Nursing Home and Hospice Billing Training Presented by Field Representatives Kinzie Baker & Liz Lovell-Poynor
|
|
- Sharon Nelson
- 5 years ago
- Views:
Transcription
1 Nursing Home and Hospice Billing Training 2018 Presented by Field Representatives Kinzie Baker & Liz Lovell-Poynor
2 Wyoming Medicaid General Manual Chapter 1- General Information Chapter 2-Getting Help When You Need It Chapter 3-Provider Responsibilities Chapter 4-Utilization Review Chapter 5-Client Eligibility Chapter 6-Common Billing Information Chapter 7- Third Party Liability Chapter 8-Electronic Data Interchange (EDI) Chapter 9-Wyoming HIPPA Electronic Specifications Chapter 10-Important Information
3 Provider Notifications RA Banner RA Payment Summary * Bulletins
4 Provider Contact It is important for all providers, both treating and pay-to providers, to maintain current and accurate contact information. Why it is important to update provider contact information? o To receive up-to-date policy information o Receive updates when Medicaid needs a copy of your new license o Any other communication which needs to occur between Wyoming Medicaid and providers To update your provider contact information, please do the following: o , mail a request on office letterhead and include the following: NPI/Provider number & Name Provide contact information Update needed Physical, correspondence, or financial address, provider phone or fax number, or addresses on file Date this change needs to go into effect Pay-to Providers can also update their contact information by logging into the Provider Web Portal and going to Update Provider Demographics addresses on file can also be updated by speaking to a representative at Provider Relations by calling options 1, 5, and then 0.
5 Getting Help Quick Reference When to write for help Online resources Requesting a provider training visit
6 Provider Responsibilities Eligibility When can a client be billed? Issues most commonly heard in call center: Clients requested to troubleshoot claims or check PA status Client billed or sent to collection Billing and coding questions Recordkeeping
7 Notes
8 Common billing Information Service thresholds Under 21 Over 21 NDC Conversion Attachments See web portal tutorial Adjustments and Voids Sterilization, Hysterectomy and Abortion Consent Form Requesting Replacement RA s Timely filing Telehealth
9 Attachment Troubleshooting Paper-Attachment cover sheet TCN How to get the TCN ACN (Attachment Control Number) Electronic Attachments How to complete Common Attachment issues: Incomplete ACN does not match Legibility issues Information on form does match claim Rendering/treating provider listed as Pay-to No Attachment indicated on claim
10 Adjustments & Voids Paper Complete all required information Attach corrected clean claim and indicate on form Attachments Electronic How to complete 6-Adjustment 7-Replacement Common Issues: All lines not included on electronic adjustment No changes made to the claim Too many changes being made Not all corrections made Not attaching supporting documents
11 Notes
12 Third party Liability Third Party Payers Unreported coverage Provider not enrolled/no Opt out option How to indicate TPL on a claim Medicare/ No Opt out option
13
14 Required Evaluations Prior to Admission Pre Admission Screening and Resident Review (PASRR) Level 1 Completed via web portal Cannot be corrected** Required for all clients regardless of payment source LT101 Valid for 90 days Can be corrected with state approval** Utilize portal to check for previously completed LT101 s Only required for Medicaid clients **Requests to delete a PASRR Level I can be sent to sara.rogers@wyo.gov & requests to correct a LT101 can be sent to sherry.mitchell1@wyo.gov
15 PASRR Level II WYhealth Medicaid will not reimburse a nursing facility for services provided to any individual with MI or MR who is admitted prior to completion of a PASRR Level II. Payment will commence upon the date of determination of appropriate placement. No retroactive payment will be made. If a PASRR Level II has been completed but is not reflected on the client file contact WYhealth
16 Attestation for Admission * What is an Attestation Form? When is an attestation form necessary? Common Attestation Form issues: Not completely filled out No signature Attest box not checked Client not in the system Client information incorrect
17
18 Scenario 1 Dates of service: 4/1/18-4/30/18 Covered Days:30 Admit date:04/01/18 Units billed: 30 Lt101 Provider referral date:3/30/18 PASRR Date: 03/30/18 Patient status: 30-Still a patient Billed amount $5, Claim paid: $5,230.00
19 Scenario 2 Dates of service 04/01/18-04/30/18 Admit date 04/01/18 Covered days: 30 Units billed: 30 LT101 Provider Referral Date: 04/09/18 Date of PASRR: 4/13/18 Claim Denied 372,370 Patient Status:30-Still a patient Billed Amount: $5,230
