PDF Reimbursement Policy - Healthy Blue MO xb```b``a`f`` H{ZiovL ]q9JuM oq=rTtIL}o90@ths#v}=bb|( }$}k Nursing care by a graduate LPN or graduate RN will be allowed. Option 6 is only for questions that do not fall in to the five categories above. This information is provided in Section 4 of the provider manuals. 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. This information could change at any time. Timely Filing Adjustments: Adjustments to a paid claim must be filed within 24 months from the date of the remittance advice that shows payment. MO HealthNet covers the continuous glucose monitor (CGM) Dexcom without prior authorization for ALL participants prescribed a daily regimen of rapid-acting or short-acting insulin. The following services are excluded from managed care and are always covered fee-for-service: For children state custody or adoption subsidy, all behavioral health services are covered fee-for-service. The COVID-19 public health emergency will expire on May 11, 2023. . **A quick reference table similar to the one below would be helpful to share with staff along with sample PE form **. To file by phone, call Member Services at 833-388-1407 (TTY 711). The carrier does not send crossovers to MO HealthNet. 03 . There is not a separate telehealth fee schedule. If a denial occurs when reprocessing call or submit a backdate request to MO HealthNet Pharmacy Administration. Due to the CO (Contractual Obligation) Group Code, the omitted information is the responsibility of the provider and, therefore, the patient cannot be billed for these claims. In the CHIP premium program (ME codes 73,74,75,97, 9S). Effective May 12, 2023, the administration of the COVID-19 vaccine will be billed to the MCO. (MO HealthNet representatives cannot grant access to an NPI, only the Provider Administrator can do this. COVID-19: Certificate of Medical Necessity Form (CMN) Signature Requirement: COVID-19: COVID-19 Testing and Specimen Collection Reimbursement, COVID-19: 1135 Waiver for Pre-Admission Screening and Resident Review (PASRR), COVID-19: COVID-19 Testing and Specimen Collection, COVID-19: DME: Delivery Slip Signature Requirement, What is MO HealthNet Presumptive Eligibility? Texas Texas utilizes a Covered Codes List Per Texas Medicaid Health Plan, effective for dates of service on or after January 1, 2015, . Missouri Department of Social Services is an equal opportunity employer/program. 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.) Enter in the ICN that supports timely filing and choose the Timely Filing button, located in the toolbar at the top of the page.The ICN is then documented in the Previous ICN field located at the top of the claim. Partners & Providers: Help Spread the Word. Medicaid Claim Adjustment Reason Code:B13 - thePracticeBridge A new or corrected claim form . Coverage from MO HealthNet Fee-for-Service providers for all categories for: the aged (65+) - ME . The first post-discharge visit shall be provided within 48 hours of an inpatient discharge unless otherwise ordered by a physician and the second post-discharge visit, if appropriate (e.g., breast feeding not well established) shall be provided within two weeks of an inpatient discharge. Certain DME requires a CMN. When the claim is retrieved, the fields will automatically be populated with the information entered on the original claim. 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. Industry practices are constantly changing and Healthy Blue reserves the right to review and revise its policies periodically. The MO HealthNet billing web site at www.emomed.com has a timely filing option available to providers. With the implementation of HIPAA national standards, previously used MO HealthNet edits and EOBs will no longer appear on Remittance Advices. Common Reasons for Denial. Frequently Asked Questions to Assist Medicare Providers UPDATED. 0000002479 00000 n 4 : X(9) The identifying number of the provider as assigned by the MO HealthNet program. Start: 01/01/1995. PLEASE READ THIS DISCLAIMER CAREFULLY BEFORE USING THE SERVICE. This information applies to MO HealthNet and MO HealthNet fee-for-service providers only. comprehensive psychiatric rehabilitation (CPR). Record Type Code : 13 . 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 Eligibility (ME) codes identify the category of MO HealthNet that a person is in. Together, we will provide funding, education and training opportunities to introduce or enhance existing telehealth services for rural providers accepting Medicaid patients. Effective May 12, 2023, this requirement will no longer be waived. Explore our communications plan, along with helpful tools and resources, in our, Reminding individuals to update their contact information. by ANGELA WILSON Pharmacy Program Manager, MO HealthNet & ERICA MAHN, PharmD, BC-ADM Executive Director of Community Pharmacy Services at Alps Pharmacy. Services requiring pre-certification can be found on the Medical Pre-Certification Criteria Documents page. Each plan, including MO HealthNet, has their own credentialing, policy, and claim processing guidelines. You should not rely on Google These generic statements encompass common statements currently in use that have been leveraged from existing statements. An identification card does not show eligibility dates or any other information regarding restrictions of benefits or third party resource information. 0000002937 00000 n There is a Help feature available by clicking on the question mark in the upper right hand corner. 