health First Colorado Member belongs to a regional organization that manages their physical and behavioral health care. Health Colorado is a regional organization and supports a network of providers to make sure Members can access care in a coordinated way. Overview Your PCP is your main contact for all your health care. They can answer questions you have about your benefits and help you get the care you need. Health First Colorado will assign you to a PCP, but you can choose another in-network provider at any time. You will be assigned a regional organization that your PCP works with. Your regional organization can also help you use your physical and behavioral health benefits and can help connect you to providers. 3

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Chapter Chapter Contacts & 02 Resources 5

Health Colorado Contacts • www.healthcoloradorae.com • Provider Resources o Provider Line Phone: (800) 397-1630 o Provider Line Fax: (719) 538-1433 o E-mail: COProviderRelations@beaconhealthoptions.com o Claims Questions – 1-800-888-3944 o Clinical Department – 888-502-4185 6

Local Provider Relations is here to support you! Contact us at COProviderRelations@beaconhealthoptions.com for assistance in:  Contracting  Credentialing  ProviderConnect Support  Training Needs Stay informed using the websites: www.healthcoloradorae.com  Access the Provider Handbook  Guide to policies and procedures  Provider Newsletters 7

Health First Colorado Resources • Provider Enrollment & Revalidation o Phone 1-844-235-2387 • Member Enrollment o Phone: 303-839-2120 o Phone: 1-888-367-6557 (outside of Denver) o enroll.healthfirstcolorado.com 8

Chapter Chapter Provider 03 Credentialing and Contracting 9

REVALIDATION FOR HEALTH FIRST COLORADO • Effective March 1, 2017 • Required in order to receive Medicaid dollars either directly through fee-for- service or via a RAE. • Applies to both in-network providers and those operating under single case agreements (SCAs). • All locations must be validated. Each facility location must have their own NPI. • Apply through the HCPF Provider Revalidation site • Please contact HCPF at 1-844-235-2387 or providerquestions@hcpf.state.co.us 10 10 10 10

Credentialing Process • Complete and submit a Request for Application to Provider Relations. o To obtain a copy of the initial application: — Phone: (800) 397-1630 — E-mail: COProviderRelations@beaconhealthoptions.com • The Request for Application will be reviewed and the full application will be sent out pending review. • Respond quickly and com pletely to ALL requests for documentation to assist with expediting your credentialing process. 11 11 11 11

Single Case Agreements (SCAs) • Providers can treat Health First members (Medicaid Patients) while they are undergoing the Contracting and Credentialing Process • Providers not in the network are required to obtain a Single Case Agreement for each member they treat. • Complete and Submit SCA Authorization Request. Ensure to respond to all sections thoroughly. Phone: (800) 804 -5008 Fax: (719) 538-1439 • Im p orta nt Note: State on SCA that the case is part of Child Welfare/ Core Services. • SCA Request will be reviewed by Clinical team to determine medical necessity. • Approved authorizations will be sent to SCA team to EXECUTE THE AGREEMENT. 12 12 12 12

Single Case Agreements (SCAs) Continued… • For Providers with approved Authorizations, you will be contacted by SCA team:  Provide Required Documentation — Malpractice Insurance Binder — State License and W-9 Form — NPI and Disclosure Form  Signed Agreement • If full documentation is NOT received in timely manner, then the SCA will be denied regardless of medical necessity. 13 13 13 13

Chapter Chapter Coding 04 14 14 14 14

Outpatient Substance Use Disorder (SUD) Benefits • Effective January 1, 2014 outpatient substance use disorder benefits were included in the Community Behavioral Health Services program. This includes: o Drug and alcohol assessment o Individual, group, and family therapy o Medication assisted therapy o Outpatient detox services provided in treatment facility o Methadone administration o Safety assessment o Drug screening and monitoring • Refer to the Uniform Services Coding Manual for specific allowable codes & modifier 15 15 15 15

The Uniform Service Coding Standards Manual What is the Uniform Service Coding Standards (USCS) Manual? • The USCS Manual is a provider’s best friend! It informs the provider on what is a covered service under the Behavioral Health benefit (Caution: Be sure to refer to your provider contract, for codes you are “contracted” to provide). It also tells you: o The clinical description of each code o The documentation requirements for each code o What modifiers are applicable o The credentials required in order to provide each service o Allowable modes of delivery (e.g., face-to-face, phone, telehealth) and allowable places of service (e.g., office, school, client home) 16 16 16 16

The Uniform Service Coding Standards Manual Cont… • Developed by the Coding Committee along side HCPF/ OBH. • Lists the covered Mental Health and SUD diagnoses and CPT/ HCPC codes • Sets forth the requirements for billing certain codes for covered: o Mental Health Services o Substance Use Disorders (SUD) • Updated on an ongoing basis – latest version effective July 1, 2019  TIP: Provider is responsible for billing using the most updated information • Can be accessed at: https:/ / www.colorado.gov/ pacific/ hcpf/ mental-health- rate-reform-0 17 17 17 17

Modifiers • Modifiers allow providers to more accurately document and report the services that are being provided. More information is provided in the Coding Manual: https:/ / www.colorado.gov/ pacific/ hcpf/ mental-health-rate-reform-0 • Up to 4 modifiers can be used per line • For the RAE, HCPF has reserved the first modifier for the identification of State Plan or B3 Modifiers as Defined by the USCS Coding Manual. (e.g., State Plan = HE) • There should always be at least one modifier per service (Typically HE) Im portant m odifiers to note: • HF for SUD services - this has to be in 2 nd position ET for Crisis services - this has to be in 2 nd - 4 th positions • 18 18 18 18

Chapter Chapter Claims 05 Payment 19 19 19 19

Claims • Claims – submitted by MH Providers and SUD Programs/ Facilities - Submit Claims to correct address per RAE Contract - CMS 1500 Form Used for Submission of Claims - Refer to Most Recent Coding Manual for instructions of completing CMS 1500 • BEACON PREFERS ELECTORNIC CLAIMS • Claims can be filed electronically through: o Direct claims submission through ProviderConnect o Batch 837 file through your Clearinghouse • Claims must be received within 90 days of the DOS or if there is other primary coverage within 90 days of the primary EOB. o Claims received after 90 days of DOS will be denied for timely filing 20 20 20 20

Claims Support • If you do not agree with a payment or denial you must: o Submit a written request for reconsideration o within 60 days of the denial date on the Beacon Provider Summary Voucher. • For Claims Support Call: (800) 888-3944 Claims Appeals Address: Beacon Health Options Attn: Claims Appeals PO Box 1850 Hicksville, NY 11802-1850 21 21 21 21

Common Errors in Submitting Claims  Missing or No Modifiers  Modifiers Placed in Incorrect Sequence  Place of Service (POS) is incorrect  Service Location is not contracted or not revalidated  Staff Requirements – Staff not having qualifications to provide service  Duration billed incorrectly  Licensure Level not Included on Certain Codes (H0020, H0033, E/ M Codes) 22 22 22 22

How to access ProviderConnect • All network providers can register online at https:/ / www.valueoptions.com/ pc/ eProvider/ providerLogin.do o Click the “ Register” button under New User? Section • To obtain additional logons contact: EDI Helpdesk at (888) 247-9311 and press option 3 (Available Monday thru Friday 8AM – 6PM EST) 23 23 23 23

Questions? 24 24 24 24

Thank You Thank You Contact Us Contact Us 888-502-4185 www.beaconhealthoptions.com | www.healthcoloradorae.com healthcolorado@beaconhealthoptions.com 25 25 25 25