20 Scenario 3 Dates of service: 4/1/18-4/30/18 Admit date: 4/1/18 Lt101 Provider Referral Date:3/30/18 Covered days: 27 Units billed: 30 Patient Status:30-Still a Patient PASRR level1 Date: 3/30/18 No PASRR Level 2 on file Claim denied 373,078 Billed amount $4,987.00
21 Notes
22 Scenario 4 Dates of service: 04/01/18-04/30/18 Admit date: 9/15/17 LT101 Provider Referral Date: 3/27/18 Covered Days:30 Units billed: 30 Patient status: 30-Still a patient Date of PASRR level 1: 9/13/17 Claim Denied 579 Billed amount $5,230.00
23 Patient Contribution Patient contribution determination Patient contribution changes Patient contribution not applied to claim Allocation discrepancies
24 Scenario 5 Dates of service: 4/1/18-4/30/18 Patient liability: $ Admit date: 11/8/17 Covered days: 29 Lt101 Provider referral date: 11/8/17 PASRR Level 1 date:11/8/17 Units billed: 30 Total amount billed:$5, Patient status:20-died Claim denied
25 Scenario 6 Dates of service: 02/02/18-02/28/17 Admit date: 2/2/18 Lt101 Provider referral date: 2/2/18 PASRR Level 1 date: 2/2/18 Covered days: 27 Total amount billed: $7, Patient status:30-still a patient Medicare payment: $6,592.00
26 Important Reminders Covered days Patient status Statement dates Units billed Leave days not covered
27 Notes
28 Hospice Services
29 Required Documentation Hospice Benefit Election Form Hospice Benefit Revocation Form
30 Hospice Services * Hospice Lock-in * Plan of care * PA Requirements * Services unrelated to the terminal illness
31
32 Scenario 1 Line Rev Code Procedure code Dates of service Billed units Line /01/18-02/28/17 28 Claim Paid: $2,544.64
33 Scenario 2 Line Rev Code Procedure code Dates of service Billed units Line /01/18-04/15/18 15 Incorrectly billed due to # of days client has been in hospice Correctly billed for client in hospice care beyond 61 days Line Rev Code Procedure code Dates of service Billed units Line G /01/18-04/15/18 15
34 Notes
35 Scenario 3 Claim for hospice services: Line Rev Code Procedure code Dates of service Billed units Line /12/18-3/31/18 19 Claim for nursing home room & board: Line Rev Code Procedure code Dates of service Billed units Line /12/18-3/31/18 19
36 Wyoming Medicaid Website Welcome Page Manuals and Bulletins Fee schedule (NCCI) Contact Us Forms Provider Training Web Tutorials
37 Notes
38 Provider Portal Claim Submission Refer to: Attachments Refer to: Registering and adding users Refer to:
39 Continuity of Care Document CCD Viewer The CCD is a HITSP standard patient summary document that contains the following information from the THR Gateway: Problems Family & Social History Immunizations Vital Signs Test Results Medications Procedures Up 2 years claims history Alerts Allergies/Adverse Reactions And more To request THR CCD Viewer access, please send an containing: Clinic Name Address Phone Number Provider Names Provider Addresses Primary Contact To Andrea Bailey at: andrea.bailey@wyo.gov Visit the website at: d-viewer
40 What is the Program Integrity Unit? The Program Integrity (PI) unit is responsible, through a coordinated process of education, reviews, audits, and appropriate corrective action plans, for ensuring the integrity and accountability of all payments made for healthcare services on behalf of a recipient. Providers new to Medicaid should view the Wyoming Medicaid Program Integrity presentation. Learn more about PI or report suspected abuse, fraud, or waste by visiting:
41 Resources Provider Relations (Option 1,5,0) o o 9-5 MST Monday - Friday o Fax Number o EDI Services (Option 3) o o o o o 9-5 MST Monday Friday EDI Enrollment Form Trading Partner Agreement WINASAP Software & Technical Support for WINASAP Technical Support for Vendors, Billing Agents, and Clearinghouses o Provider Web Portal Registration Technical Support for Provider Web Portal & Password Resets
42 *Medical Policy (Option 1,1,4,3) o 9-5 MST Monday Friday o Prior Authorizations (PAs) Requests for: o Surgeries requiring PAs o Hospice Services: Limited to Clients Residing in a Nursing Home o Status of a Pending PA o How to Complete a PA Request o Authorizations of Medical Necessity for services prior to 11/1/17 o Denials for: o WATRS -Ambulance claims/ regarding trip report o Invoices * Third Party Liability (TPL) (option 2) o 9-5 MST Monday Friday o Client accident covered by liability or casualty insurance or legal liability is being pursued o Estate and Trust Recovery o Medicare Buy-In status o Reporting client TPL o New insurance coverage o Policy no longer active o Problems getting insurance information needed to bill o Questions or problems regarding third party coverage or payers o WHIPP program
43 Questions???
WYOMING MEDICAID PROVIDER MANUAL. Medical Services HCFA-1500
WYOMING MEDICAID PROVIDER MANUAL Medical Services HCFA-1500 Medical Services March 01,1999 Table of Contents AUTHORITY... 1-1 Chapter One... 1-1 General Information... 1-1 How the Billing Manual is organized...
