1. Family Planning Workshop
Conduent Government Healthcare Solutions or Solution

2. Resources When online use: Ask Service Representative
Call Center or
New Mexico Web Portal
Provider Information section
Links and FAQ section
Provider Login section
10/9/2017
Family Planning Workshop

3. Important State Websites
PROGRAM POLICY MANUAL
BILLING INSTRUCTIONS
REGISTERS AND SUPPLEMENTS:
10/9/2017
Family Planning Workshop

4. 029 - Family Planning Medicaid
What is Category of Eligibility (COE) 029?
Medical Assistance limited to Family Planning Services, including STD screenings and treatments.
Fee For Service (FFS) Medicaid pays for family planning services.
Bill claims for clients with COE 029 to Conduent State Healthcare.
Family Planning Waiver (COE 029) clients are never in any Managed Care.
10/9/2017
Family Planning Workshop

5. 029 - Family Planning Medicaid
What populations qualify for these services?
Women transitioning from “Pregnancy Related Services Only” (COE 035) to FP (COE 029).
Women of ages who are at or below the 185% poverty level as determined by the Income Support Division (ISD).
Females below the age of 18 may qualify for other COE to cover these services.
10/9/2017
Family Planning Workshop

6. 029 - Family Planning Medicaid
Which services are covered?
Medical Claims and Institutional Claims:
The system examines the revenue code, procedure code, and any related diagnosis codes on the line. The service is covered by the Family Planning Waiver if a combination of the following code sets are used to identify the service:
Procedure Code and the diagnosis code are on the following approved code lists.
10/9/2017
Family Planning Workshop

7. Approved FPW Procedure Code List
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Family Planning Workshop

8. Pregnancy Prevention Diagnoses
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Family Planning Workshop

9. Pregnancy Prevention Diagnoses Continued
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Family Planning Workshop

10. 029 - Family Planning Medicaid Continued
Which services are covered?
Institutional Claims only:
The revenue code and diagnosis are on the following approved code lists.
10/9/2017
Family Planning Workshop

11. 029 - Family Planning Medicaid
Which services are NOT covered by this COE?
Any service that is not listed as one of the aforementioned covered services.
10/9/2017
Family Planning Workshop

12. 0029 – Service not Family Planning Related
Why does this denial occur when the service was actually for Family Planning?
Procedure code, diagnosis code, or revenue code not recognized as family planning related. If rendered service is family planning related, resubmit claim using alternate codes from approved list available. Do not bill Medicaid client for services that can be billed using an alternate approved codes.
10/9/2017
Family Planning Workshop

13. 029 - Family Planning Medicaid
What if my patient develops a condition that needs treatment that is directly related to a family planning procedure, such as a post-operative infection after sterilization, or an abnormal pap; is that covered?
10/9/2017
Family Planning Workshop

14. 029 - Family Planning Medicaid
Answer:
In these cases, submit the claim to Conduent and if denied, appeal them to MAD with a cover letter, medical records, doctors' notes, and any conditions related to the family planning procedure. The Medical Assistance Division considers these claims on a case-by-case basis.
10/9/2017
Family Planning Workshop

15. 029 - Family Planning Medicaid
Answer:
If your client receives an abnormal pap smear:
The pap reveals an STD, STD treatments are covered under COE 029 when billed using the current approved codes lists.
The pap smear indicates cervical cancer, she may also be eligible for the Breast or Cervical Cancer Program (COE 052). Refer the patient to her ISD Case Worker to verify eligibility requirements.
10/9/2017
Family Planning Workshop

16. 029 - Family Planning Medicaid
My client has the Family Planning COE (029) and desires a treatment that is covered by this COE. However, my facility doesn’t offer the necessary service. What should I tell the client?
Response:
As a provider it is important to be aware of all the services that are offered under this COE, even those you don’t offer yourself.
Refer the patient to a Medicaid Provider that can perform the necessary Family Planning covered service.
10/9/2017
Family Planning Workshop

17. 029 - Family Planning Medicaid
My client has the Family Planning COE (029) and desires a treatment that is not covered by this COE. What should I tell the client?
If the client's financial situation has changed since last application, advise her to see her ISD caseworker. She may now qualify for additional benefits that cover the service.
If the patient’s financial situation only permits them to qualify for COE 029 – Family Planning Waiver only, refer the patient to an FQHC facility which have all agreed to provide services on a sliding scale.
10/9/2017
Family Planning Workshop

18. 029 - Family Planning Medicaid
My client has the Family Planning COE (029) and desires a treatment that is not covered by this COE. What should I tell the client?
If the patient prefers to utilize your facility to obtain these non-covered services advise the patient she will be financially responsible for the services.
Have patient sign in writing indicating that she will be financially responsible for the specific non-Family Planning service that will be performed for your records.
10/9/2017
Family Planning Workshop

19. 029 - Family Planning Medicaid
Always remember to:
Check eligibility prior to performing services.
Ensure all services are covered under this COE using the current approved code lists prior to performing services.
Be aware of alternatives to offer to patients on the COE 029 – Family Planning Waiver such as FQHC facilities to establish an ongoing medical home for routine medical, dental, vision, behavioral, hearing, and all other non-family planning services.
Remind COE 035 Medicaid post partum recipients that they will be automatically enrolled under COE Family Planning Waiver services approximately 2 months from their delivery.
10/9/2017
Family Planning Workshop

20. Resources When online use: Ask Service Representative
Call Center or
New Mexico Web Portal
Provider Information section
Links and FAQ section
Provider Login section
10/9/2017
Family Planning Workshop