MyAvatar PM Provider Billing training

1. MyAvatar PM Provider Billing training Behavioral Health Bureau County of Monterey May & June 2013

2. Training Topics : • Electronic Invoice Submission Procedure • naming convention • supporting document • Introducing MyAvatar Widgets and Reports: • homeview widgets • monthly reports • Medi-Cal claims related reports • County Contacts

3. Electronic Invoice Submission Procedure MCBHD is accepting invoices electronically. This is to centralize the receiving point of contractors’ invoices and in result to expedite the payment processing (MCBHB Info Notice: 2012-01) • Email invoices to : MCHDBHFinance@co.monterey.ca.us • Within 30 days of the following the month of service • exception - within 10 days for drug Medi-Cal program Naming convention • Subject line • MH_ContractAgency_201207_ProgramName_R • ADP_ADPAgency_201207_DrugProgram_S • Supporting document • Invoice_ContractAgency_201207_ProgramName • ResLog_ContractAgency_201207_ProgramName_R

4. Why to follow the naming convention? (following the naming convention allows both the billing staff and Finance Staff to identify and locate files)

5. Invoice Supporting Documents MCBHD is currently accepting the service data via the following methods. The units of services billed of each invoice should be able to reconcile using the supporting documents: * Unsure which method your program is using? see your Program manager • Direct Data Entry to Avatar • submit UOS Summary report as a supporting document • File Import • submit a text data file in an acceptable data layout • Submit the text file as a supporting document • MCBHD staff will inform of test result with any error • Service Logs • submit service logs in an acceptable format to MCBHD • Submit service log (residential /day treatment log or outpatient logs) as a supporting documents

6. Do you have…. Following information you need to have in order to complete in entering services or generating service log/file for your invoice: • Correct Client Number Check referral documents for client’s name, client number, dob, SSN • Episode Number ensure the episode number is accurate service program is matching with episode admission program (605 Program Active Cases Report) Staff Number Rendering practitioner should have a staff number issued by MCBHD Contract term - Date of Service, Service type and Program

7. Have you also done …. Possible Duplicate Report Medi-Cal system will consider a service as duplicate when it contains the following. If the service is duplicate more than once and billed without a duplicate modifier, Medi-Cal will deny the second and subsequent claims: * If your Program has access to Avatar you can locate the Duplicate Report via “search forms”, otherwise contact a (PAR) Patient Account Representative at the number below. • Same client • Same program (sharing same NPI) • Same date of service • Same billing procedure code • Service Code 311/2, 331/2, 341/2, 351/2, and 391/2 service codes are translated into a same Medi-Cal billing procedure code • Same unit of service The report is to identify the possible duplicate services and provide you a chance to prevent the service from being denied by Medi-Cal. FAX it to :Attn PAR Duplicate @ 831 424-9808 Phone: PAR: 831-755-4563

8. Possible Duplicate Report*To be run after services have been entered but Before services have been billed to catch any possible duplicate errors.

9. ADP 7700 *(ADP 7700 should be attached with invoice and services log on a monthly basis. See deadline for ADP billing on slide 3. ADP 7700 form applies to ADP Programs only)

10. Contacts: Receipt confirmation Account Payable 831 755-4558 Invoice Reconciliation and Uploading services Patient Account Rep 831 755-4563 Invoice/Payment Status 831 755-8996 Account Payable 831 755-4597 Avatar questions EMR Help Line 831 755-4545

11. Questions?- Billing Questions: contact a PAR- Errors: contact QA

12. MyAvatar Homeview Current Home View of Provider Billing staff – important to know what your “User Role” in Avatar

13. MyAvatar Widgets Client Financial Eligibility Client Summary • Yellow, Green and Pink highlights reflect information for Ep 5, 4 and 3. • Date episode was open • Date episode was closed • Program name • Last SD: last service date • Order: order in which guarantors are currently arranged • Guar: Guarantor name (medi-cal, Medicare, umdap) • Policy No.: Insurance ID for commercial insurance. CIN# for Medi-cal clients, Medi-care no. for Medi-care, client # for UMDAP.