More informationMedicaid-Enrolled Hospice and Nursing Facility Providers
M E D I C A I D B U L L E T I N B T 1 9 9 9 2 4 J U L Y 3 0, 1 9 9 9 To: Subject: Medicaid-Enrolled Hospice and Nursing Facility Providers Treatment for Non-Terminal Conditions for Hospice Recipients Admitted
More informationWyoming Medicaid- Provider Services Updates. Provider Workshops Summer 2017
Wyoming Medicaid- Provider Services Updates Provider Workshops Summer 2017 Facilities Update TITLE 25- Involuntary Hospitalization Effective August 1, 2016- Wyoming Medicaid began processing Title 25 claims
More informationTelehealth Webinar. Wyoming Medicaid Covered Services & Billing Requirements December 14, 2016
Telehealth Webinar Wyoming Medicaid Covered Services & Billing Requirements December 14, 2016 Presenters: Sheree Nall - Provider Services Manager Melissa Davis - Field Representative Wyoming Medicaid Medicaid
More informationConnecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers
Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Training Topics Hospice Agenda HIPAA 5010 Hospice Form
More informationCommunity Mental Health Centers PROVIDER TRAINING
Community Mental Health Centers PROVIDER TRAINING June 18, 2008 & June 23, 2008 Revised July 22, 2008 LOUISIANA MEDICAID PROGRAM DEPARTMENT OF HEALTH AND HOSPITALS BUREAU OF HEALTH SERVICES FINANCING TABLE
More informationOverview. Rule References. General Provider Information
Overview Wyoming Department of Health Public Health Insurance Program Pharmacy Group 6530 HEALTHCARE RECIPIENT 0600 123 456 The Division of Healthcare Financing is discontinuing the use of EqualityCare
More informationPublic Health Nursing Conference
Public Health Nursing Conference Wyoming Medicaid Covered Services & Billing Requirements August 7, 2013 Presenter: Amy Buxton, Field Representative Public Health Services Are services provided by a physician
More informationGeneral Provider Information
Overview Overview Thank you for your willingness to serve clients of the Medicaid Program and other medical assistance programs administered by the Division of Healthcare Financing. This manual supersedes
More informationSubject: 2007 Indiana Health Coverage Programs Provider Seminar
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 2 2 S E P T E M B E R 4, 2 0 0 7 To: All Providers Subject: 2007 Indiana Health Coverage Programs Provider Seminar Overview
More informationConnecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers
Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Hospice Agenda Overview Forms Fee Schedule/Reimbursement
More informationLTC User Guide for Nursing Facility Forms 3618/3619 and Minimum Data Set/ Long Term Care Medicaid Information (MDS/LTCMI)
LTC User Guide for Nursing Facility Forms 3618/3619 and Minimum Data Set/ Long Term Care Medicaid Information (MDS/LTCMI) v 2018 0614 Contents Learning Objectives...1 Sequencing of Documents...2 Admission
More informationLTC Online Portal User Guide for Nursing Facilities and Hospice Providers
LTC Online Portal User Guide for Nursing Facilities and Hospice Providers v 2016 0420 Contents Learning Objectives...1 Medicaid Team...2 National Provider Identifier (NPI)/Atypical Provider Identifier
More informationConnecticut Medical Assistance Program. Hospice Refresher Workshop
Connecticut Medical Assistance Program Hospice Refresher Workshop Training Topics What s New in 2015? Electronic Messaging Claim Adjustments Messages Archived Proposed Changes in Hospice Rates Fiscal Year
More informationCONTRACT YEAR 2011 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT
CONTRACT YEAR 2011 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT Table of Contents 1. Introduction 2. When a provider is deemed to accept Flexi Blue PFFS terms and
More informationAdvanced Diagnostic Imaging (ADI)
Advanced Diagnostic Imaging (ADI) 2016 1 eqhealth Solutions 2 Overview of eqsuite» 24/7 accessibility to submit review requests to eqhealth via web.» Secure transmission protocols that are HIPPA security
More information5010 Changes. CHAMPS Changes 01/01/12 4/4/12. Copyright Kearney & Associates, Inc 1. 01/01/2012 Change From 4010 to 5010
Flowing Change Julie Kearney Kearney & Associates, Inc. 5010 Changes 01/01/2012 Change From 4010 to 5010 Went From Allowing 8 Diagnosis to 12 Diagnosis Postponed fines, and compliance until 04/01/2012
More informationFREQUENTLY ASKED QUESTIONS FOR PROVIDERS
