home and community-based services (hcbs) waiver program fssa.pdf · to keep them in their home and...
TRANSCRIPT
Indiana Health Coverage ProgramsDXC Technology
October 2017
Home and Community-Based Services (HCBS) Waiver Program
Agenda
– HCBS Program overview
– Member Eligibility
– Wavier Billing Information
– Provider Healthcare Portal
– Submitting electronic claims
– Searching for claims
– Remittance Advice (RA)
– Updates
– Helpful tools
– Q&A
Indiana Health Coverage ProgramsDXC Technology
HCBS Program Overview
What Is the Home and Community-
Based Services Waiver Program?
˗ In addition to traditional State Plan Medicaid benefits, members enrolled in an HCBS program are eligible to receive specific services within the HCBS program that address their specific person-centered goals and needs to keep them in their home and community.
˗ FSSA administers four HCBS 1915(c) waiver programs and three 1915(i) HCBS State Plan Options.
What Is the 1915 (c) HCBS Waiver
Program?˗ Provides services to individuals who are eligible
for Medicaid and meet specific level of care criteria but wish to remain in the community.
˗ Must be cost-neutral (cost must not exceed the cost of an institutional setting).
˗ Individual cannot be enrolled in managed care.˗ There is a specific number of approved member
slots/year. When slots are full, there may be a waiting list.
˗ Funding of last resort. Member must utilize State Plan benefits first, and then use HCBS to fill in any gaps.
Local Resources – Assessment for
Level of Care (LOC) Needs
Administered by the Division of Aging (DA)
− Aged and Disabled (A&D) Waiver
− Traumatic Brain Injury (TBI) Waiver
Administered by the Division of Disability and Rehabilitative Services (DDRS), Bureau of Developmental Disabilities Services (BDDS)
− Community Integration and Habilitation (CIH) Waiver
− Family Supports (FS) Waiver
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Member Eligibility
Member Eligibility
It is the provider’s responsibility to verify a member’s eligibility prior to providing services
The following two Eligibility Verification System options are available:
Provider Healthcare Portal
The following search options are available:
Name and date of birth (DOB) Member identification number Social Security number
Interactive Voice Response (IVR) System Member eligibility verification Level of care confirmation (NF/Waiver)
Contact IVR at toll-free at 1-800-457-4584
Provider Healthcare Portal Eligibility
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Waiver Billing Information
Waiver Billing – Authorized Services
Only authorized services that appear on the members Plan of Care/Notice of Action (NOA) may be billed
˗ For services to be authorized, they must fulfill the following criteria:
− Meet the needs of the member
− Be addressed in the member’s person-centered service plan and be identified on the NOA
− Be provided as the services that are defined and established by the waiver program
− Must not duplicate other Medicaid funded services
− Must not be billed while a member is in an institutional setting, that is, a hospital, nursing facility, or group home
Waiver Billing – Notice of Action (NOA)
When billing for HCBS services, it is important to have the NOA available in order to bill properly˗ The NOA lists the following information:
− Approved service providers
− Approved service codes and modifiers
− Approved number of units and dollar
amounts
˗ Units on the NOA may be in time
increments or dollar amounts
Waiver Billing – Notice of Action (NOA)
Waiver Billing - Claims
Waiver providers should submit their claims:
˗ Using the 837P transaction˗ Provider Healthcare Portal˗ The CMS-1500 claim form is used
when submitting paper claims
Waiver providers submit claims using their IHCP Provider ID
− Do not report a National Provider Identifier (NPI) on claims; even if you have a NPI – Bill with your Provider ID only
− Do not report or use a taxonomy code
Waiver Billing – Primary Diagnosis
Waiver providers should bill ICD-10 code R69 as the primary diagnosis code for all claims.
˗ Claims submitted without an ICD-10 primary diagnosis code will generate the denial error message, primary diagnosis code is required
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Provider Healthcare Portal
Provider Healthcare Portal
Provider Healthcare Portal
Provider Healthcare Portal
Site Key is selected when registering for the Portal
Provider Healthcare Portal
Home Page
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Submitting Professional
CMS-1500 Claims
Two ways to access claim submission
Professional Claim: Step 1
Professional Claim: Step 1
Professional Claim: Step 2
Add the diagnosis in the Diagnosis Code field.
Once the diagnosis is located, click
Professional Claim: Step 2
Professional Claim: Step 3
Professional Claim: Step 3
Professional Claim: Step 3
Professional Claim: Step 3
MODIFIERS - required
Review the Notice of Action (NOA) for the required modifiers
The modifiers on the claim must exactly match the NOA.
Professional Claim: Step 3
Add Provider ID Choose “Provider ID” from ID Type
Choose “unit” from Unit Type
Professional Claim: Step 3
Once information is entered, click
Professional Claim: Step 3
Confirm Professional Claim
Submit Professional Claim:
Confirmation
Payment/Denied
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Search CMS-1500 Claims
Two ways to access Claims Submission
OR
Search Claims
When searching for claims –you have the option to choose which type of claim to search.
Search by Claim ID, Member ID, or Service Dates and click
Search Claims: Results
Search Claims: Results
Copying and Correcting Claims
Copying and Correcting Claims
Provider Healthcare Portal User Access
Search Payment History
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Updates
Red-and-White claim form
• Effective January 1, 2018, all claims billed on professional (CMS-1500)(02-12) and institutional UB-04(CMS-1450) claim forms must be submitted on a standard red and white claim form. The IHCP will no longer accept copied (black and white) claim forms.
• Claims not received on the red-and-white claim form on or after January 1, 2018, will be returned to the provider.
• ADA Form 1260 is available only in black and white.
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Helpful Tools
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Helpful Tools
• IHCP website at indianamedicaid.com– IHCP Provider Reference Modules– Medical Policy Manual
• Customer Assistance available 8am-6pm EST Monday – Friday – 1-800-457-4584
• IHCP Provider Relations Field Consultants– See the Provider Relations Field Consultants
page at indianamedicaid.com • Secure Correspondence via the Provider
Healthcare Portal
• Written Correspondence– DXC Technology Provider Written
CorrespondenceP.O. Box 7263Indianapolis, In 46207-7263
QuestionsFollowing this session please review your schedule for the next session you
are registered to attend