Vendor Credentialing Requirements

Transcription

1 Requirements for Enrolling Self-Direction s Before using any, please call Xerox ( ) to make sure all required vendor paperwork has been processed and that the vendor has been set up on your Plan. If you use a vendor before their paperwork has been processed, they may not be paid for those dates. If a Crial Background Check (CBC) is required, the vendor may not begin working until they have passed their Consolidated Online Registry (COR) initial background check. If a vendor provides services before passing their COR background check (if required), they will not be paid for those dates. Please make sure that all enrollment paperwork (with the exception of the final crial background check) has been processed before the vendor provides services. Medicaid will not pay for any services if the vendor enrollment process has not been completed. If a vendor provides only goods (not services), you will usually only need to complete the Information Form (VIF); in other words, the vendor will probably not need to complete the entire Packet. The purpose of the VIF is to show that you will be using this vendor on your Plan. For vendors that provide goods (only), it is not necessary to get their signature on the VIF. Some examples of goods are vitas, memberships, monthly phone/internet charges, bus passes and conferences. If you are not sure about if what you want to purchase is a good or a service, please call Xerox for assistance. Description Billing Method Packet Required? Acupuncture IC: Acupuncture and/or oriental medicine license T2031 Assisted Living Daily Daily Allowed Providers: Assisted Living Provider Agency/Facility H2019 Behavior Support Consultation Allowed Providers: Individual Behavior Support Consultant (BSC) or BSC Group Practice IC: Licensed (MD, Clinical Psychologist, Psychologist Associate, SW, LPCC, LPC, Psychiatric Nurse, NM licensed marriage and family therapist, NM licensed art therapist) Biofeedback Visit IC: License in Health Care Profession whose scope of practice includes Biofeedback Chiropractic Visit IC: Chiropractic Physician License Chiropractor T1999CE-I Coaching Education for Parents, Spouse or Other Each Credentialing Grid, 08/23/2013 v.1 Page 1 of 6

2 Description Billing Method Packet Required? T1999CS-I Coaching Education for Parents/Spouse: Conferences and Sears ONLY T1999CL-I Coaching Education for Parents/Spouse: Classes ONLY Cognitive Rehab Therapy Allowed Providers: Group practice or Individual IC: License in Health Care Profession whose scope of practice includes Cognitive Rehab Therapy H2021 Community Direct Support/Navigation Allowed Providers: Community Direct Support IC: Pre-Hire Packet Provider or Community Access Provider Agency S5100 Customized Community Support Allowed Providers: Adult Day Health Agency or Adult Day Habilitation Agency T2033 Customized In-Home Living Supports Daily Allowed Providers: Customized Living Provider Agency or Individual Customized Living Provider S5160 Emergency Response Testing and Maintenance Each Agency: No Agency: VIF is required Allowed Providers: Emergency Response Provider (Agency) S5161 Emergency Response Monthly Fee Monthly Agency: No Agency: VIF is required Allowed Providers: Emergency Response Provider (Agency) T2019 Employment Supports (includes Job Coach) Each Allowed Providers: Supported Employment Provider Agency or Individual S5165 Environmental Modifications (EMOD) Each Agency: Appropriate License Allowed Providers: Individual or Company (Agency) IC: Appropriate License T1999CP-I Fees and Memberships Credentialing Grid, 08/23/2013 v.1 Page 2 of 6

3 Description Billing Method Packet Required? T1999HR-I Health-Related Equipment & Supplies T1999AE-I Adaptive Equipment and Supplies T1999EE-I Exercise Equipment and Related Items T1999NS-I Nutritional Supplements T1999OM-I Over-the-Counter Medications S8940 Hippotherapy Visit IC: License in Healthcare profession whose scope of practice includes hippotherapy. S9122 Home Health Aide Hour Allowed Providers: Home Health Agency/Homemaker Agency Homemaker/Direct Support Hourly Allowed Providers: Individual Homemaker/Direct Support Provider or Home Health Agency/Homemaker Agency T1999HG-I Household Related Goods Item/Invoice T1999AI-I Appliances for Independence Item/Invoice T1999AF-I Adaptive Furniture Item/Invoice T2019JD Job Developer Each Allowed Providers: Supported Employment Provider Agency or Individual Massage Therapy IC: Massage Therapist License Credentialing Grid, 08/23/2013 v.1 Page 3 of 6

