Front Office And Intake Review

							Front Office And Intake
                Review
Overview
 Successful Medicaid billing starts at
  intake.
 From the beginning, you need to
  know a lot about your client’s
  Medicaid eligibility status and
  Medicaid benefits



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Overview
   If you do not get all the information
    you need…
      Your payment could be delayed
      You may not get paid at all




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Overview
You need to know the following
  things:
 Does the client have Medicaid
  eligibility for the date(s) of service?
 Is the client enrolled in SALUD! or
  fee-for-service Medicaid on the
  date(s) of service?

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Overview
 Does the client have limited benefits
  under Medicaid?
 Does the client have a category of
  eligibility that requires payment of a
  copay?
 Is the client covered by Medicare?




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Overview
   Is the client covered by a
    commercial insurance plan (Third
    Party Liability – TPL)?




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Overview
 Topics in this presentation will include:
  SALUD! enrollment basics
  newborns and SALUD! enrollment
  other coordinated care programs in the
   Medicaid program
  TPL and Medicare
  Categories of eligibility and limited
   benefits.


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    MEDICAID POLICY
    MANUAL
 Program Policy Manuals and Billing
  Instructions are available from these
  HSD web addresses:
 Program manuals:
http://www.state.nm.us/hsd/mad/ProgManInd
  ex.htm
 Billing instructions:
http://www.state.nm.us/hsd/mad/OtherDocs/
  BillingInstructions.htm


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Step 1 – Check Eligibility
 The MOST important thing you can
  do prior to seeing a Medicaid client
  is confirm their Medicaid eligibility.
 The Medicaid eligibility card is NOT a
  guarantee of Medicaid eligibility.




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Step 1 – Check Eligibility
   You MUST check a client’s Medicaid
    eligibility, even if he presents his
    Medicaid card.




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  Ways to Check
  Eligibility
MedicaidEligibility Verification Services
(MEVS) – See handout for list of MEVS
vendors.
Automatic Voice Response System
(AVRS) – (505) 246-2219, (800) 820-
6901.
          Help Desk – (505) 246-2056,
Eligibility
(800) 705-4452
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Ways to Check
Eligibility
Online Eligibility Verification – ACS
website – coming in late June 2006
Please note that this tool is being
provided FREE of charge!!




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Reasons to use the
ACS AVRS
 Use the AVRS for fast, complete
  Eligibility Inquiries
 Eligibility inquiries can be quick and
  convenient using the AVRS.
 The AVRS is free!
 The AVRS is available 24 hours per
  day, 7 days per week!

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Ways to Check
Eligibility - AVRS
   The AVRS gives you ALL the information
    you need!
      Medicaid eligibility

      Benefit limits, if any, i.e., Pregnancy
       only, Family Planning, and QMB
      Co-pay information

        •Medicare coverage
        •Commercial insurance coverage

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Ways to Check
Eligibility - AVRS
 SALUD! enrollment information
    * NMRx enrollment information

 The AVRS gives you an “audit”
  number that can be used to trace
  back to the inquiry record should
  there be a discrepancy (a call to our
  help desk cannot be traced back
  should there be a discrepancy.)
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Ways to Check
Eligibility - AVRS
 The AVRS gives you “real time”
  information. It uses exactly the
  same, “real time” information a help
  desk representative sees.
 The AVRS allows 10 inquiries per
  call!
 NO wait time on the AVRS!


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Ways to Check
Eligibility - AVRS
 Phone lines into the AVRS have
  recently been expanded.
 No more fast busies!




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Ways to Check
Eligibility - AVRS
   Before calling the eligibility help
    desk, please consider using the
    AVRS. For full instructions on how to
    use the AVRS, please go to the
    following web address:
    http://nmmedicaid.acs-inc.com/pubs.html




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ELIGIBILITY INFO
   Step One: Is the client eligible for
    Medicaid on the date of service?
        Determine if the client has Medicaid
         eligibility on the date of service




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ELIGIBILITY INFO
   What happens to a claim billed to
    ACS if the client is not eligible for
    Medicaid benefits on some or all of
    the dates of service?




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ELIGIBILITY INFO
   The claim denies for the following
    reasons:




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0141– Client ID not on file
“Client not found. The patient’s
Medicaid ID# is on the claim but
cannot find a matching number in
the system”
This means the client ID was
included on the claim, however that
ID is not on file.


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0143 - Client not
Eligible
Client not eligible. The patient does not
have Medicaid eligibility to cover the
dates of service billed
The client ID was included on the claim
and the client is on file, however, the
client does not have Medicaid eligibility
for that DOS.