FREQUENTLY ASKED QUESTIONS FOR PROVIDERS TN PASRR REIMPLEMENTATION DEVELOPED: 10.5.16 REVISED: 10.17.16 Contents PASRR... 1 1. Does the person have to have be in TN to submit a PASRR?... 1 2. When does
More informationHospital Refresher Workshop. Presented by The Department of Social Services & HP Enterprise Services
Hospital Refresher Workshop Presented by The Department of Social Services & HP Enterprise Services 1 Training Topics Provider Bulletins Outpatient Claim Billing Changes Explanation of Benefit Codes Web
More informationHome Health, Hospice, and Nursing Facility. Indiana Health Coverage Programs DXC Technology October 2017
Home Health, Hospice, and Nursing Facility Indiana Health Coverage Programs DXC Technology October 2017 Agenda Billing Tips Home Health Hospice Nursing Facility Claim Form Update Helpful Tools Questions
More informationTABLE OF CONTENTS DELEGATED GROUPS
TABLE OF CONTENTS DELEGATED GROUPS DELEGATION AND ADMINISTRATIVE SERVICES OVERSIGHT... 10-1 ADMINISTRATIVE OVERSIGHT PROGRAM AND PROCESS... 10-2 DELEGATION AND ADMINISTRATIVE SERVICES OVERSIGHT Through
More informationCHILD HEALTH SERVICES TARGETED CASE MANAGEMENT COVERAGE AND LIMITATIONS HANDBOOK
Florida Medicaid CHILD HEALTH SERVICES TARGETED CASE MANAGEMENT COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration June 2012 UPDATE LOG CHILD HEALTH SERVICES TARGETED CASE MANAGEMENT
More informationCHAPTER 3: EXECUTIVE SUMMARY
INDIANA PROVIDER MANUAL EXECUTIVE SUMMARY Indiana Family and Social Services Administration (FSSA) contracts with Anthem Insurance Companies, Inc. (dba Anthem Blue Cross and Blue Shield) for the provision
More informationChapter 14: Long Term Care
I N D I A N A H E A L T H C O V E R A G E P R O G R A M S P R O V I D E R M A N U A L Chapter 14: Long Term Care Library Reference Number: PRPR10004 14-1 Chapter 14 Indiana Health Coverage Programs Provider
More informationINDIANA MEDICAID UPDATE
INDIANA MEDICAID UPDATE November 16, 1998 TO: SUBJECT: All Indiana Medicaid-Enrolled Nursing Facilities Hospital Discharge Planners Area Agencies on Aging/IPAS Contact Persons Current Form 450B Nursing
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused
More informationSubject: 2009 Indiana Health Coverage Programs Provider Seminar
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 930 A U G U S T 2 7, 2009 To: All Providers Subject: 2009 Indiana Health Coverage Programs Provider Seminar Overview The Office
More informationNumber of Persons in your Household 1 $60,300 4 $123,000 2 $81,200 5 $143,900 3 $102,100 6 $164,800
The Lilly Cares Foundation, Inc. ("Lilly Cares"), a nonprofit organization, offers a patient assistance program to assist qualifying patients in obtaining certain Lilly medications at no cost. This enrollment
More informationCredentialing Application for Hospitals and Facilities
Instructions Credentialing Application for Hospitals and Facilities 1. Please accurately and legibly complete all sections of this Credentialing Application, and mark non-applicable fields with N/A. If
More informationTABLE OF CONTENTS. Therapy Services Provider Manual Table of Contents
Table of Contents TABLE OF CONTENTS Table of Contents...1 About AHCA...2 About eqhealth Solutions...2 Accessibility and Contact Information...5 Review Requirements and Submitting PA Requests...9 First
More informationTELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL
TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL NOVEMBER 2017 CSHCN PROVIDER PROCEDURES MANUAL NOVEMBER 2017 TELECOMMUNICATION SERVICES Table of Contents 38.1 Enrollment......................................................................
More informationPalmetto GBA Hospice Coalition Questions
Palmetto GBA Hospice Coalition Questions November 1, 1999 Billing/Reimbursement/FISS 1. The hospice medical director fails to sign a patient's recertification of terminal prognosis in a timely fashion.
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused
More informationPROVIDER TYPE SPECIFIC PACKET/CHECKLIST
PROVIDER TYPE SPECIFIC PACKET/CHECKLIST (Louisiana Medicaid) Assistive Devices (Enrollment packet is subject to change without notice) Revised 03/15 GENERAL INFORMATION FOR PROVIDER ENROLLMENT Provider
More information907 KAR 1:044. Coverage provisions and requirements regarding community mental health center behavioral health services.
