Due to National Correct Coding Initiative (NCCI) edits that were effective Oct. 1, 2017, claim lines will deny for certain codes that are billed on the same day. If codes on the list for procedure-to-procedure (PTP) edits are billed on the same day, one code will deny.
If you have a claim for durable medical equipment (DME) from Oct. 1 to Oct. 11, 2017, that was denied due to a PTP edit, contact Regina Acevedo at email@example.com with the claim information. MHCP will review the claim line to determine whether we can override the denial so the claim will pay. We will not review any claim denials for dates of service on or after Oct. 12, 2017.
Providers are responsible for checking the NCCI quarterly edits on the Medicaid.gov website, National Correct Coding Initiative in Medicaid. MHCP will not review and consider for payment any claims billed incorrectly beginning with the next CMS publication of quarterly edits. The CMS NCCI went into effect for Medicaid in 2010; all DME suppliers are expected to review the publication quarterly. (pub. 10/18/17)
Effective Nov. 1, 2017, schools must use the place-of-service code 02 to identify that the service provided through telemedicine was provided at the distant site (location of the service provider) through interactive audio and video technology.
Minnesota Health Care Programs (MHCP) will send a survey to a select number of school districts who have completed the MHCP Provider Assurance Statement for Telemedicine (DHS-6806) (PDF). The survey will ask about how they verified that their subcontractors are using appropriate technology. Watch your MN–ITS Miscellaneous Received - PRVLTR folder for this survey. (pub. 10/17/17)
Minnesota Health Care Programs (MHCP) will increase the number of therapy units allowed during a six-month period to 182 starting January 1, 2018. The increased number of therapy units will allow the integration of dialectical behavior therapy–prolonged exposure (DBT–PE) into standard dialectical behavior therapy. Clinicians doing DBT–PE will need to include measureable goals, objectives and progress notes within standard treatment documentation. (pub. 10/17/17)
The Alcohol and Drug Abuse Division is collecting information from providers to help inform and guide the division’s tobacco prevention, treatment and control efforts. We would like each chemical dependency treatment program to complete two surveys: one completed by the program or treatment director and one completed by a counselor directly involved with treating clients. The survey should only take a few minutes. We need to have all surveys completed by November 15, 2017.
Click on this link to begin the survey: https://surveys.dhs.state.mn.us/snapwebhost/s.asp?k=150299875468
MHCP reprocessed claims paid incorrectly due to a processing error that caused incorrect payment to providers on certain radiology services with Centers for Medicare & Medicaid Services (CMS) status indicator B or E. Reprocessing applies the correct reimbursement rate to claims submitted within the last three years. Reprocessed claims will be reported on the Oct. 17, 2017, remittance advice. (pub. 10/3/17; rev. 10/13/17)
As of January 1, 2017, off-campus provider-based hospital departments began identifying non-excepted service lines on their claims using modifier PN (non-excepted off-campus service).
MHCP system changes are completed; service lines modified with PN will now price using the physician fee schedule. You will see these reprocessed claims on your Oct. 17, 2017, remittance advice. Refer to CMS MLN Matters 9930 for more information. (pub. 10/3/17; rev. 10/12/17)
The revised Nursing Facility (NF) Communication Form (DHS-4461) (PDF) is available for health plans and nursing facilities to use as of October 1, 2017. This form was previously known as the PMAP Communication form.
Revising the DHS-4461 form serves several purposes:
Minnesota Department of Human Service will implement start and end time requirements for IEP health-related services. Schools currently document the face-to-face time spent with children eligible for Medical Assistance (MA) when providing health-related services. Effective February 1, 2018, schools must also document the start and end time for these services.
Watch for more details and guidance about this requirement coming soon. (pub. 9/28/17)
We previously asked that client placement authorizations (CPAs), service agreements (SAs), and claims all be entered with the HK and TG modifier on separate lines for committed and complex clients. However, due to changes in billing processes and service authorizations the HK (committed complex) modifier must now be placed on the same line as the TG (high intensity) modifier.
Counties and tribes: Enter into MMIS CPAs and SAs with dates of service on or after October 1, 2017, with both the high intensity (TG) and committed complex (HK) modifiers on the same line.
Existing CPAs and SAs with the TG and HK modifier that have date spans covering days before and after October 1, 2017, need to be separated into two CPAs or SAs as follows:
Substance use disorder (SUD) providers: Enter the TG (high intensity) and HK (committed complex) on the same line for claims you submit for committed complex clients with dates of service on and after October 1, 2017.
Note: This update applies only to CPAs and SAs having both the high intensity (TG) and committed complex (HK) modifiers with dates of service on or after October 1, 2017.
Call the MHCP Provider Call Center with any additional questions at 651-431-2700 or 800-366-5411 (option #4). (pub. 9/27/17)
MHCP discovered a claims processing error that caused incorrect payment to providers for whom DHS does not have a record of current advanced diagnostic imaging (ADI) accreditation.
To receive payment, currently certified providers must maintain their accreditation and submit their recertification renewal prior to its expiration date.
Beginning November 1, 2017, MHCP will reprocess these claims with dates of service on and after August 1, 2013. We will take back claims that paid after a provider’s accreditation end date.
The accreditation policy does not apply to the following provider types:
Providers whose accreditation has ended must do the following:
Allow 30 days for MHCP to process the accreditation before submitting imaging service claims provided to fee-for-service recipients. Resubmit any claims denied before MHCP received the required information following timely billing requirements. Claims recouped that are now past timely filing will not be reconsidered for payment. (pub. 9/19/17)
Physicians or practitioners providing telemedicine services from a distant site will need to use the new place of service code 02 starting November 1, 2017. Modifiers GT (via interactive audio and video telecommunications systems) and GQ (via an asynchronous telecommunications system) are still required when billing for telemedicine services. Claims must include both the code 02 and one of the modifiers.
If telemedicine services are billed with place of service code 02, but do not include the GT or GQ modifier, that service line will be denied. If telemedicine services are billed with modifiers GT or GQ but do not include the place of service code 02, the service line will be denied.
Services billed on an outpatient claim with the GT or GQ modifier will pay zero. (pub. 9/19/17)
Minnesota Health Care Programs (MHCP) provides a billing lab for Housing Support Supplemental Service providers. We recommend that providers attend a billing lab before billing through MN–ITS to receive payment for supplemental services. See the information about the in-person lab or webinar sessions that are available on the training page MHCP enrolled provider training and register for the Billing lab for Housing Support Supplemental Service providers. (pub. 9/14/17; rev. 10/3/17)
The Minnesota Department of Human Services (DHS) will administer a grant program to help outpatient providers enrolled with Minnesota Health Care Programs (MHCP) provide access to nonnarcotic injectable or implantable medications to Medical Assistance members. DHS will purchase the first dose of a nonnarcotic injectable or implantable medication to treat substance use disorders and will provide technical assistance to providers in submitting claims for the medications to MHCP.
Grants are available to any enrolled outpatient clinic or provider that is authorized to administer a nonnarcotic injectable or implantable medication to a Medical Assistance