Transcript EPSDT Health Servcies

LOUISIANA
UNISYS
Department of
HEALTH and
HOSPITALS
Louisiana Medicaid
DHH – Bureau of Primary Care
Practice Management Technical Assistance Workshop
August 14th , 2008
Billing for Independent
Mental Health Providers
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
Independently Practicing Psychologists and Social
Workers
 Medicaid covers services provided to Medicare/Medicaid
recipients ONLY
 Medicaid uses a cost-comparison methodology to make
payments up to the Medicare coinsurance/or deductible
 Claims should crossover electronically from Medicare
Psychological and Behavioral Services (PBS)
 Must be an enrolled Psychologist participating in the PBS
program
 Covers recipients under the age of 21
 Services covered include necessary assessments,
evaluations, individual therapy, and family therapy
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 Reimbursement is based on fee-for-service
Ind. Social Worker
Claim Form Example
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PBS Claim Form Example
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Common Billing Errors
 General Claim Form Completion Codes
 003 – Recipient # invalid or less than 13 digits
 028 – Invalid or missing CPT code
 Recipient Eligibility Error Codes
 215/216/222/223 – Recipient not on file/not eligible on one or more DOS
 217 – Name/# on claim does not match file
 Timely Filing Error Codes
 272/371 – Claim exceeds 1 year filing limit/attachment requires review
 Misc. Error Codes
 433/020 – Missing/invalid diagnosis
 131 – Primary diagnosis not on file
 234 – P/F age restriction
 739 – Recipient has exceeded maximum allowed services per year
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Timely Filing Guidelines
 Initial Filing Limits
 Dates of Service Past Initial Filing Limit
 Two-Year Filing Limit
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Appeals Process
 Denied claims ARE NOT considered appeals
and should be corrected and re-filed to
Unisys
 Appeals may be filed when all efforts to get
the claim paid have been exhausted
 Requests must be submitted in writing to

DHH Bureau of Appeals
P.O. Box 4183
Baton Rouge, La. 70821-4182
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CommunityCARE
 Program Description
 Exempt Recipients
 Primary Care Physician (PCP)
 Non-PCP Providers
 Exempt Services
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Types of Services Covered
 Mental Health Rehabilitation Services
 Private providers
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Assessment
Service Planning
Community Support
Medication Management
Individual Intervention/Supportive Counseling
Group Counseling
Parent/Family Intervention Counseling
Psychosocial Skills Group Training
 All services must be Prior Authorized through SRI
 Reimbursement is based on fee-for-service
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Types of Services Covered

Mental Health Clinics
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Only State Operated Clinics
Covered Services include:
 Evaluations/Assessments
 Treatment
 Counseling Services
 Medication Management
 Injections
Reimbursement is based on fee-forservice
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MHC Claim Form Example
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Common Billing Errors
 General Claim Form Completion Codes
 003 – Recipient # invalid or less than 13 digits
 028 – Invalid or missing CPT code
 Recipient Eligibility Error Codes
 215/216/222/223 – Recipient not on file/not eligible on one or more DOS
 217 – Name/# on claim does not match file
 Timely Filing Error Codes
 272/371 – Claim exceeds 1 year filing limit/attachment requires review
 TPL Error Codes
 273 – TPL carrier code missing
 290 – No EOB from primary carrier attached
 Miscellaneous Error Codes
 194 – Claim exceeds prior authorized limits
 191 – Procedure requires prior authorization
 299/232 - Procedure not covered by Medicaid/type of service not covered14
Timely Filing Guidelines
 Initial Filing Limits
 Dates of Service Past Initial Filing Limit
 Two-Year Filing Limit
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Appeals Process
 Denied claims ARE NOT considered appeals
and should be corrected and re-filed to
Unisys
 Appeals may be filed when all efforts to get
the claim paid have been exhausted
 Requests must be submitted in writing to

DHH Bureau of Appeals
P.O. Box 4183
Baton Rouge, La. 70821-4182
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CommunityCARE
 Program Description
 Exempt Recipients
 Primary Care Physician (PCP)
 Non-PCP Providers
 Exempt Services
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Outpatient Visit Limits
If a CommunityCare recipient has used up all visits
and needs non-emergent care, the PCP
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Can either treat the recipient and not bill Medicaid
Offer to see the recipient as a private pay patient
(enrollee pays out of pocket)
Request an extension using the 158-A form
Issue a referral to a physician who will treat the
recipient
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Provider Assistance
 Provider Relations Telephone Unit:
800-473-2783 OR 225-924-5040
 Provider Enrollment Department:
225-216-6370
 Correspondence Unit:
Unisys-Provider Relations
P.O. Box 91024
Baton Rouge, LA. 70821
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Field Analysts
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THANK YOU!
For Attending This 2008
Provider Workshop
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