Illinois Department of Human Services / Division of Mental Health and Illinois Mental Health Collaborative Present

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Illinois Department of Human Services /Division
of Mental Health and Illinois Mental Health
Collaborative Present
CHP Direct Claims Submission Training

• January 2010

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Claims Training Agenda

• Overview of CHP Services
• Billing Guidelines
• Direct Claim Submission on ProviderConnect
• Claim Helpful Hints

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CHP Claims

• Under the Collaborative IT system, all services
  are submitted as claims and all claims must be
  submitted electronically
• Community Health and Prevention Service claims
  may be submitted to the Collaborative for dates
  of service 8/1/2009 and after.
• Program Code CHP

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CHP Service Codes
CPT HCPCS New Modifier Order New Modifier Order New Modifier Order Service Name Bill Unit (hrs)
CPT HCPCS 1 2 3 Service Name Bill Unit (hrs)
H0031 AH     Mental health assessment (LCP) 0.25
H0031 HN     Mental health assessment (MHP) 0.25
H0031 HO     Mental health assessment (QMHP, AM/MA) 0.25
H0032 HN     Treatment plan development, review, modification (MHP) 0.25
H0032 HO     Treatment plan development, review, modification (QMHP) 0.25
90862 52     Psychotropic medication monitoring 0.25
90862 SA     Psychotropic medication monitoring (APN) 0.25
90862 UA     Psychotropic medication monitoring (MD/DO/DC) 0.25
H0002 HE     Case management - LOCUS Event
H0004 HN     Therapy/counseling--individual (MHP) 0.25
H0004 HO     Therapy/counseling--individual (QMHP) 0.25
H0004 HQ HN   Therapy/counseling--group (MHP) 0.25
H0004 HQ HO   Therapy/counseling--group (QMHP) 0.25
H0004 HR HN   Therapy/counseling--family (MHP) 0.25
H0004 HR HO   Therapy/counseling--family (QMHP) 0.25
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CHP Service Codes
CPT HCPCS New Modifier Order New Modifier Order New Modifier Order Service Name Bill Unit (hrs)
CPT HCPCS 1 2 3 Service Name Bill Unit (hrs)
H0034 HN     Psychotropic medication training--Individual 0.25
H0034 HQ SA   Psychotropic medication training--group (APN) 0.25
H0034 HQ     Psychotropic medication training--group 0.25
H0034 SA     Psychotropic medication training--Individual (APN) 0.25
H0039 HQ     Assertive community treatment, group 0.25
H0039 HT     Assertive community treatment 0.25
H2011     Crisis intervention 0.25
H2011 HK     Crisis intervention, state operated facility screening 0.25
H2011 HT     Crisis intervention--multiple staff 0.25
H2015 HE HM   Community support, residential, individual (RSA) 0.25
H2015 HE HN   Community support, residential, individual (MHP) 0.25
H2015 HE HO   Community support, residential, individual (QMHP) 0.25
H2015 HM     Community support, individual (RSA) 0.25
H2015 HN     Community support, individual (MHP) 0.25
H2015 HO     Community support, individual (QMHP) 0.25
H2015 HQ HE HM Community support, residential, group (RSA) 0.25
H2015 HQ HE HN Community support, residential, group (MHP) 0.25
H2015 HQ HE HO Community support, residential, group (QMHP) 0.25
H2015 HQ HM   Community support, group (RSA) 0.25
H2015 HQ HN   Community support, group (MHP) 0.25
H2015 HQ HO   Community support, group (QMHP) 0.25
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CHP Service Codes
CPT HCPCS New Modifier Order New Modifier Order New Modifier Order Service Name Bill Unit (hrs)
CPT HCPCS 1 2 3 Service Name Bill Unit (hrs)
H2015 HT     Community support, team 0.25
H2017 HM     Psychosocial rehabilitation, individual (RSA) 0.25
H2017 HN     Psychosocial rehabilitation, individual (MHP) 0.25
H2017 HO     Psychosocial rehabilitation, individual (QMHP) 0.25
H2017 HQ HM   Psychosocial rehabilitation, group (RSA) 0.25
H2017 HQ HN   Psychosocial rehabilitation, group (MHP) 0.25
H2017 HQ HO   Psychosocial rehabilitation, group (QMHP) 0.25
S9480 HA HO   Mental health intensive outpatient--child 1.00
S9480 HO     Mental health intensive outpatient--adult 1.00
T1016 HK HN   Case management--mandated follow-up (MHP) 0.25
T1016 HK HO   Case management- mandated follow-up (QMHP) 0.25
T1016 HM     Case management--mental health (RSA) 0.25
T1016 HN     Case management--transition linkage and aftercare (MHP) 0.25
T1016 HO     Case management--transition linkage and aftercare (QMHP) 0.25
T1016 TF     Case management--mental health (MHP) 0.25
T1016 TG HN   Case management--client-centered consultation (MHP) 0.25
T1016 TG     Case management--client-centered consultation (RSA) 0.25
T1502     Psychotropic medication administration (LPN/RN) Event
T1502 SA     Psychotropic medication administration (APN) Event
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Claims Submission and Billing Guidelines

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Registration Requirement

• Before claim is submitted, consumer must be
  registered by the agency performing the service

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Consumer Information

• Standardized claims transactions require certain
  consumer information to verify the individuals
  identity
• The Collaborative has minimized the consumer
  information necessary for a claim to be
  submitted, while assuring that each service claim
  is correctly associated to the appropriate
  consumer

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Claim Level Information

• Consumer Information Required
• RIN
• Consumer Name
• Date of Birth
• Gender
• All must match exactly to the registration
  information on file
• Consumer address is optional

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Claim Level Information(cont.)

