Posted by Behavioral Health Billing Solutions, LLC
Ohio Council is looking for input from Ohio BH providers on their experiences with billing the Managed Care Organizations since July 1st, 2018.
In their continuing attempt to advocate for agencies across Ohio, the Ohio Council has arranged to meet with ODM and several of the MCO’s as part of the BH Post ImplementationTask Force to discuss specific claim issues and hopefully reach an understanding of the full impact of these issues across Ohio.
Please see below for more details of the request from Ohio Council.
Next week, ODM has scheduled brief (30 minute) meetings with Buckeye, CareSource, and Paramount individually as part of the BH Post Implementation Task Force to understand reported claims issues and each plan’s actions to resolve the issues.
In order to provide the requested information to ODM and the MCO’s mentioned above, Council is requesting input from providers. See below for more detail on the needed information.
Share specific problem claims examples for Buckeye, CareSource and Paramount with us. Below are the top issues the Ohio Council has identified for each plan. If you have experienced these claims payment issues, please provide 1-2 examples (ICNs) for any or all of the top issues on the BH Managed Care Plan Specific Report Form. (Note there are separate tabs in the excel file for Buckeye, CareSource and Paramount.)
Please indicate whether each claim was billed under your PT 84 or PT 95 NPI when you complete the form. Completed forms must be returned to me (lampl@theohiocouncil.org) no later than Noon on Monday 8/27 so I can compile the report and send it to ODM by end of business.
Top Claims Issues – Please use these phrases to identify the “issue reported” on Report Form.
Buckeye:
Claims underpaid (any service)
Claims paid at $0
Denied due to practitioner specialty or not loaded
Same day services denied (CPT codes and/or H codes)
OTP claims denied
CareSource
Claim under paid (any service)
Claims paid at $0
Denials for missing information (2NG, OA-16, OA-45, N232, N381)
Denials for TPL or COB (OA-22)
Same day service denied (CPT codes and/or H codes)
Nursing services denied for missing “U” modifier
Pended claims (accepted by plan, not viewable by provider)
OTP claims denied
Paramount
Claims underpaid (any service)
Claims paid at $0
Same day service denied (CPT codes and/or H codes)
Pended claims (accepted by plan, not viewable by provider)
OTP claims denied
ODM has requested the plan specific issues with data be sent to them by Monday, 8/27/18, EOB. We appreciate this is a very short turnaround.
Behavioral Health Billing Solutions has a number of clients experiencing many of these issues and more and we are encouraging all of our clients to participate and report these issues and more.
We have not billed any July or August services to the MCOs yet. We had to complete January-June billing and change our system set-up to bill MCOs. We are going to start billing July Services this week.
Hi Tom,
Apparently, I thought all responses were spam because most have been. So I apologize for the delay.
I’m curious how it’s going for you. We have run into numerous issues you need to look for. Most have been reported and are either corrected or slated to be corrected. My recommendation is to go through your EOB’s and 835’s with a fine toothed comb. I’m working with most MCO’s to report issues and I have to say they’ve been very responsive. I did have a bad moment with Katie, the automated response at CareSource, so I don’t go that route anymore. But hopefully she is fixed or so I’m hearing. I actually had to apologize to my contact, it’s possible it was a monday and she pushed me over the edge.
Paramount has become an issue. I have no other MCP sending this notification. I thought that this would be a “universal” billing system, MCP’s. I received the message below. Paramount, just last week, had my portal set up so that I could see the EOP’s and learned of the denials.
Has anyone else had this issue?
. Paramount only accepts the U Modifier when dually licensed providers are submitting claims to indicate which specialty they are acting as during the time of services rendered. Also, the Rendering NPI must also be present on all claims. To help further clarify the U Modifier scenario –
If the rendering NPI represents the specialty listed under then do not submit the claim using the modifier listed under that is directly across from that primary specialty.
Example:
LPC claims should not be billed using modifier U2.
If the LPC is working as a PSY-A, then the claim would be billed under the LPC rendering NPI using the PSY-A modifier of U1 to indicate the LPC is working as a PSY-A.
Hi Tammy,
Sorry for the late response. Paramount was the only MCO that would not accept the U modifiers needed from Jan – June. While UHC requires all modifiers, old and new be continued. Buckeye, CareSource and Molina have said they are optional. However, there’s a lot more than just this issue going on.