907 KAR 1:044. Coverage provisions and requirements regarding community mental health center behavioral health services. RELATES TO: KRS 194A.060, 205.520(3), 205.8451(9), 422.317, 434.840-434.860, 42
More informationAddressing Documentation Insufficiencies
Objectives Addressing Documentation Insufficiencies ICAHN June 9,2015 Glenn Krauss, BBA, RHIA, CCS, FCS, PCS,CCS-P, CPUR, C-CDI, CCDS, C- DAM Understand and appreciate physician frustrations with the EHR
More informationWhat is a retrospective Level of Care and what is the process for submitting a retrospective Level of Care?
Last updated 9/14/2011 The following are Frequently Asked Questions (FAQs) associated with Connecticut Level of Care and PASRR Level I/II processes. To read to the corresponding response to the questions
More informationMississippi Medicaid Hospice Services Provider Manual
Mississippi Medicaid Hospice Services Provider Manual Effective: January 2011 Revised: January 2017 Table of Contents I. Introduction II. Frequently Used Terms III. Getting Started Helpful Tips A. Before
More information9.1.1 Medicaid Managed Care Enrollment Prior Authorization Emergency Ambulance Services
Section 9Ambulance 9 9.1 Enrollment........................................................ 9-2 9.1.1 Medicaid Managed Care Enrollment................................. 9-2 9.2 Reimbursement....................................................
More informationBehavioral Health Provider Training: BHSO updates
Behavioral Health Provider Training: BHSO updates Agenda Diagnosis Code 799 Laboratory Work CPT Code Q3014- Telehealth BHSO Claims submission Process Targeted Case Management Diagnosis Codes Diagnosis
More informationPersonal Care Services (PCS): An Overview of PCS and The Request for Independent Assessment for PCS Attestation of Medical Need Form (DMA 3051)
Personal Care Services (PCS): An Overview of PCS and The Request for Independent Assessment for PCS Attestation of Medical Need Form (DMA 3051) January 2018 OBJECTIVES At the conclusion of this training,
More informationIHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT AUGUST 30, 2016
IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201648 AUGUST 30, 2016 2016 IHCP Annual Provider Seminar scheduled for October 18-20 in Indianapolis The Indiana Family and Social Administration (FSSA)
More informationDelegation Oversight 2016 Audit Tool Credentialing and Recredentialing
Att CRE - 216 Delegation Oversight 216 Audit Tool Review Date: A B C D E F 1 2 C3 R3 4 5 N/A N/A 6 7 8 9 N/A N/A AUDIT RESULTS CREDENTIALING ASSESSMENT ELEMENT COMPLIANCE SCORE CARD Medi-Cal Elements Medi-Cal
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information Agenda Passport Behavioral Health Services Overview Steps to Joining Passport Health Plan s Network Getting a Medicaid Number
More informationCLINIC. [Type text] [Type text] [Type text] Version
New York State Billing Guidelines [Type text] [Type text] [Type text] Version 2013-01 6/28/2013 EMEDNY INFORMATION emedny is the name of the electronic New York State Medicaid system. The emedny system
More informationChange Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account
PAYER ID: SUBMITTER ID: 1 Provider Organization Practice/ Facility Name Change Healthcare CLAIMS Provider Information Form *This form is to ensure accuracy in updating the appropriate account Provider
More informationMassHealth Provider Billing and Services Updates & Upcoming Initiatives. Massachusetts Health Care Training Forum July 2011
MassHealth Provider Billing and Services Updates & Upcoming Initiatives Massachusetts Health Care Training Forum July 2011 Agenda I. MassHealth Updates/Resources & Upcoming MassHealth Initiatives II. Paper
More informationIowa Medicaid Family Planning 2012
Iowa Medicaid Family Planning 2012 What is Medicaid? A public health program through which a comprehensive range of health services for persons having no income, or a low income, are provided. 1965 amendment
More informationHome Health & HP Provider Relations
Home Health & Hospice HP Provider Relations October 2010 Agenda Session Objectives Home Health Benefit Coverage Billing Overhead Multiple Visits Most Common Denials Hospice Benefit Coverage Election/Revocation/Discharge
More informationevicore healthcare... 1 Chiropractic Services Precertification Requirements... 1 Treatment Plans... 2 When to Submit the Treatment Plan...