• Provider Information required on each
• claim
• 10 digit NPI number that matches the NPI on file
  with the Collaborative
• Tax ID Number (FEIN)
• Service Location
• Taxonomy Codes are optional
• Service code and modifier combinations will
  identify staff level

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Claim Level Information (cont.)

• Program Codes
• Submit the Program Code for the service provided
  
• Program Code CHP

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Claim Line Level Information

• Service Codes
• Service codes must be valid HCPCS or CPT codes as
  shown on Service Matrix found at
• http//www.illinoismentalhealthcollaborative.com/

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Claim Line Level Information (cont.)

• Modifiers
• Staff Level Modifiers drive the allowable amount
  applied to a service
• If no staff level modifier is submitted, the
  claim will be denied unless the service does not
  require a Staff Level Modifier
• Modifier Position is very important
• Staff Level Modifier should always be in the last
  modifier position when multiple modifiers are
  submitted

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Claim Line Level Information (cont.)

• Staff Level Modifiers
• AH LCP - Licensed Clinical Psychologist
• HN MHP - Mental Health Professional
• HO QMHP - Qualified Mental Health Professional
• SA APN -Advanced Practice Nurse
• HM RSA - Rehabilitative Services Associate
• UA MD, DO, DC

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Claim Line Level Information (cont.)

• Diagnosis Codes
• Must be ICD-9 and include 4th and 5th digit
  according to ICD-9 guidelines
• Only Mental Health diagnoses that are DMH/DHS
  defined will be accepted.

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Claim Line Level Information (cont.)

• Line Notes
• For all services, the following are required
• Delivery method
• Service start time
• Service duration
• Staff ID
• Situational Requirements
• For group based services show the group id,
  clients in group, and of staff in the group
• DMH considers these data elements to be important
  and necessary components of billing and service
  reporting

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Review Services Matrix

• The Service Matrix is posted on the
  Collaborative Website in an Excel Spreadsheet
  that you may download.
• http//www.illinoismentalhealthcollaborative.com/

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Direct Claim Submission
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ProviderConnect
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Submitting Corrected/Replacement Claims

• When an original claim was incorrectly billed,
  send a corrected or replacement claim by
  indicating the Claim Frequency Type Code
• 6Corrected
• 7Replacement
• Enter the Collaboratives original Claim Number

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Questions?
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Claims Helpful Hints

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Helpful Hints to Faster Claim Processing

• Submit the correct Consumer RIN in the Consumer
  ID field
• if the RIN doesnt match the DHS assigned number,
  the claim will be uploaded to our claims
  processing system identifying the Consumer as
  UNKNOWN

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Helpful Hints to Faster Claim Processing (cont.)

• Multiple units of service rendered by the same
  practitioner staff level, on the same day, for
  the same client, must be submitted on one claim.
• All units for one service code must be submitted
  on one line.
• If claims are submitted separately, claims will
  be denied as a duplicate service.

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Helpful Hints to Faster Claim Processing (cont.)

• Example
• H2015 HN Community support, individual (MHP)
  For Consumer RIN 123456789
• 10 AM 4 units, noon 2 units, 6PM 3 units
• Submit H2015 HN on one line, with 9 units. Start
  time is 9999, duration 135 minutes

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Helpful Hints to Faster Claim Processing (cont.)

• A separate claim must be submitted for every
  different staff level rendering services (except
  for multiple disciplinary groups)

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Most Common Reasons for Claim Denial

• Consumer Information
• RIN doesnt match the RIN assigned by DHS or
  registration
• Service code on the claim is not on the list of
  covered services
• Service code billed is not one the provider is
  contracted to render (the service is not on the
  providers fee schedule).
• Consumer is not eligible/registered on the date
  of service.

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Most Common Reasons for Claim Denial (cont.)

• Codes/Modifiers
• Place of service code on the claim is not a valid
  place of service code for the service rendered
• Modifier code billed on the claim is not valid
  with the CPT or HCPCS code
• Staff level modifier is not billed on the claim
• Diagnosis code is not an ICD-9 code
• Diagnosis code does not contain a required 4th or
  5th digit

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Most Common Reasons for Claim Denial (cont.)

• Billing
• - Duplicate/Non-Rolled Services
• - Third Party Liability
• - TPL not billed with claim
• - TPL information on claim incomplete

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Timely Filing of Claims

• Claims for all services must be received by the
  Collaborative within 365 days of the date of
  service
• Claims Involving Third Party Liability (TPL) must
  be received by the Collaborative within 365 days
  of the date of the other carriers Explanation of
  Benefits (EOB), or notification of payment /
  denial.
• Timely filing limit applies to replacement claims
  as well as original claims claims must be
  received by the Collaborative within 365 days
  from date of service.

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Questions and Answers
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Thank you!
Illinois Mental Health Collaborative for Access
and Choice