Department of Vermont Health Access Advisory

Transcription

1 Department of Vermont Health Access Advisory INSIDE THIS ISSUE Dental Specialty and Other Information Updates Assisting Medicaid Members with Coverage Provider Service/Helpdesk Service Level Agreements Know your Mental Health Modifiers Reminders for Reconsideration Request PBM ewebs September Write Up September 2017 Dental Specialty and Other Information Updates Thanks to the many dental providers enrolled with Vermont Medicaid who have recently updated their specialty information for our enhanced Provider Look-Up page ( providerlookup)! Verifying that all of your information is accurate on a regular basis is a good practice to ensure the most up-to-date information regarding general dentistry and specialty service locations is available to our members. If you find that your specialty information is incorrect, please complete the General Dentist and Dental Specialties form at: and return it to DXC Technology, Attn: Provider Enrollment, PO Box 888, Williston, VT This form will be available for use until October 1, 2017, after which, dental providers will need to complete the Provider Information Change Form, located on the same page. The Provider Information Change Form should be used to change, add, or remove addresses, telephone numbers, fax numbers or addresses. You should also use this form for your demographic changes such as accepting or not accepting new patients, limiting patient age limits, as well as language accommodations or any other special accommodations in your office. If you have questions regarding the forms please contact a DXC Enrollment Specialist at Thank you for keeping your information updated to better serve our members and your patients.

2 Assisting Medicaid Members with Coverage This year, some providers may be seeing patients formerly covered by Medicaid who no longer have active coverage. In 2016, the federal government disallowed self-attestation, requiring that all current and new Medicaid members verify eligibility before activation of coverage. As a result, some Medicaid members coverage may have been terminated, due to their failure to respond to multiple requests for documentation. If you have a patient who was formerly enrolled in Medicaid, but no longer has active coverage, there are several steps you can take to help them re-enroll. Give them the phone number for the Vermont Health Connect Customer Support Center This line is available Monday-Friday from 8-5. Let them know what documentation they will need to have on hand before they can enroll. This will include: o Social security numbers and birthdays for all household members o Paystubs o Taxes o Proof of immigration status (if not American citizens) Help them find an in-person assister in their area. The directory of in-person assisters can be viewed at: Person%20Assister%20Directory% pdf If you are regularly encountering patients who require Medicaid enrollment assistance, your provider organization might consider having a member of your staff complete the certification course to become a Certified Application Counselor, which is an in-person assister dedicated to your organization. The online training takes between 3-5 hours to complete, and does not cost anything. Once a member of your staff has become a Certified Application Counselor, that person can assist your organization s patients directly with their enrollment in either Medicaid, or a Qualified Health Plan, through Vermont Health Connect. If you have patients who need to alert Vermont Health Connect of an address change, they can do so easily by calling the Customer Support Center at Provider Service/Helpdesk Service Level Agreements In an effort to maintain the highest quality of customer service, the DXC Technology Provider Service Unit (PSU) in agreement with the Department of Vermont Health Access (DVHA) has entered into a Provider Inquiry Service Level Agreement. What that means for Providers is improved turnaround times for inquiries. The following parameters have been set in place: 1. We will acknowledge every voic and within 2 business days. 2. We will resolve all inquiries within 14 business days unless DVHA policy or DXC system changes are needed. 3. Timely Filing and Reconsiderations do not fall under these parameters as there are separate processes for these situations. Should you find that your inquires are not being handled as indicated above, please outreach to our Provider Services Manager, Melissa Moore, at Melissa.a.moore@dxc.com or call directly at We appreciate your feedback.

3 Know Your Mental Health Modifiers DVHA has found that some Mental Health providers have not been billing with the necessary modifiers. It is imperative that you use the correct modifier so that you are reimbursed properly and to avoid repayments to Vermont Medicaid and/or False Claim Act penalties. As an enrolled provider, you have signed the provider contract stating that you will follow Vermont Medicaid policies and be aware of the Provider Manual guidelines. Please review the two sections of the manual, below. Per section 8.5 Supervised Billing for Behavioral Health Services: Claims are required to have either HO or HN to indicate the education level of the non-enrolled provider who performed the service. These modifiers do not reflect the level of the attending provider on the claim. This rule applies to all billing providers. Per section Psychiatry/Psychology: Certain attending providers are required to use either AH or AJ to indicate their education/licensure level. This rule does not apply to billing providers that are Designated Agencies, Specialized Services Agencies, or ADAP Preferred Providers. Modifier Modifier Description Service Provided By Attending Provider Billed on the Claim None N/A The enrolled attending provider billing on the claim AH Licensed Clinical Psychologist The enrolled attending provider billing on the claim Regular Billing Physician Nurse Practitioner Psychiatrist Psychologist (Doctorate) Billing Provider Billed on the Claim Exceptions - do not use if: Designated Agencies Specialized Service Agencies ADAP Preferred Providers AJ Licensed Clinical Social Worker The enrolled attending provider billing on the claim Psychologist (Master s) LMHC LCSW LMFT LADC Exceptions - do not use if: Designated Agencies Specialized Service Agencies ADAP Preferred Providers Supervised Billing HO Master s Degree Level The non-enrolled provider with Master s Degree Any enrolled mental health provider supervising the non-enrolled counselor HN Bachelor s Degree Level The non-enrolled provider with Bachelor s Degree Any enrolled mental health provider supervising the non-enrolled counselor

