Transcript Title goes here - Iowa Psychiatric Society

Behavioral Health Practice
Management Workshop
Presented by Gloria Scholl
October 10, 2014
2014 - Year In Review
New Medicaid Expansion
Medicaid Expansion
New plans in effect 1/1/14.
Eligibility determined by Iowa Medicaid Enterprise.
New Medicaid Expansion Plans:
• Medicaid State Plan – managed by Magellan
• Wellness Plan – managed by Magellan
• Marketplace - NOT managed by Magellan
Magellan now manages three plan types:
• Iowa Plan (traditional plan)
• Medicaid State Plan - new
• Wellness Plan - new
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Medicaid State Plan
Also referred to as “medically exempt”.
Same covered benefits as the traditional Iowa Plan.
Covers adults 19-64.
Provider network is the same.
This plan is generally not retro-active.
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Wellness Plan
Also referred to as “Iowa Wellness Plan” or “Iowa Plan Light”.
Members are those previously covered by Iowa Cares.
Covers adults 19-64.
Provider network is the same.
Coverage is the same as the Iowa Plan, except DOES NOT include the following:
•BHIS
•ACT
•IPR
•CSS
•HAB
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•Peer Support
•Res Sub Abuse Treatment
•Individualized Comp Svc Plan
•IHH
Things To Keep In Mind…
Magellan does NOT determine plan eligibility. If you have questions concerning a
member’s plan type, contact Iowa Medicaid Enterprise (IME) directly.
If you have a Wellness Plan member that you feel needs services that are not covered
by this plan, you can assist them by helping to complete and submit the application
form for the Medicaid State Plan. This form can be found on IME’s website at
www.ime.state.ia.us.
Generally eligibility for the Medicaid State Plan is not retro-active. Please keep this in
mind when providing non-covered services under this plan.
IHH Phase 2 & 3 Sites Go Live!
IHH Phase 2 & 3 Sites
Phase 2 went live on
April 1, 2014
Phase 3 went live on
July 1, 2014
Claims/Billing Changes
Claims & Billing Changes
EFT Required as of 7/1/14!
Auth Requirements for 90837 – effective 10/1/14
Day HAB Codes Move to Tiers – effective 10/6/14
• H2015 will be phased out as existing auths are
exhausted
• H2016 + appropriate modifier (U4-U9)
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Things You Should Know
Information For Billers
Claims – Expediting the Process
FACT: The majority of claims are processed within 24-48 hours.
Submit Claims Electronically.
Submit “Clean” Claims – claims with NO errors!
Submit Within Timely Filing Guidelines – 365 days from date of service.
Sign Up For Electronic Funds Transfer (EFT) – Now required!
Sign Up For Electronic Remittance Advice (ERA).
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Electronic Claim Submission Options
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Electronic Claim Submission – Help Is Available
EDI/Website Technical Support
• *EDI Hotline – 1-800-450-7281, ext. 75890 or email
[email protected]
• *Getting Started – www.edi.magellanprovider.com
• *For all other website technical assistance,
call Provider Services at 1-800-788-4005.
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Top Claim Denial Reasons
No authorization.
Member not eligible for services.
Duplicate claim submission.
Invalid/non-covered DX codes.
Invalid CPT/HCPCS codes.
Invalid or missing modifier or place of service code.
Missing name and degree of provider – CMS 1500 only.
Site not contracted/credentialed.
• Site ON contract means you should bill that rendering site.
• Sites NOT on contract means you should bill the main site as the rendering site.
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Sign Up For EFT And ERA
Electronic Funds Transfer (EFT) required as of 7/1/14. Sign up
on-line!
Electronic Remittance Advice (ERA) – Paper EOBs no longer
available when receiving EFT. Sign up on-line!
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Website Resources
www.MagellanofIowa.com
www.MagellanProvider.com
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www.MagellanofIowa.com
For Members
• Information on accessing treatment
• Provider directory or provider search function – easy to use!
For Providers
• Check Eligibility
• Provider Handbook
• Forms
• Provider Communications
• UM Guidelines
• Appeal Process Info
• Claims Information
• Much more!
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www.MagellanProvider.com
Check Member Eligibility
Submit a Claim
Check Claim Status
Request Authorization – New!
View Authorizations
Update Practice Information
Sign Up for ERA/EFT
Free CE Courses
Provider Handbook
Clinical Practice Guidelines
Medical Necessity Criteria
On-line Demos
And more!
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www.MagellanProvider.com, cont.
Did You Know You Can…
• Check Contract and Credentialing Status On-line
• Check Rates
• Update Provider/Practice Information
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Website Resources For Billers
Online Training, Demos and Website User Guides
Electronic Transaction Demos
• Submitting EDI Claims
• 835 Transactions
• EDI Testing Center
• Clearinghouses
• EFT
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Contact Information
Customer Service Contact Information
Customer Service – 1-800-638-8820; Fax 1-888-656-5302
Donna Booth, Customer Service Supervisor – 1-800-638-8820, x85251
Email – [email protected]
Christine Bryant, Customer Service Manager – 1-800-638-8820, x85009
Email – [email protected]
Dennis Petersen, Chief Operations Officer – 1-800-638-8820, x85044
Email – [email protected]
Customer Service Address
PO Box 71129
Des Moines, IA 50325
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Claims Address
PO Box 1869
Maryland Heights, MO 63043
Network Contact Information
Phone – 1-800-638-8820; Fax – 1-888-656-5163
Address – PO Box 71129, Des Moines, IA, 50325
Organizations, Hospitals, CMHCs, Substance Abuse
• Gloria Scholl, Field Network Director, x85048, [email protected]
Organizations
• Brittani McMichael, Contract Coordinator x85060, [email protected]
Groups & Individuals
• Jessica Riedell, Sr. Network Coordinator x85051, [email protected]
HAB
• Anne Thielking, Provider Relations Liaison x85045, [email protected]
IHH
• Chris Huebener, Provider Relations Liaison x85026, [email protected]
• Rhonda Boeve, Provider Relations Liaison, x85042, [email protected]
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Thank You!
The information presented in this presentation is confidential and expected to be used solely in support of the
delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the
information contained herein will be kept confidential and that the information will not be photocopied,
reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan
Health, Inc.
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