Posted by Behavioral Health Billing Solutions, LLC
Behavioral Health Billing Solutions is well known in the Ohio Behavioral Health area and we wanted to share some important information that we received this morning from Ohio Council.
Please see Ohio Council’s release below:
Good News! CMS has approved the managed care portion of provider relief payments for Behavioral Health, MyCare Ohio, and several other provider types. Unlike previous provider relief payments, the Medicaid managed care plans will process these payments directly to providers. ODM is working with them to distribute these funds as quickly as possible.
For reference, the distribution methodology for Community Behavioral Health payment is equal to approximately 10% of paid claims, using claim period from July 1, 2020, through June 30, 2021, as the basis. Distributed to providers as a lump sum. For MyCare Ohio, payment is equal to approximately 10% of paid claims, using claim period from November 1, 2020, through October 31, 2021, as the basis, and distributed to providers as a lump sum.
Please Note: Providers will almost certainly receive multiple checks from multiple plans. Here is how you can get information about HOW MUCH you should be receiving and from WHICH MCO:
PROVIDER RELIEF DASHBOARD ENSURES TRANSPARENCY, ACCURACY, AND ACCOUNTABILITY.
ODM has launched the Provider Relief Dashboard tool that allows providers to enter their Medicaid billing ID and view ALL payments that will be dispersed to them from FFS, Managed Care, and MyCare per HB 169. The dashboard details all categories of provider relief from HB 169 (ARPA HCBS and non-ARPA/GRF funds) EXCEPT for Assisted living (RCFs), PACE, and DODD waiver providers. Providers can access the tableau through the ARPA HCBS page of the ODM website by clicking the LAUNCH button in the lower right corner.
VERY IMPORTANT – PLEASE NOTE:
The managed care preprint relief payment is calculated as 10% of claims, however, the amount providers will receive with this first payment is 50% of the total.
This was required by CMS in order to avoid a situation where a provider may be “overpaid”.
At the end of calendar year (CY) 2022, ODM will reconcile a provider’s total claims to actual CY22 claims experience, and a final relief payment will be calculated.
There is no action required on the part of the provider during this reconciliation process.
ODM will work with the plans at the end of the year on this final installment of relief.
ODM will send out an announcement when the final installments are prepared and post the final amount of payment to the dashboard.
We apologize for the complexity of this process and appreciate your understanding.
For questions about any of these provider payments, please email ProviderReliefInquiries@medicaid.ohio.gov.
As always, we will remain in close contact with our partners and ODM to support the distribution of these payments. Please let us know when you start receiving payments and if you run into any challenges or concerns. We appreciate the time-sensitive nature of these funds and the importance of sustaining access to services in many communities.
Teresa Lampl, LISW-S, CEO
The Ohio Council of Behavioral Health & Family Services Providers
Additionally, we wanted to update you on the upcoming ODM changes, including the Fiscal Administrator and PNM (Centralized Credentialing). The team at Behavioral Health Billing Solutions (BHBS) is involved in the pilot Trading Partner group and is currently building a solid billing process for meeting the new expectations. In addition, we will be offering a webinar, once we get through testing, to present some of the changes to the data we send and the data we will receive from the Fiscal Administrator.
We have met with the management at Qualifacts (CareLogic) and assisted in bringing them up to speed on the structural changes that will be necessary to meet the new state billing requirements. We are waiting on them to roll out their response to the changes, but rest assured that we have already built an internal process for managing, and we will be ready to bill on July 1, 2022.
A few key points to share:
Only the client’s 12 digit Medicaid # will be accepted. We recommend that all our clients begin transitioning any client’s MCO # (except Paramount) to their Medicaid ID #. All MCOs, except Paramount, will pay and adjudicate today if you send the Medicaid ID # or the assigned unique ID #.
MyCare Plans, both Medicare and Medicaid (combined or separate), will not be sent through the OMES portal. Those will need to be sent to your clearinghouse along with Medicare, Medicare Advantage, and Commercial insurance payers. It is essential that all MyCare clients are identified and given the correct MyCare payer before July 1, 2022.
There will be new Payer IDs for the 8 MCOs. These will be included in the more detailed billing release that we send out once Qualifacts has determined what they can assist with from a structural and functionality standpoint. Ohio Rise will also be sent through OMES regardless of whether you are a CME or a provider.
MITS will sunset on June 22, 2022. The FI will go live on July 1, 2022. MCO claims before and after July 1, 2022, will be sent through OMES (FI). I will be following up on whether or not Paramount MCD is included in the Pre-July 1st group and, if so, how they should be sent.
Each MCO and Ohio Rise will need to be sent in separate files through OMES.
If you are billing through a clearinghouse, we recommend you check with them and ask them if they are prepared for the upcoming changes. I know that Etactics is part of the same group BHBS is in, and they will be prepared. They are currently actively participating in testing.
In addition, if we do not handle the 270 process for your agency, you will want to build a solid eligibility checking process as clients payer changes will be pretty active as we move through this process. Please let us know if you want more information on becoming part of our 270/271 Eligibility process.
We feel it’s essential to keep our clients in the know PRIOR to changes, so they are better prepared to manage a possibly, bumpy road. Just know that we will be with you every step of the way.
In the coming months, we will be doing updates more frequently on our website. As always, we will post those updates to Linkedin and Facebook, so be sure to add us on both social media sites. It’s going to be critical that agencies are aware of the upcoming changes as they occur.