Kim Morgan Provider Education MO HealthNet Division (MHD) MO HealthNet Division (MHD) Q and A for Missouri Family Health Council August 12, 2016

MHD Policy

Provider Manuals Provider Manual Webpage: http://manuals.momed.com/manuals/ Physician Manual: http://manuals.momed.com/collections/collection_phy/print.pdf Hospital Manual: http://manuals.momed.com/collections/collection_hsp/print.pdf

Provider Bulletins and Hot Tips Provider Bulletin Webpage: http://dss.mo.gov/mhd/providers/pages/bulletins.htm Hot Tips Webpage: http://dss.mo.gov/mhd/providers/pages/provtips.htm

Women’s Health Services Program Bulletin February 19, 2016 Effective January 1, 2016 Provide coverage when primary diagnosis is related to Sexually Transmitted Infection (STI) Services covered – family planning, family planning-related and supplies, and testing and treatment of STI diseases Attachment: A – listing of procedure codes B – listing of covered diagnosis codes See bulletin for further details http://dss.mo.gov/mhd/providers/pdf/bulletin38-19_2016feb19.pdf

Sterilizations Consent Form, Section 10.2.E(1), Physician Manual Procedure codes require Sterilization Consent Form be completed and submitted with claim: 55250, 58565, 58600, 58605, 58611, 58615, 58670, and 58671 Form must be completed and signed by the participant at least 31 days, but not more than 180 days, prior to the date of the sterilization procedure Must be 30 days between the date of signing and the surgery date (day after the signing is considered the first day when counting the 30 days) Reference: Physician Manual, Section 10.E

Provider Communications Unit (PCU) (573) 751-2896 Email via MHD Web portal https://www.emomed.com Providers’ Initial Contact! Providers should contact PCU regarding concerns or questions about proper claim filing, claims resolution and disposition, and participant eligibility questions and verification Provider Communications Unit PO Box 5500 Jefferson City, MO 65102-2500

Pharmacy & Clinical Services (573) 751-6963 or Email: clinical.services@dss.mo.gov Policy development, benefit design, coverage decisions, provider and program policy inquiries Provider Education Email: MHD.provtrain@dss.mo.gov Inquiries regarding education, training assistance and scheduling Register for Training Today! http://dss.mo.gov/mhd/providers/education/

Claim Adjustments & Resubmissions Provider Manuals Section 6 Void Claim - ONLY used when the claim paid and should never have been billed; no need for a replacement claim to resubmit Choose “Void” tab to bring up paid claim, scroll to the bottom of the claim and click on the highlighted “submit claim” button. The claim has now been submitted to be voided or credited in the system

Adjustments & Resubmissions Replacement Claim – used when a claim paid but was billed incorrectly Choose “Replacement” tab to bring up paid claim, select “edit” button to make changes, then save the changes. Scroll to the bottom of the claim and click highlighted “submit” button. The replacement claim has now been submitted

Adjustments & Resubmissions Copy Claim - Original– used when a claim or any line of a claim denied that needs to be corrected. This will copy a claim just as it was entered Choose “Copy Claim” tab to bring up claim, choose “original,” select “edit” button to make changes, then save the changes. Scroll to the bottom of the claim and click highlighted “submit” button. The corrected claim has now been submitted

Adjustments & Resubmissions Copy Claim - Advanced– used when a claim denied that had been filed using the wrong NPI or wrong claim form Choose “Copy Claim” tab to bring up claim, choose “advanced,” select “edit” button to edit NPI, then save the changes. Scroll to the bottom of the claim and click highlighted “submit” button If claim was filed on wrong form, only DCN and Name will transfer to correct form. Key in claim and click “submit” button

CyberAccess Account setup or technical questions Email: cyberaccesshelpdesk@xerox.com CyberAccess web address: https://www.cyberaccessonline.net/cyberaccess/ CyberAccess helpful Tips: http://dss.mo.gov/cd/info/forms/reference/cyberaccess-helpful-tips.pdf

Pre-Certification for services CyberAccess MHD participant claim data - procedures, diagnosis codes, and prescription information Pre-Certification for services Radiology, Durable Medical Equipment, Optical, Inpatient Drug Prior Authorization (PA) or Clinical Edit Override (EO)

CyberAccess

MO HealthNet Division Website Provider Participation Page http://dss