1. UNISYS Louisiana Medicaid DHH – Bureau of Primary Care Practice Management Technical Assistance Workshop August 14 th, 2008

2. 2 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  Reimbursement is based on fee-for-service

3. 3 Ind. Social Worker Claim Form Example

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5. 5 PBS Claim Form Example

6. 6 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

7. 7 Timely Filing Guidelines  Initial Filing Limits  Dates of Service Past Initial Filing Limit  Two-Year Filing Limit

8. 8 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

9. 9 CommunityCARE  Program Description  Exempt Recipients  Primary Care Physician (PCP)  Non-PCP Providers  Exempt Services

10. 10 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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12. 12 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-for- service

13. 13 MHC Claim Form Example

14. 14 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 covered

15. 15 Timely Filing Guidelines  Initial Filing Limits  Dates of Service Past Initial Filing Limit  Two-Year Filing Limit

16. 16 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

17. 17 CommunityCARE  Program Description  Exempt Recipients  Primary Care Physician (PCP)  Non-PCP Providers  Exempt Services

18. 18 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

19. 19 Provider Assistance  Provider Relations Telephone Unit: 800-473-2783 OR 225-924-5040 800-473-2783 OR 225-924-5040  Provider Enrollment Department: 225-216-6370 225-216-6370  Correspondence Unit: Unisys-Provider Relations P.O. Box 91024 P.O. Box 91024 Baton Rouge, LA. 70821 Baton Rouge, LA. 70821 Field Analysts Field Analysts

20. 20 For Attending This 2008 Provider Workshop THANK YOU!