Missouri

1. The Division of Special Education, Funds Management Section is offering a series of webinars related to Special Education Finance topics. This webinar covers Medicaid Billing for Direct Services, including the enrollment process to become a provider, the required documentation, allowed amounts, and the billing process. The Division of Special Education, Funds Management Section is offering a series of webinars related to Special Education Finance topics. This webinar covers Medicaid Billing for Direct Services, including the enrollment process to become a provider, the required documentation, allowed amounts, and the billing process.

2. Introduction The Missouri Department of Elementary and Secondary Education (DESE), Division of Special Education, collaborates with the Missouri Department of Social Services (DSS), MO HealthNet Division (MHD), in the promotion and implementation of medical care through Medicaid, now called MO HealthNet in Missouri's schools. DSS has the authority to promulgate rules and regulations for billing of services to MO HealthNet, while DESE assists in the distribution and interpretation of program information to schools. The MO Dept of Elementary and Secondary Education collaborates the Department of Social Services in the promotion and implementation of medical care. Support is provided through participation in the federal Early Periodic Screening Diagnosis and Treatment (EPSDT) program under Medicaid, which allows reimbursement for the provision of certain medically necessary direct services to eligible children by an approved provider. The Department of Social Services has the authority to regulate the Medicaid program, while DESE assists in the distribution and interpretation of program information to schools. The MO Dept of Elementary and Secondary Education collaborates the Department of Social Services in the promotion and implementation of medical care. Support is provided through participation in the federal Early Periodic Screening Diagnosis and Treatment (EPSDT) program under Medicaid, which allows reimbursement for the provision of certain medically necessary direct services to eligible children by an approved provider. The Department of Social Services has the authority to regulate the Medicaid program, while DESE assists in the distribution and interpretation of program information to schools.

3. Medicaid is a federal health insurance program for low income and needy people funded by federal dollars and usually matched with state and/or local dollars. In Missouri, Medicaid is now called MO HealthNet due to recent legislative changes. School-based Medicaid is funding for certain activities performed in school districts. Medicaid is now called MO HealthNet is Missouri. It is a federal health insurance program for low income and needy people funded by federal dollars that are usually matched with state and/or local funds. Schools can bill MO HealthNet on low-income and needy kids for certain activities provided in the school setting. This is referred to as School-based Medicaid services.Medicaid is now called MO HealthNet is Missouri. It is a federal health insurance program for low income and needy people funded by federal dollars that are usually matched with state and/or local funds. Schools can bill MO HealthNet on low-income and needy kids for certain activities provided in the school setting. This is referred to as School-based Medicaid services.

4. There are three Medicaid revenue sources available to Districts: Direct Services School District Administrative Claiming (SDAC) Non-Emergency Medical Transportation (NEMT) Districts can receive school-based Medicaid revenue from three different sources: Direct Services, School District Administrative Claiming, called as SDAC, and Non-Emergency Medical Transportation, called NEMT.Districts can receive school-based Medicaid revenue from three different sources: Direct Services, School District Administrative Claiming, called as SDAC, and Non-Emergency Medical Transportation, called NEMT.

5. Direct Services Today�s presentation will focus on the Medicaid Revenue of Direct Services. Let�s start by describing what direct services entail. Today�s presentation will focus on the Medicaid Revenue of Direct Services. Let�s start by describing what direct services entail.

6. Direct services are the therapies listed in the Individual Education Plan (IEP) that can be billed to Medicaid. They include: Occupational therapy Speech therapy Physical therapy Psychological/counseling services. Direct services are the Occupational, Speech, and Physical therapies listed in the Individualized Education Plan, or IEP that can be billed to Medicaid. Depending on the student�s eligibility, some psychology and counseling may be billed to Medicaid also. Direct services are the Occupational, Speech, and Physical therapies listed in the Individualized Education Plan, or IEP that can be billed to Medicaid. Depending on the student�s eligibility, some psychology and counseling may be billed to Medicaid also.

7. Provider Enrollment In order to bill for direct services, the district and each individual therapist must first go through the enrollment process to start billing for Medicaid. In order to bill for direct services, the district and each individual therapist must first go through the enrollment process to start billing for Medicaid.

8. Provider Numbers DISTRICTS will be identified by two different numbers: ? MO HealthNet (Medicaid) Provider Number ? National Provider Identifier (NPI) Number Each INDIVIDUAL THERAPIST will be identified by two different numbers: ? MO HealthNet (Medicaid) Provider Number ? National Provider Identifier (NPI) Number This process includes two steps: one on the National level, and the other on the state level. Districts, as well as individual therapists, will need to go through both enrollment procedures. The National Level enrollment is for the National Provider Identifier, or NPI, and the state level enrollment is for the MO HealthNet Provider Number. This process includes two steps: one on the National level, and the other on the state level. Districts, as well as individual therapists, will need to go through both enrollment procedures. The National Level enrollment is for the National Provider Identifier, or NPI, and the state level enrollment is for the MO HealthNet Provider Number.

9. National Provider Identifier (NPI) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the issuance of a unique number to each service provider nationwide. This number is called the National Provider Identifier (NPI). It is tracked on a national level. The NPI is obtained through an electronic web registration site. The NPI takes 1-5 days to be issued. Instructions for completing the application are located on the Funds Management webpage. The National Provider Identifier was created due to the passing of the Health Insurance Portability and Accountability Act, also known as HIPAA. This legislation requires a unique identifier be issued to each provider claiming Medicaid reimbursement nationwide. Districts may obtain their NPI by enrolling through the electronic website listed on the following slide. The NPI takes 1-5 business days to be issued. Instructions for completing the NPI are listed on the Funds Management webpage under the Medicaid link.The National Provider Identifier was created due to the passing of the Health Insurance Portability and Accountability Act, also known as HIPAA. This legislation requires a unique identifier be issued to each provider claiming Medicaid reimbursement nationwide. Districts may obtain their NPI by enrolling through the electronic website listed on the following slide. The NPI takes 1-5 business days to be issued. Instructions for completing the NPI are listed on the Funds Management webpage under the Medicaid link.

10. https://nppes.cms.hhs.gov/NPPES/Welcome.do National Provider Identifier (NPI) Districts and therapists can enroll for the NPI at the link on this slide. Remember, an NPI number is required for both the district and each individual therapist. Districts and therapists can enroll for the NPI at the link on this slide. Remember, an NPI number is required for both the district and each individual therapist.

