Posted by Behavioral Health Billing Solutions, LLC.

ohio behavioral health billing


All of us at Behavioral Health Billing Solutions, LLC are wishing you a safe and happy holiday season!


There have been a number of important changes recently that we also wanted to make everyone aware of.



1. Effective January 1st, 2020, Medicare will no longer accept the old Medicare number format that consists of the client’s social security number ending in an alpha character. The new number can be obtained from your client’s Medicare card if presented,  looking it up via your clearing house or running a 270 eligibility file through a Trading Partner. MITS always returns Medicare info including type (Part B or C, an advantage plan) if a client record is found. If you need assistance in transitioning to the new number, please feel free to let us know. We would be happy to help. 



2.The Ohio Department of Medicaid recently made a change to allow service location 99 – Community for H0005. The change is effective 11/28/2019. This is problematic because although most MCO’s denied for this location, CareSource paid it and has begun a recoupment process for all H0005 billed with a location of 99 but is in the process of sending emails to impacted clients about the delay of this recoup process. We recommend to wait until they respond with a corrected list prior to pursuing projects to correct/replace impacted claims. The manual was updated on the BH Medicaid website on November 27, 2019 and can be found here.



3. With CareSource’s change in processing to ECHO, they are now able to accept and process claims using either the client’s unique CareSource ID or the client’s actual Medicaid number. They do prefer using the CareSource ID but we (BHBS) see this as a big win because they are typically the largest MCO for most agencies and checking for the unique ID through either the CareSource portal or your clearing house incurs expense in either employee time or transaction costs through the clearing house. BHBS has tested this and received payment and are confident after receiving confirmation from CareSource and follow up testing, in passing along this beneficial improvement.



4. On December 20th, the latest stakeholder meeting was held in Ohio to discuss the Ohio SUD 1115 waiver. Many of our clients were included as panelists to discuss their opinions, however the audio was problematic so hopefully, specific information that was discussed will be distributed.



5. The Ohio Department of Medicaid announced that they will begin testing with the MCO’s to ensure their systems can adequately work with the PMF provider produced by Medicaid. Once testing is complete, the universal roster will most likely be terminated for use. The release of this is available here. 



6. At least two of the MCO’s have notified us they are moving into “Maintenance mode” stating that their adjudication of claims now meets the standards set by ODM. However, BHBS weekly reviews denials during our billing process that provides direct opposition to these claims. All MCO’s are still routinely underpaying for Supervised claims, certain licensed provider claims, and there are many denials for reasons that are simply incorrect. Our recommendation is to review every remit or payment you receive and if you are routinely receiving similar errors, open a complaint with ODM. They cannot know what we don’t report. We have had many times where we have reported issues to ODM contacts and they opened claims on our behalf so we believe this is an appropriate measure to use without fear of retribution from the MCO’s. The link to file a complaint is here and the latest escalation contacts for the MCO’s is attached.



7. There are a number of rumors going around about the MCO’s changing their guidelines on a number of issues, including timely filing and prior authorizations based on their contracts with agencies. ODM is aware of these claims and is working with the MCO’s to bring them back to understanding that ODM is in charge of how these guidelines work and until some consensus has occurred between the parties involved, timely filing will remain at 365 days.



8. If you are on CareLogic, our recommended software for BH redesign, it’s important to utilize the tools the system provides, in addition to a number of the reports the BHBS team has made available to you to track your AR and the MCO payment activity. The report created by our system admin team tracks the life cycle of a claim including service, procedure, date of service, billed or unbilled, whether a payment or denial was received, service location and rendering provider. These are essential elements to being able to determine if an open claim is un-responded to or denied for inappropriate reasons.



9. Most of you are aware that current state, the Ohio Department of Medicaid posts weekly updates of the practitioner enrollments for all type 84 and 95 providers. We recommend checking it periodically just to ensure your providers are registered correctly with Medicaid. I’m attaching the last one our team pulled down and combined with inactive providers highlighted. On the far right, select your organization name in the filter in the column highlighted in YELLOW and your current providers and their registration and status will be listed. Also, BHBS strongly supports enrolling practitioners dually if it is a credential that is allowed to do so. I’m attaching the dual licensure grid provided by the state as well as a link to a post I put on our website in August that describes what is needed to add an SUD Case Mgmt or QMHS specialty to any one sided provider. CareLogic is a system where dual credentials are easy to handle simply by creating a dual credential. Note: If a provider is an LICDC and LSW/LPC, even though the LSW or LPC can do both MH and SUD, the LICDC is considered the primary credential because of it’s independent status.



10. Also noteworthy is to mention the TPL/Medicare bypass list. Many agencies are unaware that certain services and providers are not required to bill to Medicare. For Commercial, if a clinician is allowed to do a service and it’s not a Medicaid only service (both are indicated on the attached sheet), their services must be billed to insurance for any client that has Commercial and Board/Medicaid. ODM is currently changing the rule on how quickly you can bill to Medicaid due to lack of response, which is common for non-independent providers, however the official rule has not been released yet so keep your eyes open for an update from ODM.



11. The Ohio Department of Medicaid DI processing calendar is now available. Keep in mind, this applies to ODM only. The MCO’s are required to pay 90% of clean claims within 15 days and 99% within 30. Be sure your billing team has a mechanism to track un-responded to claims. For clients of BHBS, our “All Claims – Excel” provides this data at your convenience or if we process your billing, it is also available within your weekly financial report. 



12. For those of you where we administer your CareLogic structure or if you are one of our Associate programs, we did realize a functionality issue with regard to Prior Authorizations. We are researching any possible denied claims due to this issue and will reach out to you if there are any impacted claims.



13. In addition for CareLogic users, Qualifacts has teamed with a new call reminder system that for lack of a better word, is pretty amazing. We will be doing a follow up demo in January and if anyone is interested in hearing more about it or getting a demo, let us know and we will put you in touch.



As always, we appreciate the trust you have placed with BHBS and promise to continue to provide the best, most thorough and knowledgeable support in the Behavioral Health field. We wish you all a safe and happy holiday season and remember, we are always here to help!!