Family Planning Workshop

Family Planning Workshop

Presented by:Xerox State Healthcare, LLCProvider Relations

When online use: Ask Service Representative

[email protected]

[email protected]

Call Center 505-246-0710 or 800-299-7304

New Mexico Web Portal • Provider Information section • Links and FAQ section • Provider Login section

Resources

mailto:[email protected]


Important State Websites

STATE WEBSITE:PROGRAM POLICY MANUAL

• http://www.hsd.state.nm.us/mad/policymanual.html

BILLING INSTRUCTIONS• http://www.hsd.state.nm.us/mad/billinginstructions.html

REGISTERS AND SUPPLEMENTS:• http://www.hsd.state.nm.us/mad/registers/2012.html

http://www.hsd.state.nm.us/mad/policymanual.html

http://www.hsd.state.nm.us/mad/billinginstructions.html

http://www.hsd.state.nm.us/mad/registers/2011.html

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029 - Family Planning Medicaid

What is Category of Eligibility (COE) 029?

• Medical Assistance limited to Family Planning Services, including STD screenings and treatments.

• Fee For Service (FFS) Medicaid pays for family planning services.– Bill claims for clients with COE 029 to Xerox State Healthcare.

• Family Planning Waiver (COE 029) clients are never in any Managed Care Organizations (MCOs, i.e. SALUD!, CoLTS).

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What populations qualify for these services?

• Women transitioning from “Pregnancy Related Services Only” (COE 035) to FP (COE 029)

• Women of ages 18 - 50 who are at or below the 185% poverty level as determined by the Income Support Division (ISD).

• Females below the age of 18 may qualify for other COE to cover these services.

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Which services are covered?

Medical Claims and Institutional Claims: The system examines the revenue code, procedure code, and any related diagnosis codes on the line. The service is covered by the Family Planning Waiver if a combination of the following code sets are used to identify the service:• Procedure Code and the diagnosis code are on the following

approved code lists.

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Approved FPW Procedure Code List

Pregnancy Prevention Diagnoses

Pregnancy Prevention Diagnoses Continued

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Which services are covered? (continued) Institutional Claims only:• The revenue code and diagnosis are on the following approved code

lists.

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Which services are NOT covered by this COE?• Any service that is not listed as one of the aforementioned covered

services.

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0029 – Service not Family Planning Related

Why does this denial occur when the service was actually for Family Planning?• Procedure code, diagnosis code, or revenue code not recognized as

family planning related. If rendered service is family planning related, resubmit claim using alternate codes from approved list available. Do not bill Medicaid client for services that can be billed using an alternate approved codes.

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What if my patient develops a condition that needs treatment that is directly related to a family planning procedure, such as a post-operative infection after sterilization, or an abnormal pap; is that covered?

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Answer:• In these cases, submit the claim to Xerox State Healthcare and if

denied, appeal them to MAD with a cover letter, medical records, doctors' notes, and any conditions related to the family planning procedure. The Medical Assistance Division considers these claims on a case-by-case basis.

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029 - Family Planning MedicaidAnswer:• If your client receives an abnormal pap smear:– the pap reveals an STD, STD treatments are covered under COE

029 when billed using the current approved codes lists.– the pap smear indicates cervical cancer, she may also be eligible

for the Breast or Cervical Cancer Program (COE 052). Refer the patient to her ISD Case Worker to verify eligibility requirements.

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My client has the Family Planning COE (029) and desires a treatment that is covered by this COE however my facility doesn’t offer the necessary service. What should I tell the client?• As a provider it is important to be aware of all the services that are

offered under this COE, even those you don’t offer yourself. • Refer the patient to a Medicaid Provider that can perform the necessary

Family Planning Covered service.

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My client has the Family Planning COE (029) and desires a treatment that is not covered by this COE. What should I tell the client?• If the client's financial situation has changed since last application, advise

her to see her ISD caseworker. She may now qualify for additional benefits that cover the service.

• If the patient’s financial situation only permits them to qualify for COE 029 – Family Planning Waiver only, refer the patient to an FQHC facility which have all agreed to provide services on a sliding scale.

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My client has the Family Planning COE (029) and desires a treatment that is not covered by this COE. What should I tell the client? (continued)• If the patient prefers to utilize your facility to obtain these non-covered

services advise the patient she will be financially responsible for the services. – Have patient sign in writing indicating that she will be financially

responsible for the specific non-Family Planning service that will be performed for your records.

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029 - Family Planning MedicaidAlways remember to:• Check eligibility prior to performing services.• Ensure all services are covered under this COE using the current

approved code lists prior to performing services.• Be aware of alternatives to offer to patients on the COE 029 – Family

Planning Waiver such as FQHC facilities to establish an ongoing medical home for routine medical, dental, vision, behavioral, hearing, and all other non-family planning services.

• Remind COE 035 Medicaid post partum recipients that they will be automatically enrolled under COE 029 - Family Planning Waiver services approximately 2 months from their delivery.

When online use: Ask Service Representative

[email protected]

[email protected]

Call Center 505-246-0710 or 800-299-7304

New Mexico Web Portal • Provider Information section • Links and FAQ section • Provider Login section

Resources



Documents

Family Planning Workshop