11. MO HealthNet Provider Number The MO HealthNet Division will issue a MO HealthNet (Medicaid) Provider Number. This number will only be used internally at the MO HealthNet. Effective May 12, 2008, NPI numbers will be used on all claims as opposed to the MO Medicaid Provider Number. Districts: 50xxxxxxx Therapists: 46xxxxxxx, 47xxxxxxx, 48xxxxxxx The second number the district and each individual therapist will need to enroll for is the MO HealthNet Provider Number. This number will only be used internally at the MO HealthNet Division. Some districts may have received their MO HealthNet Provider number prior to the NPI Implementation. If so, the MO HealthNet number for a district begins with �50�. The MO HealthNet number for individual therapists begins with a 46, 47 or 48, depending on the specialty of the therapist. Effective May 12, 2008, the NPI will be used on claims and all correspondence. Districts will not know or need the MO HealthNet Provider Number. The second number the district and each individual therapist will need to enroll for is the MO HealthNet Provider Number. This number will only be used internally at the MO HealthNet Division. Some districts may have received their MO HealthNet Provider number prior to the NPI Implementation. If so, the MO HealthNet number for a district begins with �50�. The MO HealthNet number for individual therapists begins with a 46, 47 or 48, depending on the specialty of the therapist. Effective May 12, 2008, the NPI will be used on claims and all correspondence. Districts will not know or need the MO HealthNet Provider Number.

12. MO HealthNet (Medicaid) and NPI District MO HealthNet Number (50) National Provider Identifier (NPI) Individual Therapist MO HealthNet Number (46, 47, 48) National Provider Identifier (NPI) Once again, for further clarification, each district will have two numbers: a MO HealthNet Provider Number and an NPI number. Each individual therapist will have two numbers: a MO HealthNet Provider Number and an NPI number. However, districts and therapists will only know the NPI number as the MO HealthNet number will only be used internally at the state. Once again, for further clarification, each district will have two numbers: a MO HealthNet Provider Number and an NPI number. Each individual therapist will have two numbers: a MO HealthNet Provider Number and an NPI number. However, districts and therapists will only know the NPI number as the MO HealthNet number will only be used internally at the state.

13. Exception to NPI Therapists who are ONLY certified through DESE with a teaching certificate in Speech and Language and who do NOT hold a state license will NOT apply for the NPI. They will be issued a pseudo-NPI from Medicaid. If they have both a license and DESE certificate � they need to apply for an NPI. For therapists who only hold a DESE certificate and not a state license will NOT apply for an NPI. They will be issued a pseudo, or fake NPI number by the MO HealthNet Division. If the therapist holds both a certificate and a state license, they will need to do the enrollment process. For therapists who only hold a DESE certificate and not a state license will NOT apply for an NPI. They will be issued a pseudo, or fake NPI number by the MO HealthNet Division. If the therapist holds both a certificate and a state license, they will need to do the enrollment process.

14. Contracted Therapy Companies If a district chooses to have the contracted therapy company bill Medicaid, the company will have to enroll for a specific provider number with the District listed as the �pay to� entity. The company must use the TM modifier to identify IEP services. All reimbursement will go directly to the school district. If a district chooses to have the contracted therapy company bill Medicaid, this company must enroll for a specific provider number with the district listed as the �Pay to�, meaning that the district will receive all of the reimbursement from Medicaid. The company must still bill under the same guidelines as the district would use if they were billing themselves. If a district chooses to have the contracted therapy company bill Medicaid, this company must enroll for a specific provider number with the district listed as the �Pay to�, meaning that the district will receive all of the reimbursement from Medicaid. The company must still bill under the same guidelines as the district would use if they were billing themselves.

15. Provider Information Let�s move onto information related to the provider. Let�s move onto information related to the provider.

16. Identifying Providers BILLING PROVIDER SCHOOL DISTRICT PERFORMING PROVIDER INDIVIDUAL THERAPIST OR CONTRACTED THERAPIST There are two different provider types. The billing provider, who submits the claim, and the performing provider, who performs the therapy. The school district will always be the billing provider. The individual therapist or contracted therapist will always be the performing provider. The individual therapist should never receive any reimbursement from Medicaid, as it will always go to the district. There are two different provider types. The billing provider, who submits the claim, and the performing provider, who performs the therapy. The school district will always be the billing provider. The individual therapist or contracted therapist will always be the performing provider. The individual therapist should never receive any reimbursement from Medicaid, as it will always go to the district.

17. Certification/Licensure for Therapy Board of Healing Arts Certified/Licensed Speech-Language Pathologist Board of Healing Arts Certified/Licensed Physical Therapist Board of Occupational Therapy Certified/Licensed Occupational Therapist DESE Certified Speech-Language Teacher Each therapist, depending on their specialty, must have the following certification/licensure in order to bill Medicaid. A Speech-Language Pathologist must be certified/licensed by the Board of Healing Arts A Physical Therapist must be certified/licensed by the Board of Healing Arts An Occupational Therapist must be certified/licensed by the Board of Occupational Therapy A speech-language teacher must be certified by DESE Speech Implementers are not eligible to bill Medicaid unless they have one of the above mentioned certifications. OT and PT assistants providing services may not bill to Medicaid either. Each therapist, depending on their specialty, must have the following certification/licensure in order to bill Medicaid. A Speech-Language Pathologist must be certified/licensed by the Board of Healing Arts A Physical Therapist must be certified/licensed by the Board of Healing Arts An Occupational Therapist must be certified/licensed by the Board of Occupational Therapy A speech-language teacher must be certified by DESE Speech Implementers are not eligible to bill Medicaid unless they have one of the above mentioned certifications. OT and PT assistants providing services may not bill to Medicaid either.

18. Licensed Psychologist Licensed Clinical Social Worker (LCSW) Licensed Professional Counselor (LPC) Licensed Psychiatrist Counseling providers must be certified as: A licensed pathologist, licensed clinical social worker, licensed professional counselor, or a licensed psychiatristCounseling providers must be certified as: A licensed pathologist, licensed clinical social worker, licensed professional counselor, or a licensed psychiatrist

19. Documentation Now that we know the enrollment process and how to identify our providers, let�s move on to what documentation is needed in order to bill Medicaid.Now that we know the enrollment process and how to identify our providers, let�s move on to what documentation is needed in order to bill Medicaid.

