Posted by Behavioral Health Billing Solutions, LLC
As always, Behavioral Health Billing Solutions, LLC (BHBS) is committed to bringing ongoing updates to Ohio Behavioral Health Providers.
We also wanted to touch base and let all of our contacts know we are still here for you every day! This morning, I sent out the email below to all of our clients. There are a number of things that it was important to share. I also wanted to make sure you were aware of our BHBS Office Hours taking place this afternoon at 2:30pm. The link is available here.
The email that went out today to our client base is below. If you would like added to our general distribution list, email firstname.lastname@example.org
I hope that all of you had a wonderful Thanksgiving. I spent a few days with family and 3 of our grandsons. It was wonderful and a good time to regroup and think about how to move forward in uncertain times, both personally and professionally.
I want to warn you that the following email will be longer than most emails, but it is very important information. Please take the time to read, take notes and ask us for more information as needed. Throughout this email, you will see recommendations for clients we bill for, as well as for clients that do their own billing. It may seem repetitive, but it is needed because the process differs.
At Behavioral Health Billing Solutions, BHBS, we have been taking advantage of the time the delay of the Fiscal Administrator allowed us, to continue testing with the state for the new deadline, February 1st, 2023, and working with the Maximus and ODM teams to research and improve some of the known deficiencies in the PNM, the new centralized credentialing process. In addition, our team is reworking all our billing processes, from eligibility to denial processing, because almost everything will change February 1st, 2023.
We’ve also been dealing with a variety of issues, mostly related to the implementation of the PNM or OhioRISE, however, there are other issues that have popped up as well.
For the clients we bill for, we’ve been reviewing claims and their response times within a shorter window, October 1st through December 1st, to see how many of you are being negatively impacted by the delays caused by issues identified with the PNM go live October 1st, and the new workflow timing changes. From systematic issues to new timelines for how the new process works regarding the time it takes to apply, dis-enroll and re-apply, or to simply make a change to an address, the expected time from start to finish has more than tripled. A while back, CareSource went to rejecting claims for provider and group affiliation issues and these numbers are now our guide for assessing provider issues because CareSource pays very quickly. We know almost immediately when CareSource believes a provider is not properly affiliated to an agency because the numbers grow exponentially in your clearing house when we bill. Unfortunately, what we are finding is substantial and many of you have been reaching out to understand why your revenue is down. Some of you are already getting into your rainy-day funds when realistically, that should be saved for when the Fiscal Administrator goes live.
In addition, we had an unexpected issue with Molina Healthcare because we started receiving incorrect denials for a service location of 11 or office. We immediately reached out to our partners at Molina, and late Thursday we were able to get confirmation that these denials were in error and a new CPSE would be posted, and claims will be reprocessed. Thankfully, Molina was very responsive, as always, and was able to determine the root cause and put corrective action in place. Keep in mind, this won’t happen overnight, they normally state that the timeline for reprocessing is 45-90 days, but my hope is that these will be turned around timelier due to high usage of this service location.
We are also still experiencing delays in receipt of 835’s (remits or EOB’s) for Molina and OhioRISE. As you know, OhioRISE went live on October 1st and unfortunately the process for getting 835’s has been challenging for multiple reasons outside our control, and as of today not all our clients are receiving EFT’s or 835’s from OhioRISE due to these issues. Molina changed their claim processer, and this has led to delays in receiving 835’s due to the complex process related to how MCO claims and payments are processed. We are working with our partners at Etactics and Aetna to resolve all outstanding issues. We have instructed our billing team to review all their clients to identify whether the change process is complete for those agencies. In both cases we have found that clients are getting paid as expected (perhaps slower), but it’s very likely your agency may be impacted by the lack of receipt of payment detail (835’s).
Our recommendation for clients who do their own billing is to go to your clearing house and see if you are receiving 835’s for Molina after mid-September. If you are not, email email@example.com or reach out to your clearing house for instructions on how to rectify. We are familiar with how Etactics has been handling this process but are less knowledgeable with how the other clearing houses are managing this change.
