Transcript Provider Relations - Illinois Mental Health Collaborative

Illinois Department of Human Services /
Division of Mental Health
and
Illinois Mental Health Collaborative
Present
CHP Direct Claims Submission Training
January 2010
Claims Training Agenda
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2
Overview of CHP Services
Billing Guidelines
Direct Claim Submission on ProviderConnect
Claim Helpful Hints
CHP Claims
3

Under the Collaborative IT system, all services are
submitted as claims and all claims must be
submitted electronically

Community Health and Prevention Service claims
may be submitted to the Collaborative for dates of
service 8/1/2009 and after.

Program Code: CHP
CHP Service Codes
New Modifier Order
Service Name
CPT HCPCS
1
4
2
Bill Unit (hrs)
3
H0031
AH
Mental health assessment (LCP)
0.25
H0031
HN
Mental health assessment (MHP)
0.25
H0031
HO
Mental health assessment (QMHP, AM/MA)
0.25
H0032
HN
Treatment plan development, review, modification (MHP)
0.25
H0032
HO
Treatment plan development, review, modification (QMHP)
0.25
90862
52
Psychotropic medication monitoring
0.25
90862
SA
Psychotropic medication monitoring (APN)
0.25
90862
UA
Psychotropic medication monitoring (MD/DO/DC)
0.25
H0002
HE
Case management - LOCUS
H0004
HN
Therapy/counseling--individual (MHP)
0.25
H0004
HO
Therapy/counseling--individual (QMHP)
0.25
H0004
HQ
HN
Therapy/counseling--group (MHP)
0.25
H0004
HQ
HO
Therapy/counseling--group (QMHP)
0.25
H0004
HR
HN
Therapy/counseling--family (MHP)
0.25
H0004
HR
HO
Therapy/counseling--family (QMHP)
0.25
Event
CHP Service Codes
New Modifier Order
Service Name
CPT HCPCS
1
H0034
HN
H0034
HQ
H0034
2
Psychotropic medication training--Individual
0.25
Psychotropic medication training--group (APN)
0.25
HQ
Psychotropic medication training--group
0.25
H0034
SA
Psychotropic medication training--Individual (APN)
0.25
H0039
HQ
Assertive community treatment, group
0.25
H0039
HT
Assertive community treatment
0.25
Crisis intervention
0.25
SA
H2011
5
Bill Unit (hrs)
3
H2011
HK
Crisis intervention, state operated facility screening
0.25
H2011
HT
Crisis intervention--multiple staff
0.25
H2015
HE
HM
Community support, residential, individual (RSA)
0.25
H2015
HE
HN
Community support, residential, individual (MHP)
0.25
H2015
HE
HO
Community support, residential, individual (QMHP)
0.25
H2015
HM
Community support, individual (RSA)
0.25
H2015
HN
Community support, individual (MHP)
0.25
H2015
HO
Community support, individual (QMHP)
0.25
H2015
HQ
HE
HM
Community support, residential, group (RSA)
0.25
H2015
HQ
HE
HN
Community support, residential, group (MHP)
0.25
H2015
HQ
HE
HO
Community support, residential, group (QMHP)
0.25
H2015
HQ
HM
Community support, group (RSA)
0.25
H2015
HQ
HN
Community support, group (MHP)
0.25
H2015
HQ
HO
Community support, group (QMHP)
0.25
CHP Service Codes
New Modifier Order
Service Name
CPT HCPCS
1
3
Bill Unit (hrs)
H2015
HT
Community support, team
0.25
H2017
HM
Psychosocial rehabilitation, individual (RSA)
0.25
H2017
HN
Psychosocial rehabilitation, individual (MHP)
0.25
H2017
HO
Psychosocial rehabilitation, individual (QMHP)
0.25
H2017
HQ
HM
Psychosocial rehabilitation, group (RSA)
0.25
H2017
HQ
HN
Psychosocial rehabilitation, group (MHP)
0.25
H2017
HQ
HO
Psychosocial rehabilitation, group (QMHP)
0.25
S9480
HA
HO
Mental health intensive outpatient--child
1.00
S9480
HO
Mental health intensive outpatient--adult
1.00
T1016
HK
HN
Case management--mandated follow-up (MHP)
0.25
T1016
HK
HO
Case management- mandated follow-up (QMHP)
0.25
T1016
HM
Case management--mental health (RSA)
0.25
T1016
HN
Case management--transition linkage and aftercare (MHP)
0.25
T1016
HO
Case management--transition linkage and aftercare (QMHP)
0.25
T1016
TF
Case management--mental health (MHP)
0.25
T1016
TG
Case management--client-centered consultation (MHP)
0.25
T1016
TG
Case management--client-centered consultation (RSA)
0.25
T1502
6
2
T1502
SA
HN
Psychotropic medication administration (LPN/RN)
Event
Psychotropic medication administration (APN)
Event
Claims Submission and Billing
Guidelines
Registration Requirement
Before claim is submitted, consumer must be
registered by the agency performing the
service
8
Consumer Information
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9
Standardized claims transactions require
certain consumer information to verify the
individual’s identity
The Collaborative has minimized the
consumer information necessary for a claim
to be submitted, while assuring that each
service claim is correctly associated to the
appropriate consumer
Claim Level Information
Consumer Information Required
•
RIN
Consumer Name
Date of Birth
•
Gender
•
All must match exactly to the registration information
on file
Consumer address is optional
•
•
•
10
Claim Level Information
(cont.)
Provider Information required on each
claim
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11
10 digit NPI number that matches the NPI on
file with the Collaborative
Tax ID Number (FEIN)
Service Location
Taxonomy Codes are optional
Service code and modifier combinations will
identify staff level
Claim Level Information (cont.)
Program Codes
Submit the Program Code for the service
provided:
 Program Code: CHP
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12
Claim Line Level Information
Service Codes
Service codes must be valid HCPCS or CPT
codes as shown on Service Matrix found at
http://www.illinoismentalhealthcollaborative.com/
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13
Claim Line Level Information (cont.)
Modifiers
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Staff Level Modifiers drive the allowable
amount applied to a service
– If no staff level modifier is submitted, the
claim will be denied unless the service
does not require a Staff Level Modifier
Modifier Position is very important
– Staff Level Modifier should always be in
the last modifier position when multiple
modifiers are submitted
Claim Line Level Information (cont.)
Staff Level Modifiers
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AH – LCP - Licensed Clinical Psychologist
HN – MHP - Mental Health Professional
HO – QMHP - Qualified Mental Health
Professional
SA – APN -Advanced Practice Nurse
HM – RSA - Rehabilitative Services Associate
UA – MD, DO, DC
Claim Line Level Information (cont.)
Diagnosis Codes
16