20. IEP / Plan of Care According to the Missouri Medicaid Provider Manual for Physical, Occupational, and Speech Therapy, a plan of care is a required component for the authorization of services to demonstrate medical need. For school districts, the Evaluation and Individualized Education Plan (IEP) are documents which may be used to support the medical need for therapy services. The following must be included in the IEP: The diagnosis for the condition The desired outcome or goals The nature of the treatment The Frequency of the treatment The most important documentation requirement is to prove and demonstrate medical necessity in order for Medicaid to be billed. This can be accomplished through the Individualized education plan, or IEP. Each IEP and/or evaluation must include the diagnosis, the goals or desired outcomes, and the nature and frequency of the treatment in order to meet the medical need component. Therefore, ALL therapy services billed to Medicaid must be contained in the IEP. The most important documentation requirement is to prove and demonstrate medical necessity in order for Medicaid to be billed. This can be accomplished through the Individualized education plan, or IEP. Each IEP and/or evaluation must include the diagnosis, the goals or desired outcomes, and the nature and frequency of the treatment in order to meet the medical need component. Therefore, ALL therapy services billed to Medicaid must be contained in the IEP.

21. Documentation � Parental Consent IDEA requires Parental Consent before accessing public insurance (�300.154). �Must obtain parental consent, consistent with �300.9, each time that access to public benefits or insurance is sought� and �Notify parents that the parents� refusal to allow access to their public benefits or insurance does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents.� Another requirement for documentation is parental consent. According to the 2004 re-authorization of Individuals with Disabilities Education Act, or IDEA, districts must obtain parental consent before accessing the student�s public benefits, which would be Medicaid. Another requirement for documentation is parental consent. According to the 2004 re-authorization of Individuals with Disabilities Education Act, or IDEA, districts must obtain parental consent before accessing the student�s public benefits, which would be Medicaid.

22. Parental Consent Components Entity Releasing the Information Student Name and DOB Date of Services Entity Information is Released to Purpose of Disclosure Information to be Disclosed Signature of Parent or Legal Guardian Date of Signature Statement saying that they may refuse to sign and still receive services/treatment. A parental consent/release of information form should contain these components Entity Releasing the Information Student Name and DOB Date of Services Entity Information is Released to Purpose of Disclosure Information to be Disclosed Signature of Parent or Legal Guardian Date of Signature Statement saying that they may refuse to sign and still receive services/treatment. The district may choose to use their own release of information form or use the sample located on the funds management webpage under the Medicaid link. A parental consent/release of information form should contain these components Entity Releasing the Information Student Name and DOB Date of Services Entity Information is Released to Purpose of Disclosure Information to be Disclosed Signature of Parent or Legal Guardian Date of Signature Statement saying that they may refuse to sign and still receive services/treatment. The district may choose to use their own release of information form or use the sample located on the funds management webpage under the Medicaid link.

23. OSEP Clarification In a letter dated January 23, 2007 from Director Alexa Posney, it states: This consent may be obtained one time for the specific services, and duration of services identified in a child's individualized education program (IEP), and an Local Education Agency would not be required to obtain a separate consent each time a Medicaid agency or other public insurer or public program is billed for the provision of required services. There has been some conflict as to how often consent must be obtained due to the language of the regulation. It states parental consent must be obtained �each time that access to public benefits or insurance is sought.� The Office of Special Education Programs, also called OSEP, has clarified this statement to indicate parent consent only has to be obtained each time the IEP is developed and/or evaluated, OR if the therapy provided changes. So it is NOT necessary for the district to obtain consent each and every time they bill Medicaid. There has been some conflict as to how often consent must be obtained due to the language of the regulation. It states parental consent must be obtained �each time that access to public benefits or insurance is sought.� The Office of Special Education Programs, also called OSEP, has clarified this statement to indicate parent consent only has to be obtained each time the IEP is developed and/or evaluated, OR if the therapy provided changes. So it is NOT necessary for the district to obtain consent each and every time they bill Medicaid.

24. Documentation - Scripts All services billed to Medicaid must have a physician script signed by a Primary Care Provider or Medicaid enrolled provider. Scripts should contain Physician Medicaid Provider Number and signature, student name, date, type of therapy, and duration. Scripts are good for one year. Medicaid will accept scripts signed by a nurse practitioner. The next documentation requirement is a physician script ordering the therapy. The district should make every attempt to have the Primary Care Provider of the student sign the script. Districts may verify the primary provider by the eligibility verification run, which will be shown later in this webinar. District may obtain the script themselves from Primary Care Physicians if the parental consent is signed and the physician is listed as one of the entities receiving information on the form. If the district is unable to obtain a script from the primary care provider, they may choose to get a script from another Medicaid enrolled physician. Again, the parent must sign the consent for the information to be released to this physician. However, if a physician other than the Primary Care Physician is utilized, the district needs to notify the Primary Care Provider of the therapy services being provided to the student. Medicaid will also accept scripts signed by a Nurse Practitioner. Scripts are valid for one year and need to contain the type of therapy, duration, frequency, physician signature and the NPI number of the physician. The next documentation requirement is a physician script ordering the therapy. The district should make every attempt to have the Primary Care Provider of the student sign the script. Districts may verify the primary provider by the eligibility verification run, which will be shown later in this webinar. District may obtain the script themselves from Primary Care Physicians if the parental consent is signed and the physician is listed as one of the entities receiving information on the form. If the district is unable to obtain a script from the primary care provider, they may choose to get a script from another Medicaid enrolled physician. Again, the parent must sign the consent for the information to be released to this physician. However, if a physician other than the Primary Care Physician is utilized, the district needs to notify the Primary Care Provider of the therapy services being provided to the student. Medicaid will also accept scripts signed by a Nurse Practitioner. Scripts are valid for one year and need to contain the type of therapy, duration, frequency, physician signature and the NPI number of the physician.

25. Therapy Logs as Medical Records Adequate medical records are records which are of the type and in a form from which symptoms, conditions, diagnoses, treatments, prognosis and the identity of the patient to which these things relate can be readily discerned and verified with reasonable certainty. Another component of documentation is therapy logs. Each therapy session must be documented with a therapy log. Another component of documentation is therapy logs. Each therapy session must be documented with a therapy log.

26. Therapy Log Components Student�s complete name; Date therapy was provided; Actual therapy provided for the student Individual or group therapy; Time therapy was delivered The signature of the therapist who provided the therapy The therapy log must contain the following components: Student�s complete name; Date therapy was provided; Actual therapy provided for the student Indicate if Individual or group therapy was provided; Time therapy was delivered The signature of the therapist who provided the therapy; The therapy log must contain the following components: Student�s complete name; Date therapy was provided; Actual therapy provided for the student Indicate if Individual or group therapy was provided; Time therapy was delivered The signature of the therapist who provided the therapy;

27. Therapy Logs Sample Here is a sample therapy log form. Districts may use this sample or create their own. Please make sure that the therapy log includes all the required components discussed on the previous slide. In this example, the gray shaded cells can be pre-printed for the therapist�s convenience. Here is a sample therapy log form. Districts may use this sample or create their own. Please make sure that the therapy log includes all the required components discussed on the previous slide. In this example, the gray shaded cells can be pre-printed for the therapist�s convenience.