Another process we are putting in place for our billing clients, is to take a deep dive into newer aged claims (60 days or less) to access the financial impact of provider/agency issues, post October 1st, as well as the Molina incorrect denials for each agency. We hope to get impacted numbers for those clients on those issues submitted to you by the end of next week or sooner. This review will include reporting to you on rejected claims from CareSource that are specifically related to provider or agency issues, and Molina service location issues coming in as denials on your 835’s. As stated before, CareSource is the only MCO currently rejecting provider or agency issues, the other MCO’s are denying those impacted claims. It’s important to note that as of February 1st, 2023, 3 new provider edits will go in place that will be for all MCO claims, OhioRISE and Fee for Service Medicaid and those claims will be rejected. A rejection means that the claim will never be fully adjudicated or receive a payment or denial. They are simply rejected claims at the clearing house level that will not be sent to the payer unless corrected and you will not receive an 835 or EOB for those claims.
Our recommendation for clients that process your own billing is to run “Claims paid all”, a proprietary report built by BHBS, that is loaded into your CareLogic system and available for you to easily run and evaluate billed claims and their responses within a 60-day window. Any claim that reports an error which states entity not affiliated or any reference to entity in the name, is most likely due to a provider issue or an agency validation issue. If you need assistance in pulling the report and isolating these issues, please send your request to firstname.lastname@example.org. We will respond in order of receipt and request that you give us 2 working days to review the request and respond.
Unfortunately, there is more that we need to share. Since October 1st, we have seen the federal exclusion list applied to clients in error that are still pending correction although they were acknowledged as an error. There are other problems that have come up related to the PNM that have caused deactivation of some agency NPI’s that have been identified and reported but could still be pending. It is very important to add that someone should be checking your provider correspondence in the PNM daily, at a minimum. This is how you, as the agency, will be notified of issues from ODM. We are working with Maximus and ODM to correct these issues but as of now, we don’t have an ETA for any corrective action. In addition, we discovered an issue with CPST adjudication of claims over 4 units. We have contacted ODM and found this was due to a new NCCI edit list that conflicts with ODM policy. They are working to determine a solution.
I’m aware this is a lot of information. There are a lot of moving parts and all of it is important to share to keep you informed and aware of issues that could impact your ability to provide services.
In closing, I wanted to remind everyone that BHBS is offering “office hours” bi-weekly, as a forum for agencies to discuss PNM problems or solutions, as well as discuss the needed changes to your software program, to be able to bill on February 1st, 2023. Please use one or more of the below links to register for the BHBS Office Hours. This forum is open to all Behavioral Health Agencies in Ohio, whether you are a client of BHBS or not, and regardless of what EHR is being used. Keep in mind, while we know the changes that are needed, we won’t be able to speak to exactly how your EHR, if other than CareLogic, will need to be updated. Ray Dalessandro from Etactics and Anjuli Herrington from Qualifacts will also be present at most of our scheduled office hours and you will have the opportunity to ask them questions directly.
The purpose and agenda for these sessions will be:
The PNM and questions or concerns related to it.
What changes are coming 02/01/23.
Any updates from our trading partner testing.
How to implement in CareLogic (which could also be applicable for other EHRs).
Open discussion and Q&A.
We hope to see many of you during our office hours scheduled for 2:30pm today. Please understand that we are your partner and are doing everything possible, including adding 5 new team members in recent months, in order to grow our capacity to continue to provide excellent services. We hope that all of you have a wonderful holiday season and take the time to enjoy family and friends.
As always, if you no longer want to receive these emails, please reply to this email with STOP in the subject line.
Below is a response I received within minutes of sending the above email.
It’s been awful over here. We have been holding claims for 38 out of our ~120 providers. My estimates are somewhere in the ballpark of $400,000-$500,000. We have providers that are going on 35+ days since credentialing application submission and every time you call Medicaid it’s “2-3 more business days”. The other part that isn’t solved yet is the centralized credentialing process. I got 7 of our 38 affiliated in PNM and when I called caresource to confirm them on the CS side, they had not been affiliated. This is all in addition to the issues you mentioned with timely payment and incorrect denials.