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

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

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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

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Pueblo County Department of Human Services and Health Colorado (Southern Colorado Medicaid)

Presented by Provider Relations Department July 2019

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Agenda

01

Overview

02

Contacts and Resources

03

Provider Credentialing & Contracting

04

Coding

05

Claims Payment

06

Questions

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Chapter Chapter

01

What is the RAE or Regional Organization?

In Colorado, Medicaid is called Health First Colorado. Every Health First Colorado Member belongs to a regional

  • rganization 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. 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.

Overview

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Chapter Chapter

Contacts & Resources

02

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

Health Colorado Contacts

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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

Local Provider Relations is here to support you!

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

Health First Colorado Resources

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Chapter Chapter

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Provider Credentialing and Contracting

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  • 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

REVALIDATION FOR HEALTH FIRST COLORADO

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  • Complete and submit a Request for Application to Provider Relations.
  • 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.

Credentialing Process

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  • 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.

Single Case Agreements (SCAs)

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  • 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.

Single Case Agreements (SCAs) Continued…

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Chapter Chapter

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Coding

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  • Effective January 1, 2014 outpatient substance use disorder benefits were included in

the Community Behavioral Health Services program. This includes:

  • Drug and alcohol assessment
  • Individual, group, and family therapy
  • Medication assisted therapy
  • Outpatient detox services provided in treatment facility
  • Methadone administration
  • Safety assessment
  • Drug screening and monitoring
  • Refer to the Uniform Services Coding Manual for specific allowable codes & modifier

Outpatient Substance Use Disorder (SUD) Benefits

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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:

  • The clinical description of each code
  • The documentation requirements for each code
  • What modifiers are applicable
  • The credentials required in order to provide each service
  • Allowable modes of delivery (e.g., face-to-face, phone, telehealth) and allowable

places of service (e.g., office, school, client home)

The Uniform Service Coding Standards Manual

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  • 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:
  • Mental Health Services
  • 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

The Uniform Service Coding Standards Manual Cont…

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  • 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 2nd position
  • ET for Crisis services - this has to be in 2nd - 4th positions

Modifiers

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Chapter Chapter

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Claims Payment

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  • 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:
  • Direct claims submission through ProviderConnect
  • 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.

  • Claims received after 90 days of DOS will be denied for timely filing

Claims

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  • If you do not agree with a payment or denial you must:
  • Submit a written request for reconsideration
  • 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

Claims Support

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  • 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)

Common Errors in Submitting Claims

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  • All network providers can register online at

https:/ / www.valueoptions.com/ pc/ eProvider/ providerLogin.do

  • 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)

How to access ProviderConnect

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Questions?

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Contact Us

Thank You Thank You

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