Posted by Behavioral Health Billing Solutions, LLC.

New info on BH Redesign

 

*** H0014 Withdrawal Management

 

The Ohio Department of Medicaid (ODM) has learned that H0014 has a daily limit of one through the National Correct Coding Initiative (NCCI). This code is currently configured as an hourly code, intended to cover multiple hours of nursing services for ASAM Level 2 WM, Withdrawal Management. In order for Medicaid to cover this service in the intended manner, a configuration change in MITS is required.

H0014 will be configured as follows:

 

  • H0014 is billed for 1 hour of RN or LPN service per day

  • H0014 with modifier AT is billed for 2‐ 3 hours of RN or LPN service per day

  • H0012 – billed when service is 4 or more hours per day

 

H0014 Rates

 

Rendering Practitioner                   H0014       H0014 AT

RN                                                   $127.68      $338.35

LPN                                                   $90.16      $238.92

Configuration changes will be effective in MITS on Jan. 5, 2018. These changes will be applied retroactively to dates of service beginning Jan. 1, 2018. This means that:

  • If a claim containing H0014 AT is submitted to MITS on Jan. 3, 2018 for a Jan. 2 date of service, the claim will deny.

  • If a claim containing H0014 AT is submitted to MITS on Jan. 6, 2018 for a Jan. 2nd date of service, the claim will pay.

 

*** MITS EDI Testing Resumes Jan. 1, 2018

 

Behavioral health agencies can resume testing claims for behavioral health redesign on Jan. 1, 2018.

This is the standard testing process ODM has always had open for all provider types.

It is important to note that ODM Rapid Response Team will not have access to these claims as was done with the testing that ended Dec. 15. Providers must rely on the 835 and 277 reports to interpret the testing results.

This is very important for providers to understand. You will need to be able to read and interpret your 277 claims response file and 835 payment file in order to fully understand issues or reimbursement percentage for claims.

  • Files must be sent to this site: https://mft‐qa.oxi.arcaas.com/mailbox

  • Up to 5,000 claims may be submitted per file.

  • Dates of service on claims must be current 2018 dates. No future dates will be accepted.

On Jan. 6, the file can only contain test claims for dates of service Jan. 1 – 6, 2018 in order to test behavioral health redesign.

 

  • Do not submit any claims for services that require prior authorization.

  • NCCI edits will be operational in the test environment.

  • Rendering practitioners identified on claims MUST be actively enrolled in MITS and affiliated with their employing agency submitting the claim.

  • Test files must comply with the coding and policy guidance on http://bh.medicaid.ohio.gov.

 

*** Rendering Practitioner – Header versus Detail

 

Questions have been raised as to where the rendering practitioner can be reported on a claim. Can the rendering practitioner be reported at the header level or does it need to be reported at the detail line? ODM guidance has been to report the rendering practitioner at the detail line. However, ODM recently completed testing to determine if a rendering practitioner can be reported in the header. Testing results show that it is acceptable to report the rendering practitioner at either the header or detail lines, but each strategy has a different effect on how claims are adjudicated as follows:

  • Rendering practitioner can be reported solely at the header. This rendering would apply to all detail lines on that claim; OR

  • Rendering practitioner can be reported solely at the detail level; OR

  • Rendering practitioner can be reported at the header and a different rendering can be reported on one or more of the detail lines. The practitioner identified in the header will apply to any detail line except the lines where a different rendering practitioner is identified. The rendering reported at the detail line will apply to that detail line.

 

*** ODM Rapid Response Team

 

Providers who have questions regarding submitted claims can contact the ODM Rapid Response Team by calling the Medicaid provider hotline 1.800.686.1516 and selecting option 9 or send email to BH-Enroll@medicaid.ohio.gov.

 

Rapid Response Team will be available during the following times:

 

Monday‐Friday: 7:30 a.m. – 7 p.m.

Saturday: 9 a.m. – 1 p.m.

*** Prior Authorization***

 

Training on use of PA sub‐system has now been posted on bh.medicaid.ohio.gov.

If you plan to submit requests for prior authorization, please review this training. It can be found http://bh.medicaid.ohio.gov/training.