Louisiana Medicaid

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Louisiana Medicaid
UNISYS

• DHH Bureau of Primary CarePractice Management
  Technical Assistance Workshop
• August 14th , 2008

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Billing for Independent Mental Health Providers

• Independently Practicing Psychologists and Social
  Workers
• Medicaid covers services provided to
  Medicare/Medicaid recipients ONLY
• Medicaid uses a cost-comparison methodology to
  make payments up to the Medicare coinsurance/or
  deductible
• Claims should crossover electronically from
  Medicare
• Psychological and Behavioral Services (PBS)
• Must be an enrolled Psychologist participating in
  the PBS program
• Covers recipients under the age of 21
• Services covered include necessary assessments,
  evaluations, individual therapy, and family
  therapy
• Reimbursement is based on fee-for-service

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Ind. Social Worker Claim Form Example
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(No Transcript)
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PBS Claim Form Example
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Common Billing Errors

• General Claim Form Completion Codes
• 003 Recipient invalid or less than 13 digits
• 028 Invalid or missing CPT code
• Recipient Eligibility Error Codes
• 215/216/222/223 Recipient not on file/not
  eligible on one or more DOS
• 217 Name/ on claim does not match file
• Timely Filing Error Codes
• 272/371 Claim exceeds 1 year filing
  limit/attachment requires review
• Misc. Error Codes
• 433/020 Missing/invalid diagnosis
• 131 Primary diagnosis not on file
• 234 P/F age restriction
• 739 Recipient has exceeded maximum allowed
  services per year

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Timely Filing Guidelines

• Initial Filing Limits
• Dates of Service Past Initial Filing Limit
• Two-Year Filing Limit

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Appeals Process

• Denied claims ARE NOT considered appeals and
  should be corrected and re-filed to Unisys
• Appeals may be filed when all efforts to get the
  claim paid have been exhausted
• Requests must be submitted in writing to
• DHH Bureau of Appeals
• P.O. Box 4183
• Baton Rouge, La. 70821-4182

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CommunityCARE

• Program Description
• Exempt Recipients
• Primary Care Physician (PCP)
• Non-PCP Providers
• Exempt Services

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Types of Services Covered

• Mental Health Rehabilitation Services
• Private providers
• Assessment
• Service Planning
• Community Support
• Medication Management
• Individual Intervention/Supportive Counseling
• Group Counseling
• Parent/Family Intervention Counseling
• Psychosocial Skills Group Training
• All services must be Prior Authorized through SRI
• Reimbursement is based on fee-for-service

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(No Transcript)
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Types of Services Covered

• Mental Health Clinics
• Only State Operated Clinics
• Covered Services include
• Evaluations/Assessments
• Treatment
• Counseling Services
• Medication Management
• Injections
• Reimbursement is based on fee-for-service

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MHC Claim Form Example
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Common Billing Errors

• General Claim Form Completion Codes
• 003 Recipient invalid or less than 13 digits
• 028 Invalid or missing CPT code
• Recipient Eligibility Error Codes
• 215/216/222/223 Recipient not on file/not
  eligible on one or more DOS
• 217 Name/ on claim does not match file
• Timely Filing Error Codes
• 272/371 Claim exceeds 1 year filing
  limit/attachment requires review
• TPL Error Codes
• 273 TPL carrier code missing
• 290 No EOB from primary carrier attached
• Miscellaneous Error Codes
• 194 Claim exceeds prior authorized limits
• 191 Procedure requires prior authorization
• 299/232 - Procedure not covered by Medicaid/type
  of service not covered

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Timely Filing Guidelines

• Initial Filing Limits
• Dates of Service Past Initial Filing Limit
• Two-Year Filing Limit

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Appeals Process

• Denied claims ARE NOT considered appeals and
  should be corrected and re-filed to Unisys
• Appeals may be filed when all efforts to get the
  claim paid have been exhausted
• Requests must be submitted in writing to
• DHH Bureau of Appeals
• P.O. Box 4183
• Baton Rouge, La. 70821-4182

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CommunityCARE

• Program Description
• Exempt Recipients
• Primary Care Physician (PCP)
• Non-PCP Providers
• Exempt Services

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Outpatient Visit Limits

• If a CommunityCare recipient has used up all
  visits and needs non-emergent care, the PCP
• Can either treat the recipient and not bill
  Medicaid
• Offer to see the recipient as a private pay
  patient (enrollee pays out of pocket)
• Request an extension using the 158-A form
• Issue a referral to a physician who will treat
  the recipient

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Provider Assistance

• Provider Relations Telephone Unit
• 800-473-2783 OR 225-924-5040
• Provider Enrollment Department
• 225-216-6370
• Correspondence Unit
• Unisys-Provider Relations
• P.O. Box 91024
• Baton Rouge, LA. 70821
• Field Analysts

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THANK YOU!

• For Attending This 2008 Provider Workshop