28. Codes & Allowed Amts Now we know the enrollment process, certification requirements, and documentation, let�s go to the codes and allowed amounts needed in order to bill MO HealthNet.Now we know the enrollment process, certification requirements, and documentation, let�s go to the codes and allowed amounts needed in order to bill MO HealthNet.

29. Diagnosis Codes A diagnosis code explains the type of condition for which the student is receiving therapy. The diagnosis code is required on the claim form when billing Medicaid. There are covered and non-covered diagnosis codes. Districts need to ensure they are using a billable code. Codes can be located in the International Classification of Diseases, 9th Revision, Clinical Modifications code book, or by using flashcode.com. Let�s start with diagnosis codes. The diagnosis code explains the condition for which the student is receiving therapy for. There are covered and non-covered diagnosis codes. Districts need to ensure they are using a billable covered code. Codes can be obtained through the International Classification of Diseases, also known as ICD, or they can search using Flashcode.com Let�s start with diagnosis codes. The diagnosis code explains the condition for which the student is receiving therapy for. There are covered and non-covered diagnosis codes. Districts need to ensure they are using a billable covered code. Codes can be obtained through the International Classification of Diseases, also known as ICD, or they can search using Flashcode.com

30. Flashcode.com May verify billable status for free at www.flashcode.com Green = Non-Billable Red = Billable Districts may verify if the code is billable through www.flashcode.com. This website will let the district search by specific code or code word such as �speech.� The green dotted items are not billable, the red are billable. Districts may verify if the code is billable through www.flashcode.com. This website will let the district search by specific code or code word such as �speech.� The green dotted items are not billable, the red are billable.

31. Place of Service Code �A place of service code is used to identify the location where services were performed. The place of service code is required on the claim form. For public school districts, this will always be �03.� A place of service code is used to identify the location where services were performed. The place of service code is required on the claim form. School districts will always use �03.� A place of service code is used to identify the location where services were performed. The place of service code is required on the claim form. School districts will always use �03.�

32. Units of Service 1 unit of service = 15 minutes Physical, occupational, and speech/language services that are covered in the Therapy Program include evaluation, treatment, splinting or casting supplies, and evaluation/fitting of appropriate equipment. One unit of service is equal to 15 minutes of therapy. Physical, occupational, and speech/language services that are covered in the Therapy Program include evaluation, treatment, splinting or casting supplies, and evaluation/fitting of appropriate equipment. If a district only provided 35 minutes of therapy, the district could only bill 2 units. One unit of service is equal to 15 minutes of therapy. Physical, occupational, and speech/language services that are covered in the Therapy Program include evaluation, treatment, splinting or casting supplies, and evaluation/fitting of appropriate equipment. If a district only provided 35 minutes of therapy, the district could only bill 2 units.

33. Rounding Up Guidance Medicaid states that a district may claim a full unit of service if: The remaining amount of time that is not face-to-face therapy is directed toward the student. For example, making more detailed therapy notes, or preparing materials for the next session with that child. Districts need to focus the entire 15 minutes of therapy on direct contact with the student. Medicaid will allow districts to round up in instances where direct therapy time is shorter than 15 minutes IF the therapist is using the remaining time directed toward that same student. For example, making more detailed therapy logs, preparing materials for the next session with that student, speaking to the student�s teacher, etc. Districts need to focus the entire 15 minutes of therapy on direct contact with the student. Medicaid will allow districts to round up in instances where direct therapy time is shorter than 15 minutes IF the therapist is using the remaining time directed toward that same student. For example, making more detailed therapy logs, preparing materials for the next session with that student, speaking to the student�s teacher, etc.

34. Modifier A modifier is used to indicate IEP services. The district will enter �TM� as the modifier when providing therapy services to IEP students. This notifies Medicaid that the amount to be paid on the claim will only be the federal portion. The district will enter �TR� as the modifier when providing therapy services to Service Plan (private school) students. A modifier is used to indicate the source of therapy. For school districts, the source is considered the IEP. Districts will always use TM as the modifier when providing services from an IEP, and will use TR when providing services from a 504 plan.A modifier is used to indicate the source of therapy. For school districts, the source is considered the IEP. Districts will always use TM as the modifier when providing services from an IEP, and will use TR when providing services from a 504 plan.

35. Procedure Codes Procedure codes indicate the type of service being provided. All therapies have unique procedures codes. A complete list of codes that may be used with the TM modifier (IEP services) are posted on the Funds Management webpage. The next slide references commonly used Procedure Codes. Procedure codes indicate the type of service being provided. All therapies have unique procedures codes. A complete list of codes that may be used with the TM modifier (IEP services) are posted on the Funds Management webpage. We will cover the most commonly used procedure codes on the following slides. Procedure codes indicate the type of service being provided. All therapies have unique procedures codes. A complete list of codes that may be used with the TM modifier (IEP services) are posted on the Funds Management webpage. We will cover the most commonly used procedure codes on the following slides.

36. THERAPY Procedure Codes Speech, Occupational, Physical Therapist The seven procedure codes are most commonly used by districts for speech, occupational and physical therapy. You will note that all individual therapies have an allowed amount of $10.00. This means that the maximum amount that can be billed to Medicaid is $10. For group therapy, the allowed amount is $3. Districts may only bill group speech therapy, not group OT or group PT. The seven procedure codes are most commonly used by districts for speech, occupational and physical therapy. You will note that all individual therapies have an allowed amount of $10.00. This means that the maximum amount that can be billed to Medicaid is $10. For group therapy, the allowed amount is $3. Districts may only bill group speech therapy, not group OT or group PT.

37. COUNSELING Procedure Codes Licensed Clinical Social Worker Here is a list of common procedure codes used by districts for counseling by Licensed Clinical Social Workers. The allowed amount is listed as well. Here is a list of common procedure codes used by districts for counseling by Licensed Clinical Social Workers. The allowed amount is listed as well.

38. COUNSELING Procedure Codes Psychologist & Psychiatrist Here is a list of common procedure codes with the allowed amounts used by districts for counseling by Psychologists and Psychiatrists. Here is a list of common procedure codes with the allowed amounts used by districts for counseling by Psychologists and Psychiatrists.