14. 1 Year MEDS HistoryBelow is a detail of the MEDS history which details the clients CIN #, County No, Month of eligibility, Aid code and current status. For a detailed explanation of aid codes refer to the Aid Code List Hyperlink Below. Aid Code List : (SDMC) Aid Code Master Chart F8 – Via Care

15. MEDS Review Medi-Cal Eligibility Status - Share of Cost 501, not eligible – 999, 000

16. MEDS Review MediCare and Other Health Coverage Eligibility Status

17. MEDS Review MediCare and Other Health Coverage Eligibility Status

18. Change Home View Customize HomeView of your homescreen Widgets

19. Avatar Reports Reports available under Avatar PM> Contract Agency PM Reports are: 602 Program Service Detail 603 Program UOS Summary 604 Program Financial Elig 605 Program Active Cases 606 Program Client Service Detail 625P Non MediCal Client List 663 MediCal claim status Report 664 MediCal Denial Response 664E MediCal Denial Per EOB Date 600P Program Trend 991 Program Service Code List

20. Contact BH IT: Trouble with Avatar: • Can’t log to Avatar • Can’t see certain report • Can’t find certain forms

21. Common Report Parameters Program: Service Start and End Date Service ENTRY start and End Date Example: Service Start (7/1/2012) and End Date (7/31/2012) + Service ENTRY start (7/1/2012) and End Date (7/31/12) will display services rendered between 7/1/2012 and 7/31/12 AND entered between 7/1/2012 and 7/31/12. A service rendered on 7/1/12 but entered late than 7/31 will not be appearing on this selection

22. 601 Program Service Detail Report

23. 604 Program Financial Eligibility Report

24. 625P Non MediCal Client per Program

25. 663 MediCal Claim Status Report Displays status of MediCal claims – approved, denied and/or pending. Also provides a summary of approved, pending and denial per each service code.

26. 664 MediCal Denial Response Report Displays denied MediCal claims and the reason of the denial based on Service Dates selected. 664E MediCal Denial per EOB Date Displays denied MediCal claims and the reason of the denial based on EOB posting dates selected regardless service dates. The contract agencies shall review the denial reports and inform the county whether to accept the denials or to provide the replacement information

27. 664 MediCal Denial Response Report Displays denied MediCal claims and the reason of the denial. The providers are to inform the county whether to accept the denials or to provide the replacement information

28. Common Denials: • CO 22 -> Private Insurance was not billed • Contractor - Provide insurance card front/back • Contractor - Provide a signed consent • County - Bill insurance and follow up • CO 22 N192-> Medicare was not billed • Contractor – Provide a Medicare Consent • County - Bill Medicare and follow up • CO 18 M80 -> Duplicate service claimed without an override code • Contractor – Indicate whether a service is true duplicate • Contractor – Credit Memo or Duplicate Override Code • County - Delete the service or replace the claim • CO 31 or 177-> Client Not eligible for Medi-Cal • Contractor – Provide the confirmation of Eligibility (EVC#) if eligible • Contractor – Provide correct Name, DOB, CIN • County - post the denial or re-bill the claim with correct CIN

29. Common Denials: • CO 31 or 177-> if Share of Cost unmet • Contractor - none • County - applied the service cost to SOC if applicable • CO 204 N30, N182 or N206 -> Pregnancy and/or Emergency only Medi-Cal • Contractor –Indicate Pregnancy and Emergency if applicable • County - post the denial or replace the claim • CO A1 MA133 -> Service Overlap an inpatient stay • Contractor – provide a correct service info or Credit Memo • County - Delete the service or replace the claim • CO B7 -> Service Program Facility Not certified • Contractor – Contact QI re: Site Certification • County - Replace the claim if applicable (when issues are resolved)

30. Replacement process of Denied Claims After denial 835s are posted in Avatar • Contract Agencies review the denials • Contract Agency instruct the county staff either To post the denial (by marking X to yes) or To submit a replacement claims • Complete it by initialing and dating the 664 reports and, FAX it to 831 – 424-9808 ATTN: PAR Denial • As directed, County will post the denials or replace the claims

31. To Disallow Approved/Denied Services If a county-paid service needs to be disallowed, follow the following • Submit a request to Delete Service via Error Reporting • Submit a Credit Memo • Specify Client, • Service Information (Date of Service, Service Code, Location, duration, staff , etc ) • Amount • Offset from a future invoice or issue a check to MCBHD

32. 600P Program Trend

33. Useful Avatar Forms • Client Update • Error Reporting • New User Request

34. Contacts: Receipt confirmation Account Payable 831 755 - 4558 Invoice Reconciliation and uploading services Patient Account Rep 831 755-4563 Invoice/Payment Status 831 755-8996 Account Payable 831 755-4597 Avatar questions EMR Help Line 831 755-4545 http://www.mtyhd.org/QI/