Must be ICD-9 and include 4th and 5th digit
according to ICD-9 guidelines

Only Mental Health diagnoses that are
DMH/DHS defined will be accepted.
Claim Line Level Information (cont.)
Line Notes
For all services, the following are required:
 Delivery method
 Service start time
 Service duration
 Staff ID
Situational Requirements:
 For group based services show the group id, # clients in group, and #
of staff in the group
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DMH considers these data elements to be important and necessary
components of billing and service reporting
Review Services Matrix
The Service Matrix is posted on the Collaborative Website in an Excel
Spreadsheet that you may download.
http://www.illinoismentalhealthcollaborative.com/
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Direct Claim Submission
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ProviderConnect
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Submitting Corrected/Replacement
Claims
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When an original claim was incorrectly billed,
send a corrected or replacement claim by
indicating the Claim Frequency Type Code
–
6=Corrected
– 7=Replacement
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Enter the Collaborative’s original Claim Number
Questions?
34
Claims Helpful Hints
Helpful Hints to Faster Claim
Processing
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Submit the correct Consumer RIN in the
Consumer ID field
–
36
if the RIN doesn’t match the DHS assigned number,
the claim will be uploaded to our claims processing
system identifying the Consumer as “UNKNOWN”
Helpful Hints to Faster Claim
Processing (cont.)
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Multiple units of service rendered by the same
practitioner staff level, on the same day, for the
same client, must be submitted on one claim.
–
–
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All units for one service code must be submitted on
one line.
If claims are submitted separately, claims will be
denied as a duplicate service.
Helpful Hints to Faster Claim
Processing (cont.)
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Example:
H2015 HN
Community support, individual
(MHP) For Consumer RIN 123456789
– 10 AM 4 units, noon 2 units, 6PM 3 units
– Submit H2015 HN on one line, with 9 units. Start
time is 9999, duration: 135 minutes
Helpful Hints to Faster Claim
Processing (cont.)
A separate claim must be submitted for every
different staff level rendering services
(except for multiple disciplinary groups)
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Most Common Reasons for Claim
Denial
Consumer Information:
–
–
–
–
40
RIN doesn’t match the RIN assigned by DHS or
registration
Service code on the claim is not on the list of
covered services
Service code billed is not one the provider is
contracted to render (the service is not on the
provider’s fee schedule).
Consumer is not eligible/registered on the date of
service.
Most Common Reasons for Claim
Denial (cont.)
Codes/Modifiers
–
–
–
–
–
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Place of service code on the claim is not a valid place
of service code for the service rendered
Modifier code billed on the claim is not valid with the
CPT or HCPCS code
Staff level modifier is not billed on the claim
Diagnosis code is not an ICD-9 code
Diagnosis code does not contain a required 4th or 5th
digit
Most Common Reasons for Claim
Denial (cont.)
Billing
- Duplicate/Non-Rolled Services
- Third Party Liability
- TPL not billed with claim
- TPL information on claim incomplete
42
Timely Filing of Claims
43

Claims for all services must be received by the
Collaborative within 365 days of the date of service

Claims Involving Third Party Liability (TPL) must be
received by the Collaborative within 365 days of the
date of the other carrier’s Explanation of Benefits
(EOB), or notification of payment / denial.

Timely filing limit applies to replacement claims as
well as original claims; claims must be received by the
Collaborative within 365 days from date of service.
Questions and Answers
44
Thank you!
Illinois Mental Health Collaborative for
Access and Choice