39. Federal/State Ratio & Payment Medicaid will pay approximately 60% of the Federal portion of the allowed amount. If $10.00 is allowed for one unit, Medicaid will pay approx. $6.00. The District is responsible for the remaining 40% State portion. Direct Services reimbursement should go back into the Direct Services program. Even though Medicaid allows a certain rate for therapy, that doesn�t mean that is the reimbursement amount. In Missouri, Medicaid will pay approximately 60% of the allowed amount, which is considered the Federal portion. The District is responsible for the remaining 40% State portion. So, if $10.00 is allowed for one unit, Medicaid will pay approx. $6.00. Direct Services reimbursement should go back into the Direct Services program. Even though Medicaid allows a certain rate for therapy, that doesn�t mean that is the reimbursement amount. In Missouri, Medicaid will pay approximately 60% of the allowed amount, which is considered the Federal portion. The District is responsible for the remaining 40% State portion. So, if $10.00 is allowed for one unit, Medicaid will pay approx. $6.00. Direct Services reimbursement should go back into the Direct Services program.

40. Managed Care (MC+) Some students qualify for a managed care program. The managed care program works more like an HMO than a straight Medicaid plan. This will not effect reimbursement for therapy services provided under an IEP. However, students in a Managed Care program may not get reimbursed for psychology/counseling unless they fall under a certain Medicaid Eligibility code. For qualifying codes, contact the MO HealthNet Unit. Some students qualify for a managed care program under Medicaid. The managed care program works more like an HMO than a straight Medicaid plan. This will not effect reimbursement for therapy services provided under an IEP. However, students in a Managed Care program may not get reimbursed for psychology/counseling unless they fall under a certain Medicaid Eligibility code. For qualifying codes, contact the MO HealthNet Unit. Some students qualify for a managed care program under Medicaid. The managed care program works more like an HMO than a straight Medicaid plan. This will not effect reimbursement for therapy services provided under an IEP. However, students in a Managed Care program may not get reimbursed for psychology/counseling unless they fall under a certain Medicaid Eligibility code. For qualifying codes, contact the MO HealthNet Unit.

41. eMOMED Now that we know the codes needed for submitting a claim, let�s move onto completing a claim and the free electronic claiming site, eMOMED.Now that we know the codes needed for submitting a claim, let�s move onto completing a claim and the free electronic claiming site, eMOMED.

42. eMOMED.com eMOMED.com is the free electronic billing site for Medicaid claiming. Claims may be submitted individually or through batches. The next part of the presentation will cover how to utilize the claiming site. eMOMED.com is the free electronic billing site for Medicaid claiming. Claims may be submitted individually or through batches. The next part of the presentation will cover how to utilize the claiming site. eMOMED.com is the free electronic billing site for Medicaid claiming. Claims may be submitted individually or through batches. The next part of the presentation will cover how to utilize the claiming site.

43. Introduction to eMOMED.com Provider Manuals Add/Update Provider Info Verify Eligibility Submit Claims Check status of claims Check payment status of claims View Remittance Advice View Denial Codes From the emomed site, districts may access provider manuals, add/update provider information, verify student eligibility, submit claims, check the status of claims, check payment of claims, and view denial codes. Each of these options will be covered in the following slides.From the emomed site, districts may access provider manuals, add/update provider information, verify student eligibility, submit claims, check the status of claims, check payment of claims, and view denial codes. Each of these options will be covered in the following slides.

44. Provider Manuals Districts can view the MO HealthNet Manuals by going to www.emomed.com, clicking on Providers, and then selecting provider manuals. Districts will utilize two manuals, the therapy manual and the psychology counseling manual. There is a red arrow next to both manuals. No login is necessary to access the manuals. Districts can view the MO HealthNet Manuals by going to www.emomed.com, clicking on Providers, and then selecting provider manuals. Districts will utilize two manuals, the therapy manual and the psychology counseling manual. There is a red arrow next to both manuals. No login is necessary to access the manuals.

45. After logging in to eMOMED, districts will be able to access the main claiming page. This page allows the district to add/update provider information, verify student eligibility, submit claims, check the status of claims, check payment of claims, and view denial codes. Again, each of these options will be covered in the following slides. After logging in to eMOMED, districts will be able to access the main claiming page. This page allows the district to add/update provider information, verify student eligibility, submit claims, check the status of claims, check payment of claims, and view denial codes. Again, each of these options will be covered in the following slides.

46. eMOMED � Adding a Provider # Once the district has access to emomed, they will need add their district�s and each individual therapist�s NPI number. Choose the �Maintain Submitter Information/Provider List� Option. Once the district has access to emomed, they will need add their district�s and each individual therapist�s NPI number. Choose the �Maintain Submitter Information/Provider List� Option.

47. eMOMED � Adding a Provider # The district will then select �add/update� and enter the NPI number for both the district and all individual therapists. These NPI numbers have been blacked out for confidentiality reasons.The district will then select �add/update� and enter the NPI number for both the district and all individual therapists. These NPI numbers have been blacked out for confidentiality reasons.

48. Student Eligibility Before billing Medicaid, the district must determine if the student is eligible. To verify eligibility, click on the �Verify Student Eligibility Link� on the main eMOMED page. Before billing, the district must determine if the student is even eligible for Medicaid. Before billing, the district must determine if the student is even eligible for Medicaid.

49. eMOMED � Verifying Eligibility To verify eligibility, choose the Verify Recipient Eligibility option. To verify eligibility, choose the Verify Recipient Eligibility option.

50. eMOMED � Verifying Eligibility The district can search by three methods: 1) Medicaid Number - or - 2) Date of Birth and Full Name - or - 3) Date of Birth and Social Security Number The district may search eligibility by the three methods: by the Medicaid Number alone, by the combination of the date of birth and full name, OR by the combination of the date of birth and social security number. Be sure to use the full real name of the student. For example, use William instead of Bill, Julia instead of Julie, and Robert instead of Bobby.The district may search eligibility by the three methods: by the Medicaid Number alone, by the combination of the date of birth and full name, OR by the combination of the date of birth and social security number. Be sure to use the full real name of the student. For example, use William instead of Bill, Julia instead of Julie, and Robert instead of Bobby.

51. eMOMED Eligibility Verification Screen Here is a screen print from the Eligibility Verification Screen. Again, using one of the search methods described in the previous slide, enter the appropriate data. Here is a screen print from the Eligibility Verification Screen. Again, using one of the search methods described in the previous slide, enter the appropriate data.

52. Eligibility Verification Run The eligibility verification run indicates the following: Eligibility Status Medicaid Eligibility (ME) Plan Code Time Period Qualifier Insurance Type Third Party Insurance The eligibility verification run indicates the following: Eligibility Status Medicaid Eligibility (ME) Plan Code Time Period Qualifier Insurance Type Third Party Insurance Each of these will be described in further detail. The eligibility verification run indicates the following: Eligibility Status Medicaid Eligibility (ME) Plan Code Time Period Qualifier Insurance Type Third Party Insurance Each of these will be described in further detail.

