EPSDT Health Servcies
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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
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
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
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
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
Field Analysts
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THANK YOU!
For Attending This 2008
Provider Workshop
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