Habilitation Services – Billing and Claims Process

1. Habilitation Services – Billing and Claims Process Presented by Dennis Petersen, COO – February 18, 2014

2. Magellan Transition • Only services rendered 7/1/13 or AFTER, should be billed to Magellan. • For all services rendered PRIOR to 7/1/13, claims should be submitted directly to Iowa Medicaid Enterprise (IME). • Existing service plans for HAB services active as of July 1, 2013, were transferred to Magellan. • Why the change in billing procedures? Magellan has processes in place to ensure HIPAA and CMS compliance. The codes/processes previously used were not in compliance in order for us to process a claim.

3. Provider Billing Codes *For all Iowa Medicaid Habilitation services, the UC modifier must be included on claims. Claims for this service submitted without this modifier will be denied. *For those members with an ETP/Ad Hoc rate, you must bill with a KX modifier in the first position, and the UC modifier in the second position in order for the claim to process at the correct rate. (i.e. T2021 KX UC) Note: This is a list of all HAB services. Please check your contract for the services your site can provide.

4. Provider Billing Codes, cont. *For all Iowa Medicaid Habilitation services, the UC modifier must be included on claims. Claims for this service submitted without this modifier will be denied. *For those members with an ETP/Ad Hoc rate, you must bill with a KX modifier in the first position, and the UC modifier in the second position in order for the claim to process at the correct rate. (i.e. T2021 KX UC) Note: This is a list of all HAB services. Please check your contract for the services your site can provide.

5. Magellan Covered Diagnosis

6. Place of Service (POS) Codes

7. Claims – Expediting the Process FACT: The majority of claims are processed within 24-48 hours. Electronic Claim Submission Submit “Clean” Claim Submit Within Timely Filing Guidelines Sign Up For Electronic Funds Transfer (EFT) Sign Up For Electronic Remittance Advice (ERA)

8. Electronic Claim Submission Options

9. Electronic Claim Submission – On-Line Training Available • Go to www.MagellanProvider.com. • Choose “Education”, and then “Online Training”. • The section on “Electronic Transactions” includes the following demos: • 835 Transactions • Clearinghouse • Submit EDI Claims • EDI Testing Center • Electronic Funds Transfer

10. Claims/Website Contact Information • General Billing Questions • Customer Service 1-800-638-8820 • EDI/Website Technical Support • Getting Started – visit our EDI Testing Center at www.edi.magellanprovider.com • EDI Hotline – 1-800-450-7281, ext. 75890 or email EDISupport@magellanhealth.com • General Website Technical Assistance • For all other website technical assistance, call • Provider Services at 1-800-788-4005.

11. Submit “Clean” Claims – Top Claim Denial Reasons • Member Not Found – Be sure you are using the correct spelling of the member’s name and DOB that appears in eligibility. If this information does not match, it will cause the claim to reject and it will not be accepted for adjudication. If the information in eligibility is incorrect, contact IME to make a correction. • No Authorization – Be sure you have an active authorization on file and units available to use. • Not Eligible – Verify member eligibility each month of service. You can do this on our website at www.magellanprovider.com or via ELVS at 800-338-7752. Even if services are authorized, the member must still have active eligibility.

12. Top Claim Denial Reasons, cont. • Invalid/Non-Covered Dx Codes – Be sure the primary Dx you are billing is a covered Dx with Magellan. Be sure ALL the Dx codes you are billing are valid. • Invalid CPT/HCPCS Codes – Confirm the code you are billing is the same code that was authorized for service. Refer to your authorization letter which can be accessed at www.magellanprovider.com. • Invalid or Missing Modifier or Place of Service Code (POS)

13. Top Claim Denial Reasons, cont. • Missing Name and Degree of Provider – CMS 1500 only • Site not contracted/credentialed – be sure the claim’s “rendering” site is contracted for the services you are billing for. Not all sites may be contracted for the same services. Be sure you are using the correct TIN/NPI number combination for that site. • Duplicate Claim Submission – if you are submitting a CORRECTED CLAIM, be sure you indicate as such on the claim so that it doesn’t deny as a duplicate. When submitting a CORRECTED CLAIM, fill out the claim the way it should have been submitted.

14. Submit Within Timely Filing Guidelines • In accordance with State requirements, Magellan requires Medicaid claims to be resolved by the 365th calendar day from the date of service.

15. Sign Up for EFT and ERA

16. Website Resources • www.MagellanofIowa.com • www.MagellanProvider.com

17. On-Line Resources

18. On-Line Resources, cont.

19. Magellan Customer Service Contact Information Customer Service – 1-800-638-8820; Fax 1-888-656-5302 Donna Booth, Customer Service Supervisor – 1-800-638-8820, x85251 Email – DLBooth@MagellanHealth.com Christine Bryant, Customer Service Manager – 1-800-638-8820, x85009 Email – CRBryant@MagellanHealth.com Dennis Petersen, Chief Operations Officer – 1-800-638-8820, x85044 Email – DAPetersen@MagellanHealth.com Customer Service Address Magellan Health Services PO Box 71129 Des Moines, IA 50325 Claims Address Magellan Health Services PO Box 1869 Maryland Heights, MO 63043

20. Additional Contact Information • ELVS – Eligibility Verification System - 1-800-338-7752 • Contracting/Rates questions, or to add an additional site – call Anne Thielking, Network Provider Relations Liaison at 1-800-638-8820 ext. 85045 • How to file an appeal – Request should be made in writing and include all supporting documentation. • Email DSMGrievance@magellanhealth.com • Fax 1-888-656-2658 or • Mail to: • Magellan Health Services • Attn: Appeals, P.O. Box 71129 • Des Moines, IA 50325

21. Q&A

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