1. Iowa Medicaid Enterprise
Welcome to
Remedial Services Provider Training

2. Agenda Introduction of Remedial Services Provider program
Remedial Services processes
Billing services on the CMS 1500

3. Iowa Medicaid Enterprise
Remedial Services

4. What are Remedial Services?
Enhance functional abilities
Recommended by the LPHA

5. LPHAs must be Iowa Plan Providers
Physicians (MD or DO)
Psychologists (PhD or PsyD)
Licensed Independent Social Workers
Licensed Mental Health Counselors
Licensed Marital & Family Therapists
Licensed Master Social Worker (employed in a mental health center)
Advanced Registered Nurse Practioners
Each must practice within scope of licensure

6. Role of LPHA Completes face-to-face assessments
Makes the diagnosis and treatment suggestions (which may include remedial services)
Orders remedial services when indicated
Assists with referral to remedial provider if requested

7. Remedial Service Providers (RSP):
Current Adult Rehab Option providers
Current RTSS providers
Agencies accredited under Chapter 24 of IAC

8. Role of Remedial Service Providers
Develop a remedial service implementation plan when requested by a member
Obtain Prior Approval for Remedial Services from IME Medical Services
Provide services as written in the plan, if requested by the member
Document services/interventions to support remedial services and billing

9. RSP Codes - Children Code Description 96152
Health and behavior intervention, 15 minute/individual
H2011
Crisis Intervention, 15 minute individual
96153
Health and behavior intervention, 15 minute/group
96154
Health and behavior intervention, 15 min-family
H0037
Community Psychiatric Supportive Treatment, per diem

10. RSP Codes – Adults Code Description H2014
Skills Training and Development, per 15 minutes
H2001
Rehabilitation Program, per half day

11. Remedial Services May Include:
Anger Management
Behavior Management
Relationship Skills
Communication Skills
Problem Solving Skills
Conflict Resolution
Skill Rehearsal
Social Skills

12. Remedial Service Implementation Plan

13. Demographics Member name Member address Member date of birth
Member Medicaid number
Remedial services provider name
RSP affiliation/company name
RSP Provider number

14. Demographics (cont) RSP Provider address LPHA Name
LPHA Affiliation/Company name
LPHA Address
Legal representative (if applicable)
Legal representative’s relationship to member
Address of representative

15. Remedial Service Plan Requirements
Remedial service implementation plan is consistent with LPHA order
Plan addresses mental health symptoms/behaviors, IAC (249A)
Plan is remedial and individualized
Member/family strengths are incorporated into the interventions

16. Plan Requirements (cont)
Roles and responsibilities are identified
Services/treatment are consistent with practice guidelines
Plan reflects member and/or legal representative
Goals and objectives are measurable and time limited
Treatment outcomes are specified

17. Remedial Services Process
Medicaid members seek out or are referred to LPHA
LPHA completes assessment, diagnosis
LPHA orders remedial services if/ when indicated
Orders for remedial services must include:
Diagnosis
Scope (remedial procedure codes)
Number of units
Duration of services (begin & end dates)

18. Remedial Services Process (cont)
Member selects an RSP
LPHA provides a copy of the order (treatment plan) to member and forwards a copy to RSP
RSP develops remedial service implementation plan if requested by the member

19. Remedial Services Process (cont)
RSP s/faxes order complete with the diagnosis & remedial service implementation plan to IME Medical Services
Medical Services will respond within 2 business days
Medical Services will send Notice of Decision to member and RSP

20. Remedial Services Process (cont)
RSP documents services and progress notes as required to support service intervention and billing
Remedial services implementation plans will be authorized for up to six months

21. Progress Notes Member name and Medicaid ID number
Date and amount of services delivered with beginning and end times
Name of staff providing service & agency name
Staff’s signature with title
Service setting

22. Progress Notes (cont)
Description of the specific service and relationship to goal
Description of the member’s response to service and progress toward goal
Recommended revision in intervention/services, as appropriate

23. Continuing Services Criteria
If behaviors/symptoms continue, then plans are revised to maximize treatment
Member is benefiting from services
New behavior/symptoms requiring remedial services are identified