53. Eligibility Status Here is a sample eligibility Verification run. The Eligibility Status is circled in red. If the student is eligible for Medicaid, the status will run as �Active Coverage�. Here is a sample eligibility Verification run. The Eligibility Status is circled in red. If the student is eligible for Medicaid, the status will run as �Active Coverage�.

54. Medicaid Eligibility (ME) Code The Medicaid Eligibility Plan Code is circled in red on this slide. This code indicates the reason why the student is receiving Medicaid. There is a list of Medicaid Eligibility codes located on the Funds Management webpage. The Medicaid Eligibility Plan Code is circled in red on this slide. This code indicates the reason why the student is receiving Medicaid. There is a list of Medicaid Eligibility codes located on the Funds Management webpage.

55. Time Period Qualifier The Time Period Qualifier is circled in red here. The time period qualifier indicates the length of coverage. A �34� identifies a student whose eligibility will typically run until the last day of the month. A �7� identifies a student whose eligibility fluctuates during the month from active to non-active. In these cases, the district may need to run eligibility more than once a month on students with a Time Period Qualifier of 7. The Time Period Qualifier is circled in red here. The time period qualifier indicates the length of coverage. A �34� identifies a student whose eligibility will typically run until the last day of the month. A �7� identifies a student whose eligibility fluctuates during the month from active to non-active. In these cases, the district may need to run eligibility more than once a month on students with a Time Period Qualifier of 7.

56. Insurance Type The insurance type indicates if the student has straight Medicaid, or if the student falls under a Managed Care plan. The managed care programs are: Healthcare USA, Missouri Care, Mercy Care Plus, Harmony Health Plan of MO, and Blue Advantage Plus of Kansas City. These plans are subject to change based on competitive bidding and award. Again, Managed Care plans won�t affect OT, PT or SP, only counseling. The insurance type indicates if the student has straight Medicaid, or if the student falls under a Managed Care plan. The managed care programs are: Healthcare USA, Missouri Care, Mercy Care Plus, Harmony Health Plan of MO, and Blue Advantage Plus of Kansas City. These plans are subject to change based on competitive bidding and award. Again, Managed Care plans won�t affect OT, PT or SP, only counseling.

57. Third Party Insurance If there is a third party liability insurance listed, in most cases, MO HealthNet won�t pay for the therapy services unless a denial is received from that insurance company. MO HealthNet will obtain denials for certain insurance providers, but not all. The only way to know if they will obtain the denial is to submit the claim. If the claim is denied, the district will need to obtain a denial or discontinue billing MO HealthNet. Third Party Insurance will be discussed in more detail later in the presentation. If there is a third party liability insurance listed, in most cases, MO HealthNet won�t pay for the therapy services unless a denial is received from that insurance company. MO HealthNet will obtain denials for certain insurance providers, but not all. The only way to know if they will obtain the denial is to submit the claim. If the claim is denied, the district will need to obtain a denial or discontinue billing MO HealthNet. Third Party Insurance will be discussed in more detail later in the presentation.

58. How to Submit a Claim Once the provider number has been entered and the student eligibility verified, the district is ready to submit a claim. Select Medical (CMS 1500) to open the claim form. Once the provider number has been entered and the student eligibility verified, the district is ready to submit a claim. Select Medical (CMS 1500) to open the claim form.

59. Required Information Student�s MO HealthNet Number Student Name Claim Frequency Type Code Enter Diagnosis Code Dates of Service Enter Place of Service Code Procedure Code Modifier Total Number of Units Total Allowable Charges Performing Provider Number The district will need the following information before submitting a claim. Student�s MO HealthNet Number Student Name Claim Frequency Type Code Enter Diagnosis Code Dates of Service Enter Place of Service Code Procedure Code Modifier Total Number of Units Total Allowable Charges Performing Provider Number Each component will be discussed in the following slides. The district will need the following information before submitting a claim. Student�s MO HealthNet Number Student Name Claim Frequency Type Code Enter Diagnosis Code Dates of Service Enter Place of Service Code Procedure Code Modifier Total Number of Units Total Allowable Charges Performing Provider Number Each component will be discussed in the following slides.

60. Claim Form (CMS 1500) This is an example of the entire claim form. Districts will only need to complete the blue highlighted areas. As we go through each required component, we will only show a section at a time. This is an example of the entire claim form. Districts will only need to complete the blue highlighted areas. As we go through each required component, we will only show a section at a time.

61. eMOMED � Student Medicaid Number The district will first enter the student�s Medicaid number under the Patient ID field. The Medicaid number is an eight digit number. The district will first enter the student�s Medicaid number under the Patient ID field. The Medicaid number is an eight digit number.

62. eMOMED � Student Name The district will first enter the student�s Last and First Name. Again, make sure it is the real name of the student. The district will first enter the student�s Last and First Name. Again, make sure it is the real name of the student.

63. eMOMED � Claim Frequency Code For the claim frequency type code, the district will enter 1 if this is the an original/first time claim. If the district is correcting a claim, they will choose 7 to replace the original claim. If the district needs to void the original claim, they will choose 8.For the claim frequency type code, the district will enter 1 if this is the an original/first time claim. If the district is correcting a claim, they will choose 7 to replace the original claim. If the district needs to void the original claim, they will choose 8.

64. eMOMED � Diagnosis Code The next required field is the diagnosis code. The district must enter a BILLABLE diagnosis code in this field. Do not enter any periods in the code. For example, for code 359.6, you would only enter in 3596.The next required field is the diagnosis code. The district must enter a BILLABLE diagnosis code in this field. Do not enter any periods in the code. For example, for code 359.6, you would only enter in 3596.

65. eMOMED � Dates of Service The next step is to enter the dates of service. One claim is equal to one date of service, meaning that you can�t bill for multiple dates. The beginning and ending date have to be the same. Each separate date that is billed is considered a separate claim. In this example, the starting and ending date is 09/11/08 The next step is to enter the dates of service. One claim is equal to one date of service, meaning that you can�t bill for multiple dates. The beginning and ending date have to be the same. Each separate date that is billed is considered a separate claim. In this example, the starting and ending date is 09/11/08

66. eMOMED � Place of Service Code The district must indicate the place of service code. It will always be 03 for school districts. The district must indicate the place of service code. It will always be 03 for school districts.

67. eMOMED � Procedure Code The district must indicate the procedure code. In this example, we are using 92506, which is for a speech evaluation.The district must indicate the procedure code. In this example, we are using 92506, which is for a speech evaluation.

