Posted by Behavioral Health Billing Solutions, LLC

ohio behavioral health billing

 

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.