Behavioral Health Substance Use and Mental Illness, MO HealthNet Eligibility (ME) Codes in regards to DMH Consumers, a child under age 19 (or age 22, if in state custody), a woman in need of treatment for breast or cervical cancer, an individual under age 26 who was in foster care on the date they turned age 18 or 30 days prior, Meet the requirements of an eligibility category - see the links below, 8 are state only funded (no federal Medicaid match) with a limited benefit package, 10 have a benefit package restricted to specific services, 5 are the Childrens Health Insurance Program (CHIP) premium program, The others are federally matched categories that provide a benefit package based on whether the person is a child, an adult, pregnant, blind, or in a nursing facility. Not all services covered under the MO HealthNet program are covered by Medicare. In using the 837 transaction, you will need to consult your Implementation Guides to determine the correct billing procedures or contact your billing agent. If access has not been granted within 7 days of the original request, please contact our Technical Support Help Desk at 573-635-3559 ) ACCEPT/DENY ACCESS REQUESTS (PROVIDER ADMINISTRATORS ONLY) Only the Administrator (or designated Sub . Call the MO HealthNet Participant Services Unit,1-800-392-2161, to find out if a specific procedure is covered. MO HealthNet Managed Care (Medicaid) https://provider.healthybluemo.com Healthy Blue is a Medicaid product offered by Missouri Care, Inc., a MO HealthNet Managed Care health plan contracting with the Missouri Department of Social Services. and complete your data for the MO HealthNet claim. MHD has added option 6 to be transferred directly to a representative. This policy assures the provider that no unauthorized person will have access to his or her submitted claims. These services should be billed as distant site services using the physicians and/or clinic provider number. This list is not all encompassing but may provide providers with helpful contact information. Providers can submit MO HealthNet claims electronically that require a TPL or Medicare denial remittance advice. Effective May 12, 2023, a written prescription is required for Durable Medical Equipment (DME) supplies and equipment. Previously pricing for Herceptin was calculated per milligram and is now calculated per vial, necessitating this change. Missing/incomplete/invalid HCPCS. This flexibility will end on May 11, 2023. Bright Futures is a national health promotion and prevention initiative, led by the American Academy of Pediatrics (AAP) and supported by the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA). Effective July 1, 2022, MO HealthNet Division (MHD) implemented changes to maximum daily quantities for certain procedure codes. MO HealthNet required providers who performed other laboratory services on the same date as the COVID-19 test to bill for the COVID-19 test on a separate claim in order to be reimbursed. Timely Filing Using the ICN: Claims resubmitted past one year from the date of service may not require documentation of timely filing attached to the claim form. Start: 01/01/1995. Code. This will bring you to the "Other Payer" header attachment. Some State of Missouri websites can be translated into many different languages using Google Translate, a third party service (the "Service") that provides automated computer A healthy diet is the best way to get the vitamins and minerals mothers need for a healthy pregnancy and the babys development. This flexibility will end on May 11, 2023. When all attachments have been created as electronic transactions, the option of filing a paper denial will end. Receive free diapers and baby wipes by quitting smoking! The requirement that, in order to treat patients in this state with telehealth, health care providers shall be fully licensed to practice in this state. When billing MO HealthNet for services provided to PE patients, pharmacy providers should make a copy of the PE-3 and PE3TEMP forms and maintain a copy in the pharmacy files for documentation of eligibility. Once you have logged on to the e-provider page, click on Provider Communications Management to send inquiries, or questions regarding proper claim filing instructions, claims resolution and disposition, and participant eligibility file problems. You will be asked to enter data just as you submitted to Medicare and the corresponding adjudication data (i.e., Reason and remarks codes, amounts assigned to these codes, etc.) For assistance call 1-855-373-4636 Or, visit your local Resource Center. Frequently Asked Questions to Assist Medicare Providers UPDATED. Denial code CO 15 means that the claim you entered has the wrong authorization