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0222 – Name/DOB
Mismatch
 Client name or birth date is
incorrect or does not match the client
record on file.
 This can happen if the ID number,
name or date of birth on the claim
has been entered incorrectly. Be sure
to confirm this information on the
Medicaid card when checking
eligibility.
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SALUD! Enrollment
   Step Two: Is the client enrolled in a
    SALUD! Managed Care Organization
    (MCO) on the date of service?
        If the client is in SALUD!, you must
         follow the SALUD! MCO’s rules and bill
         services to the MCO.




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SALUD! Enrollment
   If the client is not in SALUD!, you must
    bill according to the Medicaid Fee-for-
    Service program’s rules and you must
    bill services to ACS.




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SALUD! Enrollment
  The SALUD! MCOs are Lovelace, Molina
   and Presbyterian
  Two-thirds of Medicaid clients are
   enrolled in a SALUD! MCO.




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SALUD! ENROLLMENT
  Native Americans are not automatically
   enrolled in SALUD! but may choose to
   enroll in SALUD!
  Medicare/Medicaid dual eligibles are
   NOT enrolled in SALUD!
  Clients eligibile for family planning
   services only are not enrolled in
   SALUD!


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SALUD! ENROLLMENT
   SALUD! Enrollment Issues
      Clients are enrolled in SALUD! at the
       end of each month for the upcoming
       month.
      A client who has lost her eligibility
       when the enrollment process runs will
       NOT be enrolled in SALUD! for the next
       month.


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SALUD! ENROLLMENT
   SALUD! Enrollment Issues
      If the client’s eligibility is re-certified,
       the client will be enrolled during the
       next enrollment cycle for the next
       month.
      This explains why there can sometimes
       be “gaps” in a Medicaid client’s SALUD!
       enrollment.


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SALUD! ENROLLMENT
   SALUD! Enrollment Issues
        This is why it is SO important to check
         eligibility EVERY time you see a
         Medicaid client. Things can change!




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SALUD! ENROLLMENT
   SALUD! Enrollment Issues
      A client newly enrolled in SALUD! has
       the first 90 days of his enrollment to
       change MCOs.
      If the client does not change his MCO
       within the first 90 days, the client is
       “locked in” to that MCO for a year.



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SALUD! ENROLLMENT
   SALUD! Enrollment Issues
      The client can choose a new MCO after
       he has completed one year in his
       current MCO.
      This is why it is SO important to check
       eligibility EVERY time you see a
       Medicaid client. Things can change!



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SALUD! Enrollment
   Babies born to moms who are in
    SALUD! on the baby’s date of birth
    are automatically a member of the
    same SALUD! for their birth month
    and (usually) the following month.
    The parents can switch the baby to
    another MCO after birth month, but
    this is rare.

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SALUD! ENROLLMENT
   When a child is born to a SALUD!-
    enrolled mother, there can be a few days
    of lag time between the addition of the
    child’s Medicaid eligibility to Omnicaid
    and the creation of the SALUD!
    enrollment span in Omnicaid.



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SALUD! ENROLLMENT
 So, a provider inquiring on the
  baby’s eligibility may find that the
  child has Medicaid eligibility but no
  SALUD! enrollment.
 This does not mean the baby will
  not be made a SALUD! member
  retroactively.


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SALUD! ENROLLMENT

   Since a child born to a mother who
    is enrolled in SALUD! on the child’s
    date of birth is ALWAYS a SALUD!
    member, it is important to promptly
    determine whether the mother is a
    SALUD! member at the time the
    child was born.

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SALUD! ENROLLMENT
   If this is the case, then you can be
    confident the SALUD! enrollment for
    the baby will be made retroactive to
    the child’s birth month.




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SALUD! ENROLLMENT
   Newborn babies born to moms who
    are NOT in SALUD! on the baby’s
    date of birth are in fee-for-service
    Medicaid until they are enrolled in
    SALUD! by the normal enrollment
    process (assuming they are not
    exempt from being in SALUD!, such
    as Native Americans.)

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SALUD! ENROLLMENT
   When a baby is fee-for-service at
    birth and remains in the hospital and
    is enrolled in SALUD! during the
    hospital stay, the inpatient charges
    and services are covered by fee-for-
    service not SALUD!.



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SALUD! ENROLLMENT
   The SALUD! MCO ONLY becomes
    responsible once the baby is
    discharged from the inpatient
    hospital stay.




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SALUD! ENROLLMENT
   What happens to a claim billed to
    ACS if the client is enrolled in
    SALUD! on the date(s) of service?




