Posted by Behavioral Health Billing Solutions, LLC.
BH Redesign LIVE in 48 hours.
ARE YOU READY?
Fact: Ohio BH Redesign goes LIVE 01/01/2018. This is effective for ALL Ohio Behavioral Health Medicaid provider types 84 MH and 95 SUD.
Fact: Actual claim submission through the MITS portal and all Trading Partners go live January 1st.
Testing through the Cert Trading Partner environment reopens on January 1st.
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Does this mean that you can continue to test and not go live?
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NO! I’ve had that question come up and it’s a misconception.
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As a BH Medicaid provider, you have options available but it does not include to test until you are ready. Dates of service after December 31st, 2017 must be billed using the new Redesign code set.
Fact: There are options available to all Ohio BH Medicaid providers. These include:
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Submit claims through the new beta tested system via Electronic Data Interchange (EDI).
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Submit claims directly through the Ohio Medicaid Information Technology System (MITS) portal.
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Participate in a time-limited, cash-flow contingency plan.
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Let’s talk through these options.
1. Submit claims through the Electronic Data Exchange using a Trading Partner from claims generated from your electronic health software program.
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If you are on an electronic health record that has successfully tested from a billing and clinical standpoint, congratulations. After January 1st, be sure to check your 824, 277, and 835 files to ensure you are receiving full reimbursement for ALL claims.
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For assistance in understanding your response files, feel free to contact EMS Healthcare Informatics for tools to assist and Behavioral Health Billing Solutions, LLC on how to best understand use of the tools that are available. Tools include EDI file readers and most important right now is the Power Generator tool, which enables you to easily check your client’s eligibility prior to billing, including any Managed Care Affiliation.
2. Submit claims through the MITS Portal.
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Even if you currently enter your Medicaid claims on the portal, it’s critical to understand that the process, as of January 1st, is significantly different. For guidance on how or what is changing, go to bh.medicaid.ohio.gov or contact Behavioral Health Billing Solutions for guidance or to manage the successful entry of your Medicaid claims.
3. Participate in a time-limited, cash-flow contingency plan. Providers that choose this option will be eligible for contingency payments under the following conditions.
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Medicaid, using state funds, will advance a monthly payment for January, February, March and April 2018 equal to 54.6 percent of the provider’s average monthly Medicaid reimbursement in calendar year 2016.
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At any point, a provider may connect to the system and bill for services provided after Jan. 1, 2018.
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Medicaid will recover the advance payment by offsetting claims paid between May 1 and June 30, 2018.