number for a service or a procedure. . With the exception of certain hospice stays, nursing home room and board is covered under fee-for-service (FFS) regardless of whether the resident is in a Managed Care health plan. You can also subscribe for email alerts, continue to check this website, or follow the Department of Social Services on Facebook, Instagram, or Twitter for updated information as it becomes available. Annual income guidelines for all programs. This will provide the flexibility needed for more timely initiation of services for home health patients, while allowing providers and patients to practice social distancing. Correct claim and resubmit claim with a valid procedure code; How to Avoid Future Denials. TDD/TTY: 800-735-2966, Relay Missouri: 711, Support Investigating Crimes Against Children, Make an Online Payment to Claims & Restitution, Child Care Provider Business Information Solution, Information for Residential Care Facilities & Child Placing Agencies, Online Invoicing for Residential Treatment & Children's Treatment Services, Resources for Professionals & Stakeholders, Third Party Liability Contact Information, Webinar: National Childhood Lead Poisoning Prevention Education Webinar for Pediatricians, Bring Smiles Back to Missouri: Become a Medicaid Provider, Behavioral Health Services Request for Precertification, Dental Credentialing, Policy and Claims Processing Webinars, COVID-19: Registered Behavior Technician, Extended/Uninsured Womens Health Services COVID-19 Testing, COVID-19: DME: Multi-Function Ventilator. Missouri Department of Social Services is an equal opportunity employer/program. This site contains applications and requirements for enrollment. Information about RBT testing is available here: https://www.bacb.com/examination-information/. The Managed Care health plan will present information specific to their plan, and answer questions during their scheduled webinar. The instructions for these claim forms are located under the HELP feature available by clicking on the question mark in the upper right hand corner of the screen. Completion of the Risk Appraisal for Pregnant Women is mandatory in order to establish the at risk status of the patient and to bill the global prenatal or global delivery procedure code. The Education and Training Unit offers a variety of training opportunities and resources for providers. If the provider has not had a response from the insurance company prior to the 12-month filing limit, he/she should contact the Third Party Liability (TPL) Unit at 573/751-2005 for billing instructions. translations of web pages. including without limitation, indirect or consequential loss or damage arising from or in connection with use of the Google Translate Service. In addition this toll free number allows you to get a Prior authorization for certain drugs, diabetic supplies, smart pa for certain durable medical equipment items and certain radiology procedures that require a precertification. Effective May 12, 2023, the administration of the COVID-19 vaccine will be billed to the MCO. Call this number to discuss training options. Register Now! link at emomed.com. The COVID-19 PHE will expire on May 11, 2023. On May 11, 2023, MHD will follow CMS guidance for Medicare related to this flexibility. Visit https://mhdtrainingacademy.training.reliaslearning.com. Review Reason Codes and Statements | CMS - Centers for Medicare Your call will be put into a queue and will be answered in the order it was received. Submit a copy of your Medicare provider letter to the Provider Enrollment Unit or. If you are a provider that serves primarily rural populations in Missouri, are enrolled in MO HealthNet and provide primary and/or behavioral health care, please take our survey for more information. This enables providers to be up-to-date on the latest MO HealthNet changes. CALL : 1- (877)-394-5567. Income and asset (resource) limit guidelines for MO HealthNet for the aged, blind, disabled, and breast/cervical cancer groups. If you have a Medicare denial and a TPL denial, you will be required to add a second "Other Payer" header attachment and related detail attachment. Once the DCN is active you should reprocess any unpaid claims for the individual from the date range on the PE forms. 