Once the application is completed, you will be assigned a user ID and password. *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. The three character ID the MO HealthNet program uses to identify the billing agency or provider to whom the magnetic cartridge is sent. 3823 13 HHAs are expected to continue to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. In addition, some applications and/or services may not work as expected when translated. Children and young adults under age 21 receive the full comprehensive benefit package, unless they are: Adults age 21 and over who are receiving federally matched Medicaid based on blindness (ME codes 03, 12, 15), pregnancy (ME codes 18, 43, 44, 45, 61, 95, 96, 98), or are in a Medicaid vendor nursing facility receive the full comprehensive benefit package, except: Adults (age 21 and over) receiving federally matched Medicaid who are not in a nursing facility or receiving based on blindness or pregnancy have a limited benefit package. Correct claim and resubmit claim with a valid procedure code; How to Avoid Future Denials. 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. The remittance advice lists the Claim Adjustment Reason Codes and Remittance Remark Codes showing why the claim failed. The Provider Resource Guidecontains MO HealthNet division contact information including provider communication, pharmacy/clinical services, exception process, participant services, and a list of ME Codes with benefit package information. 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. If a child who is in the legal custody of the Department of Social Services Childrens Division (CD) is hospitalized but is no longer in need of medical care at the hospital, and that child is pending a placement, CD will reimburse the provider at the same rate the hospital would receive per day for an inpatient admission. Date and time: Thursday, May 4, 2023 2:00 -3:30 PM Eastern Time (US & Canada). The Google Translate Service is offered as a convenience and is subject to applicable Google Terms of Service. Effective July 1, 2022, MO HealthNet Division (MHD) implemented changes to maximum daily quantities for certain procedure codes. The Managed Care health plan will present information specific to their plan, and answer questions during their scheduled webinar. See the MO HealthNet Home Health Provider Bulletin dated August 24, 2022. In which case, post-discharge care is required. 0000000016 00000 n You should not rely on Google Call or send an e-mail for help in establishing the required electronic claims format, network communication, or assistance with the MO HealthNet billing web site and other simple help tips. 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! including without limitation, indirect or consequential loss or damage arising from or in connection with use of the Google Translate Service. Services requiring pre-certification can be found on the Medical Pre-Certification Criteria Documents page. The MO HealthNet Division (MHD) requires that providers follow the Bright Futures/ American Academy of Pediatrics (AAP) Periodicity Schedule, which is available at https://www.aap.org/en/practice-management/). Missouri Department of Social Services is an equal opportunity employer/program. What happens next: **A quick reference table similar to the one below would be helpful to share with staff along with sample PE form **. There are currently 68 ME codes in use. The PE form will list the participants case number (DCN) for claim processing. Visits must be physician ordered and included in a plan of care. 0000000571 00000 n home and community based waiver services (authorized by DMH Division of Developmental Disabilities or Department of Health and Senior Services). Information regarding the IVR is located in Section 3 of the provider manuals. Providers must enroll with Missouri Medicaid Audit and Compliance (MMAC) in order to be reimbursed for medical services provided to MO HealthNet participants. PE ensures reimbursement to MO HealthNet pharmacy providers for any covered medication dispensed to the patient. The online PASRR process is automated and can be found on COMRUs webpage: https://health.mo.gov/seniors/nursinghomes/pasrr.php, MO HealthNets Preadmission Screening and Resident Review (PASRR) policy is accessible in Section 13.7 of the MO HealthNet Nursing Home manual at: http://manuals.momed.com/collections/collection_nur/print.pdf, DMH PASRR information is accessible at https://dmh.mo.gov/dev-disabilities/programs/pasrr-level-ii-assessments. MO HealthNet Eligibility (ME) Codes in regards to DMH Consumers. More information on post-discharge visits can be found in Section 13.15 of the Home Health Manual found at: https://manuals.momed.com/collections/collection_hom/print.pdf. Written inquiries are also handled by the Provider Communications Unit and can be mailed to the following address: Provider Communications Unit PO Box 5500 Jefferson City, MO 65102-5500. Many times a provider may learn of a change in insurance information prior to the MO HealthNet agency since the provider has an immediate contact with their patients. A graduate LPN or graduate RN may provide nursing services (during this public health emergency) until receipt of the results of the first licensure examination taken by the graduate nurse or until ninety (90) days after graduation, whichever comes first. Medicare Advantage/Part C plans do not forward electronic crossover