ForwardHealth Medicaid Information & Resources Katherine Fischer Nov. 6, 2015

Agenda Medicaid Enrollment Wizard and Resources Review Submitted questions Portal Overview and Resources. General Portal navigation. Provider-related links. Resources and communications. .

For Dentist… You have been approved! Now what? Dental Providers facilities can request a Waiver to be both a biller AND a renderer. Review Sample Letter Compose and mail request to: Alan White Department of Health Services Office of the Inspector General 1 W. Wilson St P.O Box 309 Madison, WI  53701

Frequently Asked Questions What is the difference between “Straight Medicaid” and Medicaid HMO? Answer: Straight Medicaid means the members are part of fee for service – you would bill Medicaid/WI ForwardHealth directly via the Portal. If the members belong to an HMO, then in order to be able to be reimbursed for services for them, you would need to contract directly with the HMO.

FAQ Continued: EHR vs. Paper – We understand that billing to Medicaid must be done electronically; however – does the FCC (free & charitable clinic) have to have electronic health records (EHRs) or can they still do paper charting?  Are audits done to review billing – what is looked at and needs to be kept? Answer: You can submit claims electronically or by paper, however there is a $1.10 charge for paper submission Topic #10637 Topic #201 #202 and #204

FAQ Continued: HIPAA – What are the HIPAA requirements that are applicable to a FCC that accepts Medicaid? Do you have sample forms that an FCC Medicaid patient would need to sign? Answer: Topic# 200

FAQ’s Continued Reimbursement – What are the reimbursements for dental and behavioral health? How do the copays work? Answer: Max fee Schedule Do we need certified coders? Can the coders and billers be volunteers of the clinic or must they be paid employees? Answer: This is an Administrative question and we can not give you specific guidance on this matter. Coding must be done legally and correctly as well as HIPAA compliant. They do not need to be certified coders.

FAQ’s Continued Are Free Clinics required to ask members for the copay, or are they able to simply write them all off and take the hit Answer: Wisconsin statutes at s.49.45(18)(ac), require the collection of copayment unless, the provider determines that collecting such copayment would exceed the amount to be collected.  Further, the law states that payments to providers will be reduced by the specified copayment. Please see language at: https://docs.legis.wisconsin.gov/statutes/statutes/49/IV/45/18.

FAQ’s Continued Could a provider that is certified Medicaid at one clinic, provide services at a different clinic? Answer: Yes!

FAQ’s Continued Medicaid Certification but not bill/see Medicaid - Can a FCC apply for a Medicaid Certification so that they can look up if their patients have BadgerCare, but not actually see Medicaid patients nor bill Medicaid? Answer: Yes. Application fee may apply depending on provider type.

FAQ’s Continued Is there differences in reimbursement on clinic vs. provider? Answer: No difference in payment

FAQ’s Continued Liability requirements for being a Medicaid Certificate clinic – What insurances are needed? i.e. risk, bonding, liability, professional, clinic, malpractice, etc are required of a Medicaid provider/clinic? Does use of the VHCP suffice? Answer: For this you will need to follow up with Regulations and Licensing

Questions Cont… Free Clinics that receive the Dental waiver (allowing the clinic to be both biller & performer) – do the practicing dentists have to be Medicaid certified? Answer: The Dental Waiver exempts all practicing dentists with the approved clinic from having to be Medicaid certified. ***This is the only provider type that this currently applies to.

Overview and Resources

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