0000001661 00000 n PDF Medicaid NCCI 2021 Coding Policy Manual - Chap1GenCodingPrin Sample appeal letter for denial claim. Effective May 12, 2023, MO HealthNet will require a referring physician for claims submitted by independent laboratories for all COVID-19 testing. PDF Remittance Advice Manual Potentially, the claim will not process immediately, but the information can be used for reprocessing the claim in the coming days. Please note, for patients who have not filled an opioid through MO HealthNet in the past 90 days, the pharmacy will still need to run a 7-day fill prior to a full 30-day prescription, regardless of the MME. MO HealthNet does not require a prior authorization for opioid prescriptions less than 50 MME per day. The MO HealthNet Division (MHD) covers maternal depression screening procedure code 96161, which may be billed under the childs Departmental Client Number (DCN), for administering a maternal depression screening tool during a well-child visit. Any eligible pregnant woman who meets any one of the identified risk factors, as determined by the administration of the Risk Appraisal for Pregnant Women, is eligible for prenatal case management services and a referral should be made to a MO HealthNet participating prenatal case management provider. Claim Status Category Codes | X12 We are asking providers to help spread the word so Missourians can stay informed. The MO HealthNet participant must be at least 21 years of age at the time the consent is obtained and must be mentally competent. The COVID-19 public health emergency will expire on May 11, 2023. comprehensive substance treatment and rehabilitation (CSTAR). Timely Filing Criteria - Original Submission MO HealthNet Claims with Third Party Liability: Claims for participants who have other insurance and are not exempt from third party liability editing must first be submitted to the insurance company. Neither the State of Missouri nor its employees accept liability for any inaccuracies or errors in the translation or liability for any loss, damage, or other problem, All appropriate MO HealthNet participating providers are urged to perform risk appraisals on pregnant women during the initial visit and as changes in the patient's medical condition indicate. 4 The procedure code is inconsistent with the modifier used, or a required modifier is missing. As many as two in three youth with depression are not identified by their primary care providers and fail to receive any kind of care. In addition, some applications and/or services may not work as expected when translated. Additional information regarding why the claim is denied may be . Item billed was missing or had an incomplete/invalid procedure code; Next Step. The COVID-19 public health emergency will expire on May 11, 2023. OTs, PTs and SLPs are not permitted to perform assessments in nursing only cases. which have not been provided after the payer has made a follow-up request for the information The complete list of codes for reporting the reasons for denials can be found in the X12 Claim Adjustment Reason Code set, referenced in the in the Health Care Claim Payment/Advice (835) Consolidated Guide, and available from the . NCCI for Medicaid | CMS This information applies to MO HealthNet and MO HealthNet fee-for-service providers only. Fact sheet for State and Local Governments About CMS Programs and Payment for Hospital Alternate Care Sites. Auxiliary aids and services are available upon request to individuals with disabilities. If the required information is not present, the claim will be denied with a Claim Adjustment Reason Code or Remittance Advice Remark Code. To find a location near you, go to dss.mo.gov/dss_map/. 3823 0 obj <> endobj cannot. The PE form will list the participants case number (DCN) for claim processing. In addition, some applications and/or services may not work as expected when translated. endstream endobj 3834 0 obj <>/Size 3823/Type/XRef>>stream MO HealthNet has developed an index for historical and ongoing Hot Tips and a COVID-19 index for associated Hot Tips. Running the claim for cash and putting it on a patient account for future reprocessing, Create consistent documentation for claims affected, Set a reminder to reprocess (as soon as 5 days later or up to 30 days later). You may call a specialist at 573/751-2896. Excel Sheet showing ME Codes dated 08/01/2022 16.97 KB. Providers must enroll with Missouri Medicaid Audit and Compliance (MMAC) in order to be reimbursed for medical services provided to MO HealthNet participants. Remittance Advice Remark Codes and Claim Adjustment Reason Codes - Missouri Their telephone number is 1-800-766-0686. MO HealthNet Eligibility (ME) codes identify the category of MO HealthNet that a person is in. If the participant cannot tell you the name of the pharmacy that filled their last prescription, the provider may call the Pharmacy Help Desk toll free at 1-800-392-8030. Call the toll free number for emergency requests or fax non-emergency requests to initiate a request for essential medical services or an item of equipment that would not normally be covered under the MO HealthNet program. Register for a webinar today: Fact sheet: Expansion of the Accelerated and Advance Payments Program for . Questions may be directed to (866) 771-3350. The carrier does not send crossovers to MO HealthNet. Grievances. 