Contents Obtaining Precertification... 1 evicore healthcare... 1 Chiropractic Services Precertification Requirements... 1 Treatment Plans... 2 When to Submit the Treatment Plan... 3 Date Extensions on
More informationPlease Note: Please send all documentation related to the credentialing portion of this documentation to:
Please ote: The application process is split into different actions. Please send all documentation related to the contracting portion of this documentation to: Fax to: (916)350-8860 Or email to: BSCproviderinfo@blueshieldca.com
More informationAll Indiana Health Coverage Programs Providers. Indiana Health Coverage Programs Seminars
P R O V I D E R B U L L E T I N B T 2 0 0 0 1 6 M A Y 5, 2 0 0 0 To: Subject: All Indiana Health Coverage Programs Providers Overview The Office of Medicaid Policy and Planning (OMPP), the Office of Children
More informationRequired Data for Claim Forms (CMS-1500 & UB-04) Claim Submission Instructions (MLTC) Care Healthcare and VNSNY CHOICE Transition
2018 Provider Manual VNSNY CHOICE Appendix V Claims CMS-1500 Form (Sample) UB-04 Form (Sample) Required Data for Claim Forms (CMS-1500 & UB-04) Claim Submission Instructions (MLTC) ICD-10 FAQ Care Healthcare
More informationOREGON ADMINISTRATIVE RULES DEPARTMENT OF HUMAN SERVICES, PUBLIC HEALTH DIVISION CHAPTER 333 DIVISION 270
OREGON ADMINISTRATIVE RULES DEPARTMENT OF HUMAN SERVICES, PUBLIC HEALTH DIVISION CHAPTER 333 DIVISION 270 OREGON POLST (PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT) REGISTRY 333-270-0010 Purpose (1)
More informationHealth Net Access. Provider Reference. Arizona. Lisa Pasillas-Le, Health Net We help you work efficiently with Health Net.
Health Net Access Provider Reference Lisa Pasillas-Le, Health Net We help you work efficiently with Health Net. Guide Arizona Introduction INTRODUCTION Health Net Access, Inc., a subsidiary of Health
More informationMEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE
MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE SUBJECT BY Health Insurance Portability & Accountability Act (HIPAA) NUMBER: 99-02-07 Peg J. Dierkers, Ph.D. Deputy
More information2018 Northern California HMO Provider Manual Kaiser Foundation Health Plan, Inc.
2018 Northern California HMO Provider Manual Kaiser Foundation Health Plan, Inc. Welcome from Kaiser Permanente It is our pleasure to welcome you as a contracted provider (Provider) participating under
More informationNotice of Privacy Practices
River Valley Chiropractic LLC Notice of Privacy Practices Effective 9/2014; Revised 9/2014 If you have any questions about this notice, please contact the River Valley Chiropractic Privacy Officer at 308-534-5840.
More informationChapter 11 Section 3. Hospice Reimbursement - Conditions For Coverage
Hospice Chapter 11 Section 3 Issue Date: February 6, 1995 Authority: 32 CFR 199.4(e)(19) 1.0 APPLICABILITY This policy is mandatory for reimbursement of services provided by either network or nonnetwork
More informationNJ Department of Human Services. FREQUENTLY ASKED QUESTIONS (FAQs) FOR PROVIDERS NJ FamilyCare MANAGED LONG TERM SERVICES AND SUPPORTS (MLTSS)
NJ Department of Human Services FREQUENTLY ASKED QUESTIONS (FAQs) FOR PROVIDERS NJ FamilyCare MANAGED LONG TERM SERVICES AND SUPPORTS (MLTSS) Assisted Living Billing Process when Member is Pending Enrollment
More informationQ & A: Frequently Asked Questions Regarding the DMHAS Mental Health Fee-For-Service (FFS) Program
Department of Human Services Division of Mental Health and Addiction Services Q & A: Frequently Asked Questions Regarding the DMHAS Mental Health Fee-For-Service (FFS) Program General Mental Health FFS
More informationProvider Manual. Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) TNGA Provider Manual (3)
Provider Manual Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) TNGA Provider Manual (3) Table of Contents Table of Contents... 2 Welcome!... 3 Important Contact Information...