68. eMOMED � Modifier The district must enter the Modifier. It will always be TM for IEP service and TR for 504 plan services. The district must enter the Modifier. It will always be TM for IEP service and TR for 504 plan services.

69. eMOMED � Diagnosis Code Reference Since the district can enter multiple diagnosis codes on the claim form, the section asks again which diagnosis code relates to the claim. So if the district wanted to use the diagnosis from box 1, they would enter 1. If the district wanted to use the diagnosis entered in box 2, they would enter 2.Since the district can enter multiple diagnosis codes on the claim form, the section asks again which diagnosis code relates to the claim. So if the district wanted to use the diagnosis from box 1, they would enter 1. If the district wanted to use the diagnosis entered in box 2, they would enter 2.

70. eMOMED � Total Allowed Charges The district will enter the allowed charges for the services. If more than one unit is billed, the district must calculate the TOTAL amount. In this example, if one unit of speech therapy is allowed $10, and the district provided 45 minutes of therapy, that would be 3 units. Multiply 3 times $10 to get $30.The district will enter the allowed charges for the services. If more than one unit is billed, the district must calculate the TOTAL amount. In this example, if one unit of speech therapy is allowed $10, and the district provided 45 minutes of therapy, that would be 3 units. Multiply 3 times $10 to get $30.

71. eMOMED � Total Units Again, if the district provided 45 minutes of therapy on this date, that would equal three units since one unit is equal to 15 minutes. Take 45 divided by 15 to get the number of units. Again, if the district provided 45 minutes of therapy on this date, that would equal three units since one unit is equal to 15 minutes. Take 45 divided by 15 to get the number of units.

72. eMOMED � EPSDT The district should check the EPSDT box since school-based Medicaid services fall under the EPSDT program. This information is reported to the Federal Government showing that MO is following regulations and providing EPSDT services. The district should check the EPSDT box since school-based Medicaid services fall under the EPSDT program. This information is reported to the Federal Government showing that MO is following regulations and providing EPSDT services.

73. eMOMED � Performing Provider The district must enter the NPI number of the therapist performing the service. This is not the district�s NPI number. This will be the individual or contracted therapist NPI number.The district must enter the NPI number of the therapist performing the service. This is not the district�s NPI number. This will be the individual or contracted therapist NPI number.

74. Completed Claim Form Once all of the data is entered, this is what the completed claim form will look like. As pointed out earlier, the district is only required to complete certain fields on the claim. This one date of service, 09/11/08 counts as one claim. Once all of the data is entered, this is what the completed claim form will look like. As pointed out earlier, the district is only required to complete certain fields on the claim. This one date of service, 09/11/08 counts as one claim.

75. eMOMED � Add Another Claim To add another date of service or different type of therapy, select add detail lines. Do not enter more than 10 claims at a time as this may �clog� up the error review system and cause all the claims to be denied. To add another date of service or different type of therapy, select add detail lines. Do not enter more than 10 claims at a time as this may �clog� up the error review system and cause all the claims to be denied.

76. eMOMED � Submit Completed Claim When all claim information has been entered, click on the calculate Line changes button. Then click submit. This will submit the claim information to MO HealthNet for processing.When all claim information has been entered, click on the calculate Line changes button. Then click submit. This will submit the claim information to MO HealthNet for processing.

77. Third Party Liability (TPL) Denials Districts may seek a Third Party Liability denial from primary insurance companies when claims are denied by Medicaid because of the third party insurance. Districts may send a letter to the insurance requesting a denial of payment for therapy services provided under the Individuals with Disabilities in Education Act (IDEA). It is very important that the district�s legal council review letter before sending. A sample letter requesting denial of payment may be viewed on the Funds Management webpage. Third Party Insurance means that there is a primary insurance that may have to pay before Medicaid pays. Typically, the only way to know if Medicaid won�t pay first is to submit a claim and see if it is denied because of this reason. If it is denied, the district has a recourse. They can try to obtain a denial letter themselves from the third party insurance company. There is a sample letter posted on the Funds Management webpage for requesting a denial from a third party insurance. It is very important that the district�s legal council review letter before sending. Third Party Insurance means that there is a primary insurance that may have to pay before Medicaid pays. Typically, the only way to know if Medicaid won�t pay first is to submit a claim and see if it is denied because of this reason. If it is denied, the district has a recourse. They can try to obtain a denial letter themselves from the third party insurance company. There is a sample letter posted on the Funds Management webpage for requesting a denial from a third party insurance. It is very important that the district�s legal council review letter before sending.

78. Determining TPL In order to determine if a student has TPL insurance, look at the Eligibility Verification Run. In order to determine if a student has TPL insurance, look at the Eligibility Verification Run.

79. Attaching TPL Denial to Claim Form If the district obtains a denial letter from the Third Party Insurance company, they must attach the denial to the claim form. Select �Add Header (other payer)� at the bottom of the claim form. If the district obtains a denial letter from the Third Party Insurance company, they must attach the denial to the claim form. Select �Add Header (other payer)� at the bottom of the claim form.

80. TPL Claim Attachment Under the Filing Indicator field, choose CI for commercial insurance. Under the other payer name field, enter the insurance name. In our example, the insurance is Anthem. Under the Filing Indicator field, choose CI for commercial insurance. Under the other payer name field, enter the insurance name. In our example, the insurance is Anthem.

81. TPL Claim Attachment The Paid amount should indicate $0. The Paid date should indicate the date of the denial letter. The Paid amount should indicate $0. The Paid date should indicate the date of the denial letter.

82. TPL Claim Attachment The Group code will always be PR for Patient Responsibility and the Reason Code will always be 096. The Adjustment amount is the amount of total charges on the claim. The Group code will always be PR for Patient Responsibility and the Reason Code will always be 096. The Adjustment amount is the amount of total charges on the claim.

83. Claim Status - Daily Claims Summary This allows the biller to view all the claims submitted for that session. Check for accuracy at this time. After completing claims for the day, the system allows one more additional check for accuracy under the Daily Claims Summary option. After completing claims for the day, the system allows one more additional check for accuracy under the Daily Claims Summary option.

84. Claim Status - Daily Claims Summary The Daily Claims Summary is located on the main emomed page.The Daily Claims Summary is located on the main emomed page.

85. Payment Status - Claim Confirmation Report This report is available the day after claims are submitted. This is a heads-up before the Remittance Advice is available to research denied claims. Claim status codes are: I � To Be Paid K � To Be Denied C � Suspended (Still processing) M � Medical Claim The Claim Confirmation report is available the day after claims are submitted. It is a heads-up as to the status of a claim. It indicates which claims will be paid, denied and suspended. I means the claim will be paid K means the claim will be denied. C means the claim is suspended for further processing. The Claim Confirmation report is available the day after claims are submitted. It is a heads-up as to the status of a claim. It indicates which claims will be paid, denied and suspended. I means the claim will be paid K means the claim will be denied. C means the claim is suspended for further processing.

