FY2016 DCFS WEB-BASED MEDICAID BILLING SYSTEM UPDATE TRAINING. July 21, 2015 July 23, 2015 August 6, 2015

Transcription

1 FY2016 DCFS WEB-BASED MEDICAID BILLING SYSTEM UPDATE TRAINING July 21, 2015 July 23, 2015 August 6, 2015

2 Welcome Introduction of Speakers Webinar Housekeeping Overview of Agenda Highlights Transition Walk-Through of System Screens Provider Q&A AGENDA OVERVIEW 2

3 User Interface Changes Streamlined Site and Service Management ICD-10 Readiness Front End Error Controls Error Correction and Void/Adjust Process Changes Service and Error Reports to Include $$ Values RSA Procedure Codes for Eligible Contract Types Prevention Diagnosis HIGHLIGHTS 3

4 RSA PROCEDURE CODES DHS 59 Illinois Administrative Code 132, Section (July, 2014) Rehabilitative Services Associate An RSA must be at least 21 years of age, be a high school graduate or have a GED certificate, have demonstrated skills in the field of services to adults or children, have demonstrated the ability to work within the Provider's structure and accept supervision, and have demonstrated the ability to work constructively with Clients, treatment resources and the community... 4

5 RSA PROCEDURE CODES Eligibility to use the RSA-level Procedure Codes: Non-Residential Part 132 Medicaid contract type Allowed by DCFS Program Plan Included on Medicaid Certificate Provided and documented in compliance with Part 132 Provided July 1, 2015 or later RSA-level services to be included: Case management - Client-centered consultation (RSA) - T1016 TG Community Support, Individual (RSA) - H2015 HM Community Support, Group (RSA) - H2015 HM HQ 5

6 PREVENTION DIAGNOSIS DHS 59 Illinois Administrative Code 132, Section (July, 2014) Medical Necessity or Medically Necessary For Clients under the age of 21, medical necessity or medically necessary may additionally mean that the Client has more than one documented criteria of a mental illness or serious emotional disorder as listed in the DSM-IV that is likely to impact the Client's level of role functioning across critical life areas and needs a Medicaid reimbursable Part 132 mental health service recommended by the completion of an approved Healthy Kids screen by a physician or the completion of a Mental Health Assessment and included in an ITP that could not have been omitted without adversely affecting the Client's level of functioning 6

7 PREVENTION DIAGNOSIS Service Definition and Reimbursement Guide (September, 2014) Reporting the Diagnosis Code for Medicaid Eligible Individuals Under the Age of 21 In the event that services are provided to an individual that qualifies in this manner, the provider shall report the appropriate ICD-9 (or ICD -10 effective 10/1/15) diagnosis code for which the individual demonstrates more than one criterion as the individual s diagnosis code. In addition, to identify the preventative nature of the service being performed, the provider must report the following data in the NTE01 and NTE02 loops of the 2300 segment. NTE 01: Provider must report DGN NTE 02: The Provider is allowed an 80 byte field. This field should be populated with the word, Prevention when the provider is serving an individual under the age of 21 that meets the, more than one criterion standard for Medical Necessity from 59 Ill. Adm. Code, Part

8 Existing Data will be uploaded into the new system by DCFS: Medicaid Contracts Certified Sites and MCMH Services Client Headers FY15 and FY16 Client Services Initially, Logins and Passwords will be the same Current Import file structure will be compatible with new system through 01/01/16 TRANSITION 8

9 Walk-Through of System Screens Questions and Answers 9

10 Please complete the brief satisfaction survey that you will receive via following this webinar. Recording of this Webinar will be posted at For additional information and assistance, contact your Agency s Infant-Parent Institute consultant at (217)