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SALUD! ENROLLMENT
   The claim will deny for EOB 0101 –
    “Service dates within managed care
    enrollment period” which meand the
    client was enrolled in SALUD! for all
    the dates on the claim…




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SALUD! ENROLLMENT
OR…
 The claim will deny for 0094 –
  “Service dates overlap managed
  care enrollment period. All or part
  of the dates of service billed fall
  within the patient's MCO
  enrollment…”


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SALUD! ENROLLMENT
OR…
 The claim will deny for 0106 –
  “Inpatient claim service dates within
  Managed Care Enrollment period.”




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SALUD! ENROLLMENT
   With all these denials, you will have to
    bill the SALUD! MCO the client was
    enrolled in on the date(s) of service.
   This will delay payment for your group or
    facility.
   You may run into complications if you
    have not met all MCO requirements for
    the service (such as a PA or referral.)


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SALUD! ENROLLMENT
   NM Medicaid programs/services
    “carved out” of the SALUD!
    coverage are:
     HCBS Waivers – paid by ACS
     Personal Care Option – paid by ACS

     Behavioral Health – paid by Value
      Options



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SALUD! ENROLLMENT
 This means HCBS waiver services or
  PCO services provided to clients
  enrolled in SALUD! are paid by ACS
  (fee-for-service Medicaid.)
 Behavioral health services provided
  to clients enrolled in SALUD! are
  paid by Value Options (which we
  are about to cover.)

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Other Coordinated Care
Medicaid Programs
   Value Options is the “Statewide
    Behavioral Health Entity”. It
    manages ALL behavioral health
    services supplied to Medicaid clients
    and beneficiaries of other State
    behavioral health programs.



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Other Coordinated Care
– Value Options
    All Medicaid clients are enrolled in
     Value Options for their behavioral
     health services




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Other Coordinated Care
– Value Options
  Value Options is billed for all these
   services EXCEPT for Medicare
   crossovers where Medicare has paid
   for a behavioral health service.
  Medicaid (ACS) pays the crossover.




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Other Coordinated Care
– Value Options
   What happens to a claim billed to
    ACS if the client is enrolled in Value
    Options on the date(s) of service?




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Other Coordinated Care
– Value Options
    The claim will deny for EOB 0101 –
     “Service dates within managed care
     enrollment period”




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Other Coordinated Care
– Value Options
OR…
 The claim will deny for 0094 –
  “Service dates overlap managed
  care enrollment period. All or part
  of the dates of service billed fall
  within the patient's MCO
  enrollment…”


  FEBRUARY/MARCH 2006                   54
Other Coordinated Care-
Value Options
 OR…
  The claim will deny for 0106 –
   “Inpatient claim service dates within
   Managed Care Enrollment period.”




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Other Coordinated Care-
Value Options
  Services will have to be billed to
   Value Options.
  This will delay reimbursement for
   your group or facility.
  You may run into complications if
   you have not met all Value Options
   requirements for the service (such
   as a PA or referral.)

     FEBRUARY/MARCH 2006                56
Other Coordinated Care
- NMRx
  All Medicaid clients NOT enrolled in
   SALUD! and NOT in a nursing home
   or a group home for the
   developmentally disabled are
   enrolled in “NMRx”
  This “Preferred Drug List” (PDL) plan
   is managed by Presbyterian Health
   Plan.
     FEBRUARY/MARCH 2006              57
Other Coordinated Care-
NMRx
    This includes Medicare dual eligibles
     enrolled in the Medicare D benefit
     unless they are residents in a long
     term care facility.




     FEBRUARY/MARCH 2006                 58
Other Coordinated Care-
NMRx
    Pharmacies billing ACS will receive
     denials if the client is enrolled in
     NMRx




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Another State
Insurance Program
   State Coverage Insurance (SCI) is a
    program to increase insurance coverage
    among workers whose employers don’t
    offer health insurance and among the
    self-employed.
   SCI is NOT true Medicaid even though
    clients are given a category of eligibility
    by ISD – 062, 063, or 064.


    FEBRUARY/MARCH 2006                       60
Another State
Insurance Program
   ACS and SALUD! MCOs will
    ABSOLUTELY NOT pay claims for
    SCI enrollees.




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Another State
Insurance Program
   SCI enrollees are NOT issued NM
    Medicaid cards. They may be issued
    insurance cards by the SCI Health
    Plan they have enrolled in.