86. Claim Confirmation Report Here is a screen print of a Claim Confirmation Report. The codes mentioned on the previous slide indicating the status of the claim are circled in red. Here is a screen print of a Claim Confirmation Report. The codes mentioned on the previous slide indicating the status of the claim are circled in red.

87. Payment Status - Claim Confirmation Report The Claim Confirmation report is located on the main emomed page. The Claim Confirmation report is located on the main emomed page.

88. Remittance Advice & Denial Codes The RA will provide the following information: Student Name Date of Service and Procedure Code Group Code, Reason & Remark Code Quantity Billed, Allowed Amt, & Paid Amt The remittance advice, also called RA, tells the district how much was paid or denied on each claim. It contains the Student Name, Date of Service, Procedure Code, Reason and Remark Code, quantity billed, allowed amount and paid amount. The remittance advice, also called RA, tells the district how much was paid or denied on each claim. It contains the Student Name, Date of Service, Procedure Code, Reason and Remark Code, quantity billed, allowed amount and paid amount.

89. Remittance Advice Report This is a screen print of the Remittance Advice. The first column indicates the dates of service.This is a screen print of the Remittance Advice. The first column indicates the dates of service.

90. Remittance Advice Report The second item circled indicates the procedure code.The second item circled indicates the procedure code.

91. Remittance Advice Report The next column indicates the modifier. The next column indicates the modifier.

92. Remittance Advice Report The reason code indicates the reason why a claim was denied. If the code states B6, the claim was paid.The reason code indicates the reason why a claim was denied. If the code states B6, the claim was paid.

93. Remittance Advice Report The remark code gives further information on why the claim was denied. If code states HE N14, the claim was paid. The remark code gives further information on why the claim was denied. If code states HE N14, the claim was paid.

94. Remittance Advice Report This column indicates the number of units.This column indicates the number of units.

95. Remittance Advice Report The RA gives the allowed amount. The RA gives the allowed amount.

96. Remittance Advice Report The RA gives the paid amount. The RA gives the paid amount.

97. Remittance Advice & Denial Codes The RA is located on the main emomed webpage.The RA is located on the main emomed webpage.

98. Claim Processing Schedule The claims processing schedule lists the dates the cycles are run and their corresponding check dates. Checks are mailed or directly deposited in to a provider�s account twice each month, the 5th and the 20th, for any amounts due. The claims processing schedule lists the dates the cycles are run and their corresponding check dates. Checks are mailed or directly deposited in to a provider�s account twice each month, the 5th and the 20th, for any amounts due.The claims processing schedule lists the dates the cycles are run and their corresponding check dates. Checks are mailed or directly deposited in to a provider�s account twice each month, the 5th and the 20th, for any amounts due.

99. Claim Processing Schedule Here is an example of the Claims Processing Schedule.Here is an example of the Claims Processing Schedule.

100. Claim Processing Schedule The Claims Processing Schedule is located on the main emomed page. The Claims Processing Schedule is located on the main emomed page.

101. Batch Processing For Large Districts, verifying eligibility and claim submission may be more efficiently done by batching software. This is where you send in multiple names in a specified format. Software for batching must be HIPAA compliant and may be purchased from one of the vendors listed at www.wpc-edi.com For Large Districts, verifying eligibility and claim submission may be more efficiently done by batching software. This is where you send in multiple names in a specified format. Software for batching must be HIPAA compliant and may be purchased from one of the vendors listed at www.wpc-edi.com For Large Districts, verifying eligibility and claim submission may be more efficiently done by batching software. This is where you send in multiple names in a specified format. Software for batching must be HIPAA compliant and may be purchased from one of the vendors listed at www.wpc-edi.com

102. Batching HIPAA Software Formats Submission Formats: Response Formats: 270 Eligibility Inquiry 271 Eligibility Response 276 Claims Status Inquiry 277 Claim Status Response 837 Claim Submission 835 Remittance Advice Here are the numbers for the formats the district will need to batch. Submission Formats: Response Formats: 270 Eligibility Inquiry 271 Eligibility Response 276 Claims Status Inquiry 277 Claim Status Response 837 Claim Submission 835 Remittance Advice Here are the numbers for the formats the district will need to batch. Submission Formats: Response Formats: 270 Eligibility Inquiry 271 Eligibility Response 276 Claims Status Inquiry 277 Claim Status Response 837 Claim Submission 835 Remittance Advice

103. Timelines The district has one year from the date of service to submit claims. If a claim is denied, the district has one additional year to resubmit from the date of service. The district has one year from the date of service to submit claims. If a claim is denied, the district has one additional year to resubmit from the date of the service.The district has one year from the date of service to submit claims. If a claim is denied, the district has one additional year to resubmit from the date of the service.

104. The district must enroll for a National Provider Identifier Each therapist must enroll for a National Provider Identifier The district must enroll as a MO Medicaid Provider Each therapist must enroll as a MO Medicaid Provider Obtain Parental Consent Obtain a Physician Script for each therapy type Obtain access to free billing site eMOMED.com Submit Claims Billing Process Summary In summary, the in order to bill: The district must enroll for a National Provider Identifier Each therapist must enroll for a National Provider Identifier The district must enroll as a MO Medicaid Provider Each therapist must enroll as a MO Medicaid Provider Obtain Parental Consent Obtain a Physician Script for each therapy type Obtain access to free billing site eMOMED.com Submit Claims In summary, the in order to bill: The district must enroll for a National Provider Identifier Each therapist must enroll for a National Provider Identifier The district must enroll as a MO Medicaid Provider Each therapist must enroll as a MO Medicaid Provider Obtain Parental Consent Obtain a Physician Script for each therapy type Obtain access to free billing site eMOMED.com Submit Claims

105. Important Websites www.dss.mo.gov/mhd Provider Enrollment, Provider Search, Bulletins & Internet Access http://www.dese.mo.gov/divspeced/Finance/index.html Further clarification on Medicaid www.emomed.com Submit electronic claims, verify eligibility, provider manuals https://nppes.cms.hhs.gov/NPPES/Welcome.do Enroll for NPI Number www.wpc-edi.com Obtain HIPPA forms, codes, and software Please note these important websites and bookmark as your favorites. They are sites that are used frequently by Medicaid billers. Please note these important websites and bookmark as your favorites. They are sites that are used frequently by Medicaid billers.