More informationABOUT AHCA AND FLORIDA MEDICAID
Section I Introduction About AHCA and Florida Medicaid ABOUT AHCA AND FLORIDA MEDICAID THE FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION The Florida Agency for Health Care Administration (AHCA or Agency)
More informationCOLORADO MEDICAL ASSISTANCE PROGRAM COLORADO MEDICAID EDI CONTRACT INSTRUCTIONS (SKCO0)
COLORADO MEDICAL ASSISTANCE PROGRAM COLORADO MEDICAID EDI CONTRACT INSTRUCTIONS (SKCO0) Enrollment Instructions: Make sure you add your new TPID (9400026) in Step 4 and select the appropriate boxes in
More informationMEDICAID DENTAL PROGRAM Policy Review
MEDICAID DENTAL PROGRAM Policy Review What is Medicaid? Wyoming Medicaid is a joint federal and state government program that pays for medical and dental care for eligible low income and medically needy
More informationChapter 3. Covered Services
Chapter 3 Covered Services This chapter covers the services for which hospitals may receive reimbursement through the Health Care Responsibility Act (HCRA). HCRA reimburses out-of-county hospitals for
More informationNursing Facility Provider Liaison Meeting Frequently Asked Questions (FAQ) Document
Nursing Facility Provider Liaison Meeting Frequently Asked Questions (FAQ) Document The questions MDHHS received from providers in response to L-Letter 17-18: Medicaid Nursing Facility Provider Liaison
More informationPrivate Duty Nursing. May 2017
Private Duty Nursing May 2017 Overview Provider Enrollment Member Eligibility Private Duty Nursing Services Specialized Private Duty Nursing Services Billing Additional Information 2 Provider Enrollment
More informationODM FACILITY COMMUNICATION FREQUENTLY ASKED QUESTIONS (FAQ) Updated 09/2016
ODM 09401 FACILITY COMMUNICATION FREQUENTLY ASKED QUESTIONS (FAQ) Updated 09/2016 This document was developed as a response to the webinars that the Ohio Department of Medicaid (ODM) held to train nursing
More informationIf you have any questions about this notice, please contact the SSHS Privacy Officer at:
Notice of Privacy Practices 0 Effective Date: April 14, 2003 Revision Date: July 15, 2016 South Shore Health System ( SSHS ) is an integrated health care delivery system. For a list of entities which comprise
More informationResponding to Today s Health Care Regulatory Environment
Responding to Today s Health Care Regulatory Environment St. Joseph s Health Michael R. Holper SVP, Compliance and Audit Services October 26, 2016 2014 Trinity Health. All Rights Reserved. 1 We operate
More informationSterilization Consent Form Instructions
Sterilization Consent Form Per Title 42 Code of Federal Regulations (CFR) 441, Subpart F, all sterilization procedures require a valid consent form regardless of the funding source. For timely processing,
More informationHANDBOOK FOR PROVIDERS OF SCHOOL BASED/ LINKED HEALTH CENTER SERVICES
HANDBOOK FOR PROVIDERS OF SCHOOL BASED/ LINKED HEALTH CENTER SERVICES CHAPTER S-200 POLICY AND PROCEDURES FOR SCHOOL BASED/ LINKED HEALTH CENTERS Illinois Department of Healthcare and Family Services CHAPTER
More informationProvider s Frequently Asked Questions Availity in California
Page - 1 - of 6 Provider s Frequently Asked Questions Availity in California Who is Availity? Availity is a multi-payer portal at availity.com that gives physicians, hospitals and other health care professionals
More information7.1.1 STAR and STAR+PLUS Program Enrollment Prior Authorization Emergency Ambulance Services Medicaid Limitations and Exclusions
Section 7Ambulance 7 7.1 Enrollment........................................................ 7-2 7.1.1 STAR and STAR+PLUS Program Enrollment............................ 7-2 7.2 Reimbursement....................................................
More information# December 29, 2000
#00-53-3 December 29, 2000 Minnesota Department of Human Services 444 Lafayette Rd. St. Paul, MN 55155 OF INTEREST TO! County Social Service Directors/Supervisors! County Designated LMHA for PASRR! County
More informationTable of Contents. 1.0 Description of the Procedure, Product, or Service Definitions Hospice Terminal illness...
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 1.1.1 Hospice... 1 1.1.2 Terminal illness... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information Agenda Passport Behavioral Health Services Overview Steps to Joining Passport Health Plan s Network Getting a Medicaid Number
More informationCare Wisconsin Medicaid SSI Provider Manual
Care Wisconsin Medicaid SSI Provider Manual Revised: January, 2016 Dear Provider: The Care Wisconsin Provider Manual serves as a reference for information pertaining to the Care Wisconsin Medicaid SSI
More informationSubject: Indiana Health Coverage Programs 2003 Seminar
P R O V I D E R B U L L E T I N B T 2 0 0 3 4 8 J U L Y 1 5, 2 0 0 3 To: All Providers Subject: Overview The Office of Medicaid Policy and Planning (OMPP), the Children s Health Insurance Program (CHIP),
More informationISMA Coalition Meeting March 22, 2013
ISMA Coalition Meeting March 22, 2013 Questions and Answers 1. For the Office of Medicaid Policy and Planning (OMPP): The final rule (42 CFR 447.700) under the Affordable Care Act (ACA) provision, provides
More informationProvider Frequently Asked Questions (FAQ)
1. What behavioral health services does Magellan of Virginia manage for Virginia Medicaid? Covered Services Magellan is responsible for management of the behavioral health services for the fee-for-service
More informationWY Medicaid Behavioral Health Provider Outreach
WY Medicaid Behavioral Health Provider Outreach Teresa Kirn, RN IQCI Manager, Care Management Department July 23, 26, and 27, 2018 Advancing Healthcare Improving Health One of the nation s leading healthcare
More informationProvider Manual Supplement
Provider Manual Supplement Tennessee CHOICES Amerigroup Community Care 1-866-840-4991 providers.amerigroup.com/tn 02.16 TABLE OF CONTENTS Introduction... - 4 - TennCare CHOICES Long-Term Services & Supports...