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Another State
Insurance Program
 If the SCI eligible is enrolled in an
  SCI Health Plan, the AVRS will
  indicate which SCI plan he/she is in.
 If the SCI eligible is NOT enrolled in
  an SCI Health Plan, the AVRS will
  indicate the client is NOT eligible.
 If a claim is submitted for an SCI
  client, it will deny for no eligibility.
    FEBRUARY/MARCH 2006                 63
LIMITED CATEGORIES
OF ELIGIBILITY
 029 – Family Planning
 035 – Pregnancy Related
 041, 044 – Qualified Medicare
  Beneficiary (QMB)



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LIMITED CATEGORIES
OF ELIGIBILITY
   COE 029 – Family Planning – Covered
    Services
       Counseling services, laboratory tests,
        medical procedures, and pharmaceutical
        supplies and devices related to family
        planning purposes, e.g., birth control
        pills.



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LIMITED CATEGORIES
OF ELIGIBILITY
   029 – Family Planning – Covered
    Services – continued:
       Sterilizations, i.e., tubal ligations.
       Regular reproductive health
        exams/screenings, i.e., pap smears and
        sexually transmitted disease screenings.



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LIMITED CATEGORIES
OF ELIGIBILITY
029 – Family Planning –
Non-covered Services
       Abortions
       Hysterectomies
       Treatment services for infertility




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LIMITED CATEGORIES
OF ELIGIBILITY
   029 – Family Planning – Non-
    covered Services - continued
        Inpatient Services
        Management or treatment of medical
         conditions/ problems discovered
         during screenings or caused by or
         following a family planning procedure,
         i.e., treatment for STDs, ultrasounds
         or cervical cancer

    FEBRUARY/MARCH 2006                           68
LIMITED CATEGORIES
OF ELIGIBILITY
   029 – Family Planning – Non-
    covered Services - continued
       Other medical conditions not family
        planning related.




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LIMITED CATEGORIES
OF ELIGIBILITY
   What happens when you submit a
    claim to ACS for a non-family
    planning service for a client who
    has family planning eligibility?




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LIMITED CATEGORIES
OF ELIGIBILITY
The claim denies for:
 0029 – Service not Family
  Planning
     This exception will post if the client
      has COE 029 - Family Planning and
      the service is not a family planning
      service.



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LIMITED CATEGORIES
OF ELIGIBILITY
 035 – Pregnancy Related (non-
  presumptive.) Covered Services
  are
 Pregnancy related services only:
        Prenatal care

        Delivery

        2 months of postnatal care

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LIMITED CATEGORIES
OF ELIGIBILITY
   035 – Pregnancy Related Non-
    Covered Services
     Abortions (elective)
     Vision, Dental, Hearing
     Psychiatric/Psychological
     Chiropractic
     Plastic Surgery (elective)
     Anything not medically related to
      the pregnancy
    FEBRUARY/MARCH 2006                   73
LIMITED CATEGORIES
OF ELIGIBILITY
   What happens if a claim is
    submitted to ACS for services
    that are not pregnancy related
    and the client has category of
    eligibility 035?




    FEBRUARY/MARCH 2006              74
LIMITED CATEGORIES
OF ELIGIBILITY
The claim denies for:
 0707 – Procedure not Pregnancy
  Related
 This exception will post if the
  client has a COE for pregnancy
  related services only and the
  service is not a pregnancy
  related service.

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LIMITED CATEGORIES
OF ELIGIBILITY
Note: Presumptive Eligibility for
 pregnant women:
This COE is also 035 but ONLY
 covers pre-natal care. This will be
 indicated when you verify Medicaid
 eligibility.



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LIMITED CATEGORIES
OF ELIGIBILITY
   041, 044 – Qualified Medicare
    Beneficiary (QMB)
   MEDICAID covers the co-insurance and
    deductible on MEDICARE covered
    services only after MEDICARE has paid.

   If service is not covered by Medicare,
    MEDICAID WILL NOT PAY.


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LIMITED CATEGORIES
OF ELIGIBILITY
What happens if you bill a
non-crossover to ACS for a QMB
 client?




    FEBRUARY/MARCH 2006          78
LIMITED CATEGORIES
OF ELIGIBILITY
The claim denies for:
 0266 – QMB Client/Bill Crossover
  only




 FEBRUARY/MARCH 2006                 79
SCHIP and WDI Copays
 Two Medicaid categories of eligibility
  require the Medicaid client to
  sometimes pay a copayment.
 Payments for services to SCHIPS
  and WDI clients are reduced by the
  copay amount owed by the client.