6683. *Explain the business scenario or use case when the requested new code would be used, the reason an existing code is no longer appropriate for the code list's business purpose, or reason the current description needs to be revised. Healthy Blue is a Medicaid product offered by Missouri Care, Inc., a MO HealthNet Managed Care health plan contracting with the . Providers are cautioned that an approved authorization approves only the medical necessity of the service and does not guarantee payment. Therefore, providers must submit through the MO HealthNet billing Emomed web site at emomed.com. Medicaid denial reason code list | Medicare denial codes, reason Compare physician performance within organization. The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L35490 Category III Codes with the exception of the following CPT codes: 2021 CPT/HCPCS Annual code update: 0295T, 0296T, 0297T, and 0298T deleted. people with disabilities ME codes 04,13,16,23,33,34, 41,85,86, women receiving breast or cervical cancer treatment ME codes 83, 84, presumptive eligibility: ME codes 58,59,87,94. trailer Dentists: Please watch this video to hear from current and participating Missouri dental Medicaid providers, as well as others who are here to help and be resources for you! must. The following contacts are also available to assist providers: Wipro Infocrossing Healthcare Services, Inc. The list of topics and schedule is included in the attachment and on our MO HealthNet Provider Training Calendar. Information about Bright Futures screening services can be found on their website at: https://brightfutures.aap.org/clinical-practice/Pages/default.aspx. Coverage from MO HealthNet Fee-for-Service providers for all categories for: the aged (65+) - ME . Providers call (573) 751-2896 for questions regarding claims, eligibility and more. This 8 or 10-digit number will remain the participants processing information for MO HealthNet services for life, so once this information is received, the pharmacy can build insurance coverage into the pharmacy system for processing. If you are up to 36 weeks pregnant, a current tobacco user, quit since becoming pregnant or quit within three months of becoming pregnant, enroll now! PDF Non-Covered and Covered Codes Policy, Professional - UHCprovider.com In the CHIP premium program (ME codes 73,74,75,97, 9S). CO-16 M49 indicates an issue with the rate table in the provider's Medicaid profile, CO-16 MA130 indicates that there is incomplete information in the provider's Medicaid profile. You can help by reminding participants about their upcoming annual review dates. There are provisions for emergency situations that are referenced in Section 10 of the provider manual. Effective May 12, 2023, prior authorizations for all procedure codes managed by the MHDs Radiology Benefit Manager (RBM) will be approved for 30 days. A Sterilization Consent Form is required for all claims containing the following procedure codes: 55250, 58600, 58605, 58611, 58615, 58670, and 58671. The MO HealthNet Division maintains an Internet web site. There is not a separate telehealth fee schedule. Occupational, physical, and speech therapy in an IEP, Applied Behavior Analysis for Autism Spectrum Disorder, 0F* Foster Care Title IV-E/Independent-Former Foster Care (18-25) in an IMD, 5A* Adoption Subsidy Title IV-E in an IMD, 58^, 59*^ Presumptive Eligibility for Pregnant Women, 94^ Presumptive Eligibility for Show Me Healthy Babies, 64*,65* - Group Home Health Initiative Fund, 80^, 89^ Uninsured Womens Health Services. For initial assessments and reassessments, verbal or written orders for care/services must be obtained prior to delivery of service. As long as the date you provide a service is after the date on the PE-3 and PE-3 TEMP forms, MO HealthNet will guarantee reimbursement for any covered medication dispensed, including medications that generally require prior authorization. Each session is created and presented by Relias and all are available as live webinars and will be recorded so you can earn continuing education credit on your own time. Together, we will provide funding, education and training opportunities to introduce or enhance existing telehealth services for rural providers accepting Medicaid patients. Please see Section 1 of your provider manuals for a description of the ME /Plan Codes and explanation of benefit restrictions. Refer to the DME Provider Manual Section 13.15.B for details on the Direct Delivery Requirements and Section 7.2 for details on the CMN process.