4 Reminders for Reconsideration Request The Provider Reconsideration Process is an avenue for enrolled providers to request a review of certain claim payments or denials by the DVHA. To better serve providers, we have improved the Reconsideration Request Process. The DVHA will review a decision of an adjudicated claim for the following: Coding Errors; which may include place of service, modifier, diagnosis and provider type/specialty and/or Improper Payments; which includes claims that paid different than expected. Please note that any providers submitting a corrected claim should not send in a reconsideration request, those claims need to be submitted through the usual claims process. Providers sending in a request for reconsideration regarding a claim payment/denial must use the latest version of the Reconsideration Request Form located on our website. Requests must be submitted within 30 calendar days after the DVHA gives notice to the provider of its decision. A complete submission of a reconsideration request includes the following: A completed and accurate Reconsideration Request Form Reconsideration request letter explaining why you are asking for a review of the claim A new claim form (red & white CMS 1500/UB 04 or ADA dental claim form) Any remittance advice(s) associated with the claim Notes and supporting documentation If any of the information is not included in your request, the request will be returned to you for completion. For more information please refer to section of the provider manual for complete instruction. PBM ewebs The State of Vermont chose Change Healthcare as its new Pharmacy Benefits Manager (PBM) effective January 1, Since that time, Change Healthcare has implemented many new and exciting systems functionality as part of the PBM. One of the last pieces of functionality that that is being developed is the ewebs Provider Portal. The ewebs Provider Portal is designed for use by prescribers, pharmacies, and program administrators. It provides a secure way for registered users to look up member eligibility, member history, drug formulary information, Preferred Drug List (PDL) criteria, and to submit and track PA requests online. Prescribers are guided through preferred or non-preferred selections, as well as potential step therapy, dose limits or other PDL criteria giving them the ability to make informed drug choices within a PDL.

5 PBM ewebs (Cont.) Some of the features that will be available to registered users Include: Member Inquiry Look up demographic information for any Medicaid enrolled individual, including a profile of their current and historic pharmacy claims Pharmacy Inquiry Find pharmacy information Formulary Inquiry Find drug information, including coverage status, PDL step order, and PA criteria Diagnosis Inquiry Find diagnosis code definitions Program alerts, announcements and updates We are excited to be able to offer ewebs to prescribers, pharmacists and members. Training information will be sent out later to prescribers and pharmacies in preparation for ewebs launch. In addition, we will continue to keep you updated throughout the coming months. Please direct any questions you may have about the ewebs Provider Portal to Cassandra.George@ Vermont.Gov Please share the information contained in this publication with all staff members. Thank you! Cherie Bergeron Account Executive - DXC Technology Cory Gustafson Commissioner - Dept of Vermont Health Access

6 Provider Resources Provider Manuals: Provider Resources: VT Medicaid Banner: **Please make sure to check the Banner regularly for the most up-to-date information.** Provider Enrollment Application Packets: Contact Us Department Of Vermont Health Access 312 Hurricane Lane, Suite 201, Williston, VT Hours of Operation: Monday - Friday 7:45AM to 4:30PM Phone: (802) Fax: (802) DXC Technology 312 Hurricane Lane, Suite 101, Williston, VT Hours of Operation (Provider Services): Monday - Friday 8:00AM to 5:00PM Out-of-State Phone: (802) OR- In-State Phone: (800) Fax: (802) DISCLAIMER; CPT is a registered trademark of the American Medical Association (AMA). Current Procedural Terminology / CPT codes, descriptors, and other data only are copyright 2012 AMA. All Rights Reserved. Applicable FARS/DFARS restrictions apply to government use. Fee Schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.