Mental Health Physician Clinic
ldquoTraining on theIntegrated Behavioral Health
Services Regulationsrdquo
Resources
Resources
bullDHSSBH WebsitebullhttphealthhssstateakusdbhbullTraining Materials bullDocuments amp PublicationsbullFormsbullFAQrsquosbullRegulations bullLinks
Regulations Clarification Process1 Procedure for Providers to inquire about
meaning or applicability of BH Services Regulations
2 Mechanism for DHSSBH to explain (FAQ) or interpret (Clarification) BH Services Regulations
3 Method for compiling information leading to updates in Manual and potential revisions of BH Services Regulations
Regulations Clarification Cont
Procedure1 Provider completes amp submits Form2 DHSSBH staff researches question amp
develops recommended response3 DHSSBH Executive Team reviews edits
and approves response 4 DHSSBH staff posts response as FAQ on
website and informs Provider OR5 Publishes response as Clarification in
Billing Manual and informs ALL Providers
MHPC Requirements
Definition 7AAC 160990(b)(95)
ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Resources
Resources
bullDHSSBH WebsitebullhttphealthhssstateakusdbhbullTraining Materials bullDocuments amp PublicationsbullFormsbullFAQrsquosbullRegulations bullLinks
Regulations Clarification Process1 Procedure for Providers to inquire about
meaning or applicability of BH Services Regulations
2 Mechanism for DHSSBH to explain (FAQ) or interpret (Clarification) BH Services Regulations
3 Method for compiling information leading to updates in Manual and potential revisions of BH Services Regulations
Regulations Clarification Cont
Procedure1 Provider completes amp submits Form2 DHSSBH staff researches question amp
develops recommended response3 DHSSBH Executive Team reviews edits
and approves response 4 DHSSBH staff posts response as FAQ on
website and informs Provider OR5 Publishes response as Clarification in
Billing Manual and informs ALL Providers
MHPC Requirements
Definition 7AAC 160990(b)(95)
ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Resources
bullDHSSBH WebsitebullhttphealthhssstateakusdbhbullTraining Materials bullDocuments amp PublicationsbullFormsbullFAQrsquosbullRegulations bullLinks
Regulations Clarification Process1 Procedure for Providers to inquire about
meaning or applicability of BH Services Regulations
2 Mechanism for DHSSBH to explain (FAQ) or interpret (Clarification) BH Services Regulations
3 Method for compiling information leading to updates in Manual and potential revisions of BH Services Regulations
Regulations Clarification Cont
Procedure1 Provider completes amp submits Form2 DHSSBH staff researches question amp
develops recommended response3 DHSSBH Executive Team reviews edits
and approves response 4 DHSSBH staff posts response as FAQ on
website and informs Provider OR5 Publishes response as Clarification in
Billing Manual and informs ALL Providers
MHPC Requirements
Definition 7AAC 160990(b)(95)
ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Regulations Clarification Process1 Procedure for Providers to inquire about
meaning or applicability of BH Services Regulations
2 Mechanism for DHSSBH to explain (FAQ) or interpret (Clarification) BH Services Regulations
3 Method for compiling information leading to updates in Manual and potential revisions of BH Services Regulations
Regulations Clarification Cont
Procedure1 Provider completes amp submits Form2 DHSSBH staff researches question amp
develops recommended response3 DHSSBH Executive Team reviews edits
and approves response 4 DHSSBH staff posts response as FAQ on
website and informs Provider OR5 Publishes response as Clarification in
Billing Manual and informs ALL Providers
MHPC Requirements
Definition 7AAC 160990(b)(95)
ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Regulations Clarification Cont
Procedure1 Provider completes amp submits Form2 DHSSBH staff researches question amp
develops recommended response3 DHSSBH Executive Team reviews edits
and approves response 4 DHSSBH staff posts response as FAQ on
website and informs Provider OR5 Publishes response as Clarification in
Billing Manual and informs ALL Providers
MHPC Requirements
Definition 7AAC 160990(b)(95)
ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
MHPC Requirements
Definition 7AAC 160990(b)(95)
ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Definition 7AAC 160990(b)(95)
ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Qualified Professional Licensing Regulation
Licensed Psychologist 7AAC 110550
Licensed Psychological Associate AS 0886
Licensed Clinical Social Worker AS 0895
Licensed Physician Assistant 7AAC 110455
Licensed Advanced Nurse Practitioner
7AAC 110100
Licensed Psychiatric Nursing Clinical Specialist
AS 0868
Licensed Marital amp Family Therapist
AS 0863
Licensed Professional Counselor AS 0829
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
MHPC Requirements 7 AAC 135030
1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health
disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to
staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through
written agreement with a MHPC or other member of the MHPC staff
6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service
a could not otherwise be provided orb is provided at a location clinically more appropriate than
MHPC c reason that service was provided in alternate location or
via telemedicine is clearly documented in recipients clinical record
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
MHPC Requirements 7 AAC 135030
1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff
2 Direct supervision meansA Psychiatrist on premises to deliver medical services
at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine
the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary
and clinically appropriateF Assume professional responsibility for services
provided
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
MHPC Services
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Clinic Service Limits amp Requirements
A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year
1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document
providers qualifications to provide neuropsychological testing and evaluation services)
5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because
a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication
6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months
7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per
day
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Payment
If a physician provides clinic services in a MHPC the physician may submit a claim for payment
A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR
B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)
NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Mental Health Intake Assessment
A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining
a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan
See 7 AAC 135130 for more information on documentation
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Integrated Mental Health and Substance Use Intake Assessment
1 Documented in accordance with 7 AAC 135130 (Clinical Record)
2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of
active treatment as necessaryb Updated as new information becomes available
3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake
Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Psychiatric Assessments
ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo
A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and
experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Psychiatric Assessments Cont
Both types of Psychiatric Assessments must include
bull a review of medical amp psychiatric history or presenting problem
bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems
including functional impairmentsbull treatment recommendations
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Psychological Testing and Evaluation
ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo
Psychological testing and evaluation includes
bull the assessment of functional capabilities
bull the administration of standardized psychological tests
bull the interpretation of findings
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management
service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo
To qualify for payment a provider must monitor a recipient for the purposes of
1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the
recipients need and3 monitoring the recipients response to medication
includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Psychotherapy
ldquoThe department will pay a MHPC for one or more
of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo
insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Psychotherapy ClarificationBiofeedback or relaxation therapy may be
provided as an element of insight-oriented and interactive individual psychotherapy if