More informationTable of Contents. FREQUENTLY ASKED QUESTIONS Iowa ServiceMatters/PathTracker Webinars 1/25/2016 2/2/2016. PASRR/Level I Questions...
Below you will find the frequently asked questions for the ServiceMatters and PathTracker Webinars conducted 1/25/2016 2/2/2016. Answers to these questions were based on knowledge and policy as of 3/1/2016.
More informationBCBSNC Best Practices
BCBSNC Best Practices Thank you for attending today! We value your commitment of caring for our members your patients and our shared goals for their improved health An independent licensee of the Blue
More informationNew Mexico Department of Health Developmental Disabilities Supports Division PASRR
New Mexico Department of Health Developmental Disabilities Supports Division PASRR Presented by Sandyeva Martinez, LMSW PASRR Program Manager/Supervisor 1 What is PASRR? Pre Admission Screening and Resident
More informationeqsuite User Guide for Electronic Review Request Acute Inpatient Medical/Surgical DRG Reimbursed
eqsuite User Guide for Electronic Review Request Acute Inpatient Medical/Surgical DRG Reimbursed CONTENTS OVERVIEW OF SYSTEM FEATURES... 3 ACCESSING THE SYSTEM... 4 USER LOG IN - GETTING STARTED... 5 SUBMITTING
More informationSterilization Consent Form Instructions
Sterilization Consent Form Per Title 42 Code of Federal Regulations (CFR) 50, Subpart B, all sterilization procedures require a valid consent form regardless of the funding source. For timely processing,
More informationProvider Manual. Amerigroup Kansas, Inc https://providers.amerigroup.com/ks KS-PM
Provider Manual Amerigroup Kansas, Inc. 1-800-454-3730 https://providers.amerigroup.com/ks KS-PM-0018-18 June 2018 Apply for network participation Interested in participating in the Amerigroup Kansas,
More informationResidential Rehabilitation Services (RRS) Level 3.1 Frequently Asked Questions (Updated 4/5/2018)
Contracting Residential Rehabilitation Services (RRS) Level 3.1 Frequently Asked Questions (Updated 4/5/2018) Q: I haven t heard from the MBHP contracting department. What should I do? A: Applications
More informationLearning Objectives. Section 1 Florida Medicaid Handbooks. Presentation Outline
Learning Objectives Share basic Florida Medicaid compliance tips with new Florida Medicaid providers Refresh current Florida Medicaid providers basic Medicaid compliance knowledge Improve compliance with
More informationhospic Hospice Care 1 Hospice care is a medical multidisciplinary care designed to meet the unique needs of terminally ill individuals.
Hospice Care 1 Hospice care is a medical multidisciplinary care designed to meet the unique needs of terminally ill individuals. Hospice care is used to alleviate pain and suffering, and treat symptoms
More informationAssessment. SMP Foundations Training Kit. Table of Contents
SMP Foundations Training Kit Assessment Table of Contents Participant Assessment Questions and Answer Form Assessment Questions... 10 Pages Answer Form... 2 Pages Trainer s Resources Answer Key... 2 Pages
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information 1 Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency
More informationPUBLIC DISCLOSURE OF FINANCIAL ASSISTANCE. (Full Financial Assistance Policy Continues Below)
PUBLIC DISCLOSURE OF FINANCIAL ASSISTANCE Adventist Home Health, Inc. ( AHH ) will make available to all patients home health care regardless of race, creed, gender, age, sexual orientation, national origin,
More informationConnecticut interchange MMIS
Connecticut interchange MMIS Provider Manual Chapter 7 Hospice August 10, 2009 Connecticut Department of Social Services (DSS) 55 Farmington Ave Hartford, CT 06105 DXC Technology 195 Scott Swamp Road Farmington,
More informationATTENDING PHYSICIAN ORDERS AND COVERAGE
ATTENDING PHYSICIAN ORDERS AND COVERAGE Patient s Choice of Attending Physician: CMS defines the hospice Attending Physician as either: a doctor of medicine or osteopathy legally authorized to practice
More informationMember Handbook. Effective Date: January 1, Revised October 30, 2017
Member Handbook Effective Date: January 1, 2018 Revised October 30, 2017 2017 NH Healthy Families. All rights reserved. NH Healthy Families is underwritten by Granite State Health Plan, Inc. MED-NH-17-004
More informationPatient Consent Form
Alexander Raskin, M.D., Q.M.E. Assistant Clinical Professor UCLA School of Medicine ORTHOPEDIC SURGERY SPORTS MEDICINE ARTHROSCOPY 16311 Ventura Blvd., Suite 1150, Encino, CA 91436 T (818) 788-ORTHO (6784)
More information