claims to MO HealthNet. TDD/TTY: 800-735-2966, Relay Missouri: 711 This modification allows an OT, PT, or SLP to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. Effective May 12, 2023, MO HealthNet will require providers to obtain prior authorization for the above listed Chest CT Scan HCPCS codes when the above listed COVID-19 related diagnosis codes are present. The provider will receive a Medicare Remittance Advice that indicates if Medicare has denied a service. A new or corrected claim form . MO HealthNet requires no additional paperwork from your office to cover the Dexcom GCM for eligible participants. The current review reason codes and statements can be found below: Please email PCG-ReviewStatements@cms.hhs.gov for suggesting a topic to be considered as our next set of standardized review result codes and statements. (IA, KS, MO, NE Providers) J5 MAC Part B IA, KS, MO, NE Providers. The Healthcare Auditing and Revenue Integrity report, lists the average denied amount per claim due to missing modifiers. Only the billing provider may reverse a point of sale claim. Complete fee schedules of outpatient hospital procedure codes with the MO HealthNet allowed amount under the OSFS methodology can be found at the following links: Effective immediately, providers should begin using the updated Behavioral Health Services Request for Precertification form for psychotherapy/counseling services that require precertification. Claims for dates of service July 1, 2022 and forward with units above the new maximum daily quantity will deny. To find a location near you, go to dss.mo.gov/dss_map/. Effective May 12, 2023, the signature of the participant or their designee is required on the delivery slip. MO HealthNet reimburses up to two post-discharge skilled nurse visits in the home within two weeks of an early inpatient discharge for a stay of less than 48 hours for a vaginal delivery and for a stay of less than 96 hours for a cesarean section delivery when provided by a home health agency. Issuing a permanent card instead of mailing a card each month saves printing and postage fees. These services are exempt from the home-bound requirement. occupational, physical, and speech therapy. Register for a webinar today: There are provisions for emergency situations that are referenced in Section 10 of the provider manual. 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 0000000910 00000 n The Sterilization Consent Form must be completed and signed by the participant at least 31 days, but not more than 180 days, prior to the date of the sterilization procedure. Providers call (573) 751-2896 for questions regarding claims, eligibility and more. non-emergency medical transportation (NEMT). Industry practices are constantly changing and Healthy Blue reserves the right to review and revise its policies periodically. There are circumstances where the service does not translate correctly and/or where translations may not be possible, such Procedure code was invalid on the date of service. Copies of remittance advices, return-to-provider letters, claim confirmation reports, or letters from the MO HealthNet Division may serve as documentation. The submission of the 485 Plan of Care form may be delayed; however, it must be submitted within 30 days after the end of the public health emergency. Contact Provider Communications Interactive Voice Response (IVR) system at (573) 751-2896. Instead, HIPAA compliant Remittance Advice Remark and Claim Adjustment Reason Codes are used. Healthy Blue Friday, April 14, 2023 - 12:00 p.m. to 1:00 p.m. Home State Health Friday, April 21, 2023 - 12:00 p.m. to 1:00 p.m. United Healthcare Friday, April 28, 2023 - 12:00 p.m. to 1:00 p.m. MO HealthNet Friday, May 12, 2023 - 12:00 p.m. to 1:00 p.m. On March 20, 2020, in response to the COVID-19 outbreak and due to the closure of testing centers administering the Registered Behavior Technician (RBT) exam, the MO HealthNet Division (MHD) published a provider hot tip temporarily waiving the RBT requirement for technicians who met all other requirements but had not taken the RBT exam. Inpatient hospital admissions must be certified by Conduent (formally Xerox Care and Quality Solutions), the organization responsible for admission certification. Therefore, providers must submit through the MO HealthNet billing Emomed web site at emomed.com. 3835 0 obj <>stream MO HealthNet has developed an index for historical and ongoing Hot Tips and a COVID-19 index for associated Hot Tips. 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. During the COVID-19 public health emergency (PHE), if a participant was enrolled in a Managed Care Organization (MCO), the administration of the COVID-19 vaccine was billed to the MO HealthNet Fee-for-Service program, and not to the MCO. The program is also known as the Early Periodic Screening, Diagnostic and Treatment (EPSDT) program. This toll free number is available to MO HealthNet participants regarding their requests for access to providers, eligibility questions, covered/non-covered services or unpaid medical bills. 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. Billing and Coding Guidance. Prior authorization will be completed by the Bureau of Special Health Care Needs upon receipt of the 485 Plan of Care. As a reminder, an approved precertification approves only the medical necessity of the service and does not guarantee payment. The requirement that physicians must have an established relationship with the patient before providing services via telehealth, per RSMo. This includes waiving the requirement for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time. Enroll in Baby & Me-Tobacco Free and access one-onone phone or video counseling from the comfort of your home, a plan to support and help you quit smoking and up to $350 in gift cards for diapers and baby wipes. MO HealthNet will also present information and resources on May 12, 2023, and be available to answer questions. 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, The criteria for an early inpatient discharge and the post-discharge visits must be met. Healthy Blue is a Medicaid product offered by Missouri Care, Inc., a MO HealthNet Managed Care health plan contracting with the . 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, MO HealthNet provider enrollment application site, Frequently Asked Provider Enrollment Questions, Medical Pre-Certification Criteria Documents. This flexibility will end on May 11, 2023. Coverage from MO HealthNet Fee-for-Service providers for all categories for: the aged (65+) - ME . The MO HealthNet participant must be at least 21 years of age at the time the consent is obtained and must be mentally competent. Very soon, the Family Support Division (FSD) will be required to check the eligibility of all MO HealthNet (Missouri Medicaid) participants, including Managed Care health plan members of Healthy Blue, Home State Health, and United Healthcare. The four hours of orientation training for new employees is waived with the exception of child abuse/neglect indicators and reporting, and universal precaution procedures. 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. 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.) occupational, physical, and speech therapyare only covered as an outpatient hospital or home health service; social worker/counselor services are not covered; vision care for pregnant women is limited to one exam per year and glasses are limited to one pair every two years. 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. (MO HealthNet representatives cannot grant access to an NPI, only the Provider Administrator can do this. Annual Reviews Coming: Partners & Providers: Help Spread the Word! 03 . During the COVID-19 public health emergency, effective with dates of service on or after March 1, 2020, the state plan allowed MO HealthNet to reimburse all providers 100% of the Medicare rate for COVID-19 testing and specimen collection codes. MO HealthNet eligibility may be verified through the following eligibility verification system 24 hours per day, 7 days per week: MO HealthNet Eligibility (ME) /Plan Code indicates the eligibility group or category of assistance under which an individual is eligible. You may call a specialist at 573/751-2896. This flexibility will end on May 11, 2023. If a patient presents a pharmacy provider with a PE-3 or PE-3 TEMP, the pharmacy can bill for covered medications provided to the patient. Employees are not required to retroactively complete the four hours of orientation training waived between March 17, 2020 and May 11, 2022. Ask.MHD@dss.mo.gov. The forms, however, are valid once issued and guarantee eligibility after the date on the form. <]>> This function is available for virtually all claims originally submitted electronically or on paper. We are asking partners, advocates, providers, and friends to help spread the word so Missourians can stay informed. The COVID Public Health Emergency will expire on May 11, 2023. The Risk Appraisal for Pregnant Women form must be sent directly to the enrolled MO HealthNet Case Management Provider of the patient's choice and a copy filed in the patient's medical record. Reason Code: 181. During the COVID-19 public health emergency (PHE), MO HealthNet (MHD) did not require providers to obtain prior authorization for Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes were present: B34.2, B97.29, J12.89, J20.8, J22, J40, J80, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.8, P22.0, P28.5, R05, R06.02, R09.02, R50.9, Z03.818, Z09, Z20.828, Z86.19, Z11.52, Z20.822, Z86.16, M35.81, M35.89 and J12.82. The COVID PHE will expire on May 11, 2023. Program restrictions such as age, category of assistance, managed care, etc., that limit or restrict coverage still apply and restricted services provided to participants are not reimbursed. ex0q 184 n767 billing provider not enrolled with tx medicaid deny ex0s 45 pay: auth denial overturned - review per clp0700 pend report pay ex0u 283 n767 attending provider not enrolled with tx medicaid deny . you received on your Medicare Remittance Advice. You should not rely on Google The flexibility allowed providers to treat patients in this state if they are licensed in the state in which they practice. select a code list from the pulldown menu. The MO HealthNet Division maintains an Internet web site. Excel Sheet showing ME Codes dated 08/01/2022 16.97 KB. and how to make it work in my pharmacy, Behavioral Health Services Reminder on Maximum Quantity Changes Effective July 1, 2022, Nursing Home Coverage for Participants within the Adult Expansion Group (E2) and Managed Care, Maternity Stays and Post-Discharge Home Visits, How to File a Claim with MHD as the Tertiary Payer, The 2022 2023 Respiratory Syncytial Virus (RSV) season is winding down, Childrens Division Legal Custody Youth and Inpatient Stay When Not Medically Necessary.