Posted by Behavioral Health Billing Solutions, LLC 

Ohio Medicaid cancelled tomorrow’s EDI Work group at a rather critical time in the process.

Many provider agencies were upset at the news released at Monday’s Prior Authorization training that for Residential PA’s, the independent provider submitting the PA must also render services.

Since this is not a typical work flow for many residential facilities, my phone started immediately ringing. Many of us are trying to get more detail on exactly what it means for residential facilities since this was not our understanding of the process.

Where do the supervisory guidelines apply? At this point, we don’t know. More to come, however, it obviously won’t be discussed tomorrow.

ODM is compiling their beta testing results, as is BHBS. We have tested for a number of agencies on a variety of software programs with varied results.

I can’t state often enough, an accepted claim is not always a fully paid claim. Read your 277U and compare to your 835 to see what you’re true reimbursement is for each and every file. However, it’s important to note that we have been notified from DXE that any test files sent December 1st – December 5th, will not receive response files until Thursday, December 7th. 

My testing will be posted once I have everything accounted for from all test files sent including:

1. Pass/Fail file count

2. 277U Claim Acceptance Percentage

3. 835 Overall Reimbursement rate

All broken down by vendor software.


In Lieu of the regularly scheduled meeting, ODM did provide several updates. Please see below:

  • Common testing errors are also included in the attachment.

  • Rendering NPI

  • Recently there has been some discussion as to where the rendering NPI can be reported.  Is there flexibility to report it in either the header or detail?  ODM is in the process of testing this and will provide an update to this workgroup.

  • IT documents update:

  • Manual

  • CPT codes common to both MH and SUD – LICDCs, LCDCs and CDC-As are specific to provider type 95.  Places of service have been broken out for which ones are specific to 84s and which ones to 95s.

  • H0001 is now an encounter code as there is an MUE of 1.  No change in the rate. Keep in mind, this used to be a time-based code with a rate of $77.11 an hour. Now it’s encounter based but no change in rate? The new rate is the same as the old one, we just can no longer bill for more than one hour as it is an encounter rate. Sounds a bit like a rate change….. 

  • Code chart – now includes allowable rendering practitioners for SUD residential codes

  • Supervisor Rendering

  • Added CNS, CNP, PA to those who can order nursing services.

  • Corrected practitioners for H0012.

  • Removed licensed school psychologist from rendering SUD residential services

  • Diagnosis Code Groups

  • Diagnosis codes F14.15 and F14.22 were removed as they require an additional character to be valid

  • Procedure codes 86580 and 82075 were previously omitted from the chart – added to Group C

  • Also the Supervising/Rendering/Ordering guide was recently updated with some pretty substantial changes. Guide can be found here.