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Categories of Eligibility
with Co-pays

  071 – SCHIP (State Children’s Health
  Insurance Program)

  074 – WDI (Working Disabled
  Individuals)

  Clients with these COEs may owe co-
  pays for some services.
    FEBRUARY/MARCH 2006                  81
FEBRUARY/MARCH 2006   82
 WORKING DISABLED
 INDIVIDUAL (WDI)
 CO-PAY AMOUNTS
    $7.00 outpatient therapy and behavioral health
     services
    $20.00 emergency room services
    $30.00 inpatient hospital services
    $7.00 doctors visit, urgent care or vision visit
    $7.00 dentist visit
    $5.00 prescriptions
Please note: Native Americans are exempt from these co-
payment requirements.

      FEBRUARY/MARCH 2006                                 83
Medicare Coverage
   Claims for clients with Medicare
    coverage must be billed to
    Medicare first.




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Medicare Coverage
   What happens if you bill ACS for
    a Medicare covered service
    without billing Medicare first?




    FEBRUARY/MARCH 2006                85
Medicare Coverage

 The claim denies for:
  0265 - Client is Medicare Part B
 Eligible




   FEBRUARY/MARCH 2006                86
Medicare Coverage
Sometimes   a service normally
covered by Medicare is NOT due to the
place of service or other situation.




   FEBRUARY/MARCH 2006                  87
Medicare Coverage
 In these cases, you don’t have to bill
Medicare first. The claim can be
submitted on paper to Medicaid with
“Medicare Never Covers This Service”
on it.




    FEBRUARY/MARCH 2006                    88
Medicare Coverage
 Please keep in mind that Medicaid
will NOT pay if the claim is denied by
Medicare for administrative reasons,
such as “not medically necessary.”




    FEBRUARY/MARCH 2006                  89
Third Party Liability
(TPL)
   Medicaid is the payer of last resort,
    except for clients covered by the
    Indian Health Service (IHS).
   TPL is all commercial insurance.




    FEBRUARY/MARCH 2006                     90
Third Party Liability
(TPL)
   TPL must be billed primary to
    Medicaid.
   Medicaid does not consider
    Medicare TPL.




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Third Party Liability
(TPL)
   TPL can be a traditional plan with a
    coinsurance.
   TPL can be a traditional HMO plan
    with copays.
   TPL can be a PPO or other
    commercial “hybrid” plan.


    FEBRUARY/MARCH 2006                    92
Third Party Liability
(TPL)
   What happens to a claim billed to
    ACS when a client has TPL and a
    TPL payment or denial is not
    indicated on the claim?




    FEBRUARY/MARCH 2006                 93
Third Party Liability
(TPL)
The claim denies for:
0750 – Client has TPL - Resubmit with
TPL EOB
Remember, you must bill the primary
insurer PRIOR to billing Medicaid.



   FEBRUARY/MARCH 2006                   94
Third Party Liability
(TPL)
The claim denies for:
0750 – HMO/No TPL Attachment




  FEBRUARY/MARCH 2006           95
VERIFY THIRD PARTY
LIABILITY (TPL)
 TPL –
  Adding/removing/updating
  clients’ TPL resource.
 Call TPL Helpdesk at (505) 246-
  9988 ext. 195, (800) 299-7304
  ext. 195.



    FEBRUARY/MARCH 2006             96
REMITTANCE ADVICE
NEWSLETTER
 A newsletter listing the most
  current issues for billing providers
  is updated weekly and included
  with the RA.
 This newsletter contains any
  changes in claims processing,
  systems issues, and billing tips for
  common billing errors.
    FEBRUARY/MARCH 2006                  97
RA Newsletter
 Keep current with important
  information.
 Be sure to check the RA Newsletter
  every week.




    FEBRUARY/MARCH 2006            98
FEBRUARY/MARCH 2006   99
                            COMING
                        ATTRACTIONS!
        Coming Late Spring 2006
 On-Line Eligibility Inquiry
     Providers will be able to run eligibility
      inquiries on-line. This will be a free
      service!




  FEBRUARY/MARCH 2006                             100
                            COMING
                        ATTRACTIONS!
         Coming Late Spring 2006!
 On-Line Claims Inquiry will allow
  providers to check claim status, client
  eligibility, and prior authorization
  information. This is a FREE service to
  providers. Check your RA Newsletter
  for more information.


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                            COMING
                        ATTRACTIONS!
         Coming Late Spring 2006!
 On-Line Prior Authorization Inquiry –
Providers will be able to check PAs on
  file with ACS on-line. These are PAs
  that have been sent to ACS from
  BCBS. This will be a free service.


  FEBRUARY/MARCH 2006                 102
FEBRUARY/MARCH 2006   103