24. Discharge Criteria Remedial goals/objectives are achieved
Age appropriate functioning is achieved
Member is not compliant with remedial services
Member is not benefiting from services

25. Quality Review Process
Quality review will evaluate documentation as follows:
Member demographics; emergency and crisis information, releases
LPHA diagnosis and order (treatment plan)
Member functional assessment information sufficient to support remedial service implementation plan

26. Quality Review Process (cont)
Evidence of collaboration with other community resources
Documentation of member/member’s guardian participation in treatment planning
Remedial services implementation plan is individualized
Plan goals and objectives are measurable and time limited

27. Quality Review Process (cont)
Roles and responsibilities for services are identified
Plan is implemented as written
Documentation of referrals for further evaluation if needed
Ancillary services identified
Billing matches progress notes

28. Quality Review Will Evaluate:
Time from member referral to remedial treatment plan development
Continuity of treatment
Affiliation of LPHA to RSP
Gaps in service

29. Quality Review will Evaluate:
Achieved treatment results
Member satisfaction with services
Results of quality review will be compiled with copies submitted to providers and IME Policy
Medical Services will offer RSP quality improvement training and education

30. Remedial Services Contact Information
IFMC (Medicaid)
PO Box 36478
Des Moines, IA
or local
Fax

31. Iowa Medicaid Enterprise
Billing Services
to the IME

32. (Eligibility Verification System)
Eligibility Verification
System (ELVS)
Verify member eligibility for today’s date or past date of service.
Verify member enrollment with the Iowa Plan.
Member eligibility can be verified by date of birth – ddmmyyyy and social security number or
the State ID number.
Access your last payment amount and date.
(Local)

33. Electronic Claim Submission
Electronic Date Interchange Support Services (EDISS)
AM-5 PM
EDI paperwork must be completed and forwarded to EDI for enrollment
Find forms at follow directions in the Tool Box
PC-ACE Pro: free software

34. Billing Information Mailing address for all claims from RSP:
Iowa Medicaid Enterprise (IME)
PO Box
Des Moines, IA
Provider Services phone numbers:
Monday – Friday 7:30 AM -4:30 PM

35. IME Contacts for Claims
Medicaid Claims
P. O. Box
Des Moines, Iowa
Provider Correspondence
P. O. Box 36450

36. IME Phone Numbers ELVS (Eligibility Verification System)
24 Hours a Day/7 Days a Week
(Local)
PROVIDER AUDITS AND RATE SETTING
8:00 AM – 5:00 PM
(Local)
PROVIDER SERVICES
7:30 AM – 4:30 PM
(Local)
MEMBER SERVICES
8:00 AM – 5:00 PM
(Local)

37. Billing Tips
IME suggests that claims should be billed no more often than once per month
CMS 1500 claim forms must be used and correctly completed
IME payment cycles are weekly

38. Completing the Claim Form
Discussion of each required box
Detailed instructions are included in the handout
Many boxes are not required or are optional
Ensure all required boxed are correctly completed or the claim will not pay

39. Claim Submission Issues
Use original claim forms, do not make copies
Do not use red or light colored ink
Do not use highlighter of any color
Position data in the center of each box, not touching any red line

40. Submission Issues (cont)
Diagnosis codes (ICD-9) and CPT codes cannot include description on the form
Column E Diagnosis Code must have the corresponding number from box 21, not the actual diagnosis code
Indicate both dollars and cents for sub-charge and total charge.
Limit the use of handwritten information

41. Timely Filing Guidelines
Original claim submissions must be filed within 12 months of the through date of service.
If the claim was filed timely but denied, then it can be resubmitted up to 12 months from the remit denial date.
Claims after 12 months must be filed on paper with “resubmission” and the original filing date in the signature box.
Adjustments can be filed within 12 months of the payment date.

42. Credit/ Adjustment Requests
Used to change information on a paid claim:
Paid amount needs to be changed
Number of units needs to be changed
Dates of service need to be changed
Complete form correctly and entirely
Form # found on the IME Website
Must be filed within 12 months of payment

43. Reimbursement Interim rates on DHS web site
By agency
By service
Based on current information
Cost report- due 3 months after agency fiscal year end
Cost settlement
Interim rates recalculated