1 prescribed by a psychiatrist (if provided in MHPC)
2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions
a chronic pain syndromeb panic disordersc phobias
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis
intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of
1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the
short-term crisisrdquo
A MHPC is NOT required to use Dept form to document short-term crisis intervention
A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a
telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo
The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session
The facilitating provider is not required to document a clinical problem or treatment goal in the note
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Screening amp Brief Intervention
ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Screening amp Brief Intervention (conrsquot)
Brief intervention is motivational discussion focused on
raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Screening amp Brief Intervention (conrsquot)
MHPC must refer to appropriate program that will meet recipientrsquos needs if
1 Screening reveals severe risk of substance use
2 Recipient is already substance use dependent
3 Recipient already received SBIRT and was unresponsive
MHPC must document SBIRT in progress note
SBIRT does not require assessment or Tx Plan
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Documentation Requirements
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Clinical Record RequirementsThe clinical record must include
bullAn assessmentbullA behavioral health treatment plan that
meets the requirements of 7AAC 135120bullA progress note for each day the service is
provided signed by the individual providerbullMust reflect all changes made to the
recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the
active interventions that the provider provides to or on behalf of the recipient in order to document active treatment
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Treatment Plan
bull Documented in accordance with 7 AAC 135130 (clinical record)
bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal
representative (18 and older)bull Based upon the input of a Treatment Team if the
recipient is a child (under 18)bull Signed and supervised by psychiatrist operating
MHPC and by the recipient or the recipientrsquos parent or legal representative
bull Reviewed every 90-135 days to determine need for continued care
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Treatment Plan Documentation
bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related
to the findings of the assessmentbullThe services and interventions that will be
rendered to address the goalsbullThe name signature and credentials of
the psychiatrist operating MHPCbullThe signature of the recipient or the
recipientrsquos parent or legal representative
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a
recipient under 18 must include
bull The recipientbull The recipientrsquos family members including parents guardians
and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff
A behavioral health treatment team for a recipient under 18 may include
bull Representative(s) from alternative living arrangements including foster care residential child care or an institution
bull Representative(s) from the recipients educational system
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Treatment Team Cont
All members of treatment team shall attend meetings of the team in
person or by telephone and be involved in team decisions unless the clinical record documents that
1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being
2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or
3 weather illness or other circumstances beyond the members control prohibits that member from participating
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Progress Notes
7AAC 135130(8) Requires
bull Documented progress note for each service each day service is provided
bull Date service was providedbull Duration of the service expressed in service units
or clock time bull Description of the active treatment provided
(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward
treatment goalsbull Name signature and credentials of the individual
who rendered the service
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Medicaid Billing
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Medicaid is Payer of Last Resort
bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo
under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid
Military and Veteranrsquos Benefits Private Health Insurance
bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Behavioral Health Medicaid Payment
bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid
bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody
bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
CAMA
bullCAMA is the acronym for Chronic and Acute Medical Assistance
bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a
limited number of health conditions andHas very limited coverage
bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the
number of medications a person can receive in a month
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Medicaid Program Policies amp Claims Billing Procedures Manual
Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets
Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations
Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order
Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Services
New Codes Services Changing Services Codes
Code Service Description
H0031-HH
Integrated Mental Health amp Substance Use Intake Assessment
Q3014 Facilitation of Telemedicine
90846 Psychotherapy Family w out patient present
S9484-U6
Short-Term Crisis Intervention (15 min)
99408 Screening Brief Intervention amp Referral for Treatment
Code Description Change
H0031 Mental Health Assessment
bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate
90849 Psychotherapy Multi Family Group
bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Service Authorization bullAnnual Service Limits will switch from
CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records
currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change
bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135
days of planned services and will be submitted approximately 3 to 4 times annually
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website
bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your
agreement and acceptance of the copyright notice Claim form instructions
CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services
Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center
School Based Services)bull select ldquoForms
Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms
bull select ldquoUpdatesrdquo Manual replacement pages
bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver
bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical
support to accommodate electronic submission of claims and other transactions
bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider
communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program
integrity)
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Claims Billing and Payment Tools amp Support
bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra
Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800
bull Websitesbull ndash Fiscal Agent (ACS)
wwwmedicaidalaskacombull ndash DHSSDBH
wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12
MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT
bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Claims EditingAll edits are three-digit codes with explanations of how
theclaim was processed
ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service
ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)
The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within
thatspecific Remittance Advice
- Contact ACS Inc Provider Inquiry for clarification as needed
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Integrated BH Regulations TrainingClaims Adjudication Process
Flow
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Provider Appeals
REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180
days)Disputed recovery of overpayment (60
days)Three Levels of Appeals
First level appeals Second level appealsCommissioner level appeals
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
Recommend Billing Processesbull Read and maintain your
billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are
eligible to providebull Verify procedure codesbull Obtain Service
Authorization if applicable bull File your license renewals
andor certificationpermits timely (keep your enrollment current)
bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions
THANK YOU FOR ATTENDING
THANK YOU FOR ATTENDING