4 S8990 S9445 S9470 G0152 T1007 G0151 H2032 T1003 T1002 T1005HHA T1005SD Billing Packet Description Method Required? Naprapathy Visit IC: Naprapathic Physician License Native American Healers Session Nutritional Counseling Adults Hourly IC: Registered Dietician License Occupational Therapy Allowed Providers: Individual Occupational IC: OT License Therapist or Group Practice Personal Plan Facilitation Each Allowed Providers: Personal Plan Facilitator -- Sole IC: Proof of Certification in Planning Tool Proprietor or Personal Plan Facilitation -- Agency Physical Therapy IC: PT License Physical Therapist Play Therapy IC: License in a mental health profession whose scope of practice includes play therapy Private Duty Nursing LPN Allowed Providers: Home Health Agency, Rural IC: LPN License Health Clinic, FQHC or Individual Private Duty Nursing RN Allowed Providers: Home Health Agency, Rural IC: RN License Health Clinic, FQHC or Individual Respite Home Health Aide Allowed Providers: Respite Agency Respite Standard Allowed Providers: Individual Provider (not RN, LPN or HHA) or Respite Provider Agency Credentialing Grid, 08/23/2013 v.1 Page 4 of 6

5 T1005LPN T1005RN G0153 T1999TS T1999CR T1999PR T1999FX T1999CPEP T1999IS T1999CELL T1999LS T1999ICL T1999IC T1999IL T1999CPL Billing Packet Description Method Required? Respite LPN Allowed Providers: Respite Provider Agency or IC: LPN License Individual LPN Respite RN Allowed Providers: Respite Provider Agency or IC: RN License Individual RN Speech/Language Pathology Allowed Providers: Individual Speech Language IC: Business License Pathologist (SLP) or Group Practice Technology for Safety and Independence Computer Purchase (item) Printer Purchase (item) Fax Machine Purchase (item) Cell Phone and Related Equipment Purchase (item) Internet Cell Phone Landline Internet/Cell Phone/Landline (bundled) Internet/Cell Phone (bundled) Internet/Landline (bundled) Cell Phone/Landline (bundled) Credentialing Grid, 08/23/2013 v. 1 Page 5 of 6

6 T1999OS T2004 T2007 T2003 T2049 Billing Packet Description Method Required? Office Supplies (purchased as items) Transportation Commercial Carrier Pass Allowed Providers: Transportation Commercial Carrier Transportation Time Hourly Allowed Providers: Transportation Agency or IC: Transportation Appendix, Pre-Hire Packet Individual Driver Transportation Trip Each Allowed Providers: Transportation Agency or IC: Transportation Appendix, Pre-Hire Packet Individual Driver Transportation Mile Per Mile Allowed Providers: Transportation Agency or IC: Transportation Appendix, Pre-Hire Packet Individual Driver If the vendor has a professional license (such as a registered nurse or therapist), their licensing board has already completed a background check. They do not need to do another one for Self-Direction. Provider agencies are responsible for completing crial background checks (CBC) on all their staff. Confirmation of the CBC must be available to the State and Xerox for review as requested. Please remember that for any vendor providing services, a Agreement must be completed before payment can be made for any service. If a vendor s pay rate needs to be changed (for vendors providing services), a new Agreement must be completed and submitted to Xerox at least 15 days before the pay rate change will become effective. The above grid provides an overview of general vendor credentialing requirements. In certain specific cases, additional licensing or other documentation may be required. Please contact Xerox ( ) or your Support Broker/Consultant if you have any questions. Credentialing Grid, 08/23/2013 v. 1 Page 6 of 6