Louisiana Medicaid

1. UNISYS Louisiana Medicaid DHH – Bureau of Primary CarePractice Management Technical Assistance Workshop August 14th , 2008

2. Billing for Independent Mental Health Providers • Independently Practicing Psychologists and Social Workers • Medicaid covers services provided to Medicare/Medicaid recipients ONLY • Medicaid uses a cost-comparison methodology to make payments up to the Medicare coinsurance/or deductible • Claims should crossover electronically from Medicare • Psychological and Behavioral Services (PBS) • Must be an enrolled Psychologist participating in the PBS program • Covers recipients under the age of 21 • Services covered include necessary assessments, evaluations, individual therapy, and family therapy • Reimbursement is based on fee-for-service

3. Ind. Social Worker Claim Form Example

5. PBS Claim Form Example

6. Common Billing Errors • General Claim Form Completion Codes • 003 – Recipient # invalid or less than 13 digits • 028 – Invalid or missing CPT code • Recipient Eligibility Error Codes • 215/216/222/223 – Recipient not on file/not eligible on one or more DOS • 217 – Name/# on claim does not match file • Timely Filing Error Codes • 272/371 – Claim exceeds 1 year filing limit/attachment requires review • Misc. Error Codes • 433/020 – Missing/invalid diagnosis • 131 – Primary diagnosis not on file • 234 – P/F age restriction • 739 – Recipient has exceeded maximum allowed services per year

7. Timely Filing Guidelines • Initial Filing Limits • Dates of Service Past Initial Filing Limit • Two-Year Filing Limit

8. Appeals Process • Denied claims ARE NOT considered appeals and should be corrected and re-filed to Unisys • Appeals may be filed when all efforts to get the claim paid have been exhausted • Requests must be submitted in writing to • DHH Bureau of Appeals P.O. Box 4183 Baton Rouge, La. 70821-4182

9. CommunityCARE • Program Description • Exempt Recipients • Primary Care Physician (PCP) • Non-PCP Providers • Exempt Services

10. Types of Services Covered • Mental Health Rehabilitation Services • Private providers • Assessment • Service Planning • Community Support • Medication Management • Individual Intervention/Supportive Counseling • Group Counseling • Parent/Family Intervention Counseling • Psychosocial Skills Group Training • All services must be Prior Authorized through SRI • Reimbursement is based on fee-for-service

12. Types of Services Covered • Mental Health Clinics • Only State Operated Clinics • Covered Services include: • Evaluations/Assessments • Treatment • Counseling Services • Medication Management • Injections • Reimbursement is based on fee-for-service

13. MHC Claim Form Example

14. Common Billing Errors • General Claim Form Completion Codes • 003 – Recipient # invalid or less than 13 digits • 028 – Invalid or missing CPT code • Recipient Eligibility Error Codes • 215/216/222/223 – Recipient not on file/not eligible on one or more DOS • 217 – Name/# on claim does not match file • Timely Filing Error Codes • 272/371 – Claim exceeds 1 year filing limit/attachment requires review • TPL Error Codes • 273 – TPL carrier code missing • 290 – No EOB from primary carrier attached • Miscellaneous Error Codes • 194 – Claim exceeds prior authorized limits • 191 – Procedure requires prior authorization • 299/232 - Procedure not covered by Medicaid/type of service not covered

15. Timely Filing Guidelines • Initial Filing Limits • Dates of Service Past Initial Filing Limit • Two-Year Filing Limit

16. Appeals Process • Denied claims ARE NOT considered appeals and should be corrected and re-filed to Unisys • Appeals may be filed when all efforts to get the claim paid have been exhausted • Requests must be submitted in writing to • DHH Bureau of Appeals P.O. Box 4183 Baton Rouge, La. 70821-4182

17. CommunityCARE • Program Description • Exempt Recipients • Primary Care Physician (PCP) • Non-PCP Providers • Exempt Services

18. If a CommunityCare recipient has used up all visits and needs non-emergent care, the PCP Can either treat the recipient and not bill Medicaid Offer to see the recipient as a private pay patient (enrollee pays out of pocket) Request an extension using the 158-A form Issue a referral to a physician who will treat the recipient Outpatient Visit Limits

19. Provider Assistance • Provider Relations Telephone Unit: 800-473-2783 OR 225-924-5040 • Provider Enrollment Department: 225-216-6370 • Correspondence Unit: Unisys-Provider Relations P.O. Box 91024 Baton Rouge, LA. 70821 • Field Analysts

20. THANK YOU! For Attending This 2008 Provider Workshop