0000001661 00000 n 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. 02 : Provider Number . There are circumstances where the service does not translate correctly and/or where translations may not be possible, such There will be four webinars, each one featuring a different MO HealthNet Managed Care health plan. During pregnancy, mothers also need more folic acid and iron than usual. Participants who are enrolled in a Managed Care health plan, and who are seeking admission into a nursing home, will remain in a their Managed Care health plan until a nursing home level of care is determined, or for 60 calendar days, whichever comes first. All claims processed by MO HealthNet are listed on the providers remittance advice. Register Now! link at emomed.com. Providing the service as a convenience is The IVR provides answers to such questions as participant eligibility, last two check amounts, and claim status using a touch-tone telephone. The providers Medicare identification number is not on file in the MO HealthNet Division provider files. 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. 0000001152 00000 n Telehealth services may be provided to a MHD participant, while the participant is at an originating site, and the provider is at another location (the distant site.) Emomed The program is also known as the Early Periodic Screening, Diagnostic and Treatment (EPSDT) program. 0000000016 00000 n MHD did not require additional CMS flexibility for these options, and they will continue. X(2) The two digit code that identifies the type of record (in this . accurate. More than 1.4 million Missourians have healthcare coverage through MO HealthNet and will be impacted by this change. Please note that claims may be reversed up to 60 days from the original date of service. Provider FAQ | Missouri Department of Social Services trailer Based on close monitoring of local RSV activity MHD will end the RSV prophylaxis prior authorizations of Synagis on 2/28/2023. Billing and Coding Guidance | Medicaid 0000001918 00000 n Information regarding the IVR is located in Section 3 of the provider manuals. Procedure code was invalid on the date of service. Effective May 12, 2023, the state plan will require MO HealthNet to reimburse for COVID-19 testing and specimen collection codes performed in the outpatient setting 90% of the Medicare rate and independent laboratories 80% of the Medicare rate. not an endorsement of the product or the results generated and nothing herein should be construed as such an approval or endorsement. By selecting a language from the Google Translate menu, the user accepts the legal implications of any misinterpretations or differences in the translation. . Prior authorization will be completed by the Bureau of Special Health Care Needs upon receipt of the 485 Plan of Care. This information applies to MO HealthNet and MO HealthNet fee-for-service providers only. 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. You can help by reminding participants about their upcoming annual review dates. Compare physician performance within organization. Fee-for-Service. The Department of Social Services issues a permanent MO HealthNet identification card for each MO HealthNet participant. All MO HealthNet eligibility requirements for Family Healthcare Programs. Provider manuals, bulletins, e-mail blast, fee schedule, forms, training booklets, hot tips, and frequently asked questions are located on this web site. The list of topics and schedule is included in the attachment and on our MO HealthNet Provider Training Calendar. If you have questions or your pharmacy has difficulty processing claims for individuals with PE, contact MO HealthNet Pharmacy Administration at (573) 751-6963 or MHD.PharmacyAdmin@dss.mo.gov. MO HealthNet managed care health plans are responsible for providing information to their providers in accordance with MO HealthNet managed care contracts. Income and asset (resource) limit guidelines for MO HealthNet for the aged, blind, disabled, and breast/cervical cancer groups. 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. This flexibility will end on May 11, 2023. The non-COVID-19 index location has not moved; it is also located below for quick reference. Medicaid denial reason code list | Medicare denial codes, reason This list is not all encompassing but may provide providers with helpful contact information. These screenings are designed to identify health and developmental issues as early as possible. 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. NCCI for Medicaid | CMS 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. Explanations of Remittance Advice Remark Codes and Claim Adjustment Reason Codes are available through the Internet at: http://www.wpc-edi.com/reference/. 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. Low-income New Yorkers win the right to a root canal Use this web site for claim submissions; eligibility verification; claims, prior authorization, and attachment status; and check amount inquiries. Fact sheet: Expansion of the Accelerated and Advance Payments Program for . The following contacts are also available to assist providers: Wipro Infocrossing Healthcare Services, Inc. Information for current providers is also available for those who may need to change an address or make other changes. Providers may send/receive secure e-mail inquiries through the MO HealthNet web portal at emomed.com. Auxiliary aids and services are available upon request to individuals with disabilities. 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.