EDI/IT BH Redesign Workgroup May 10, 2017 Agenda Welcome - - PowerPoint PPT Presentation

EDI/IT BH Redesign Workgroup

May 10, 2017

Welcome Practitioner enrollment and affiliation Trading Partner Testing IT Document Updates Q&A Document

Agenda

Practitioner Enrollment

Enrollment status as of May 10th:

Enrollments Applications Provider Types Total enrolled as

• f 04/10/17

Total enrolled as

• f 4/26/2017

Total enrolled as

• f 5/10/2017

Oldest dated application Applications in “Submit Status” Applications Returned to Provider LISW (Type 37) 1,887 1,982 2,059 4/20/2017 12 115

2/27/2017

LPCC (Type 47) 1,973 2,108 2,207 4/20/2017 30 119

01/09/2017

IMFT (Type 52) 44 51 52 N/A 1

04/17/2017

LICDC (Type 54) 296 336 344 4/26/2017 25 29

02/13/2017

Nurses (Type 38) 897 915 1,018 4/3/2017 68 175

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

http://medicaid.ohio.gov/PROVIDERS/Billing/TradingPartners.aspx

• 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

Trading Partner Testing

http://medicaid.ohio.gov/PROVIDERS/Billing/TradingPartners.aspx

• “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

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 1st and beyond

http://medicaid.ohio.gov/PROVIDERS/Billing/TradingPartners.aspx

• “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

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 22nd
• https://register.gotowebinar.com/#register/4952243634902258434
• Prior Authorization Training – May 23rd
• https://register.gotowebinar.com/register/8342927488327893763
• Basic Billing for PT 84/95 Agency Billing Staff
• Wednesday, June 14th
• Thursday, June 27th
• Register here:

http://medicaid.ohio.gov/PROVIDERS/Training/BasicBilling/TrainingCalendar/ tabid/502/Default.aspx?SearchEvent=%7Cbehavioral%20health%7C

Questions

Appendix

• 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

New MITS Bits Encouraging Practitioner Affiliation

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 restrictions Coverage and pricing Submit clean claims for services without service limits (audits, PA) that require the NPI of the rendering provider Coverage, pricing and provider requirements Submit clean claims for services without service limits (audits, PA) that require a modifier for a non-enrolled rendering provider and the NPI of a supervising provider Coverage, pricing and provider requirements Submit clean claims for services without service limits (audits, PA) that require a modifier for a non-enrolled rendering provider Coverage, pricing and provider requirements Submit clean claims for services without service limits (audits, PA) that require the NPI of the rendering provider and the NPI of the ordering provider Coverage, pricing and provider requirements Submit clean claims for services with service limits (audits) up to the limit; then submit claims that will exceed the limit to test the audit Coverage, pricing and service 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

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

• Header Level

Supervisor Rendering Billing Provider Supervisor NPI

• Agency NPI
• Supervisor reported at header applies to all detail lines
• Claim will pay based on the supervisor’s rate

Billing Example: Incorrect Reporting of Supervisor

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

Header Level

Supervisor Rendering Billing Provider Supervisor NPI

• Agency NPI
• 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

Update to 837P Companion Guides

Loop ID Reference Name Codes Notes/Comments 2310D NM1 Supervising Provider Name Provider must be enrolled with Ohio Medicaid 2310D NM109 Supervising Provider Identifier Provider NPI 2310D REF Supervising Provider Secondary Identification ODM generally expects Supervising Providers to be ‘Typical’ Providers 2310D REF01 Reference Identification Qualifier G2 Provider Commercial Number 2310D REF02 Supervising Provider Secondary Identifier Atypical Provider ID assigned by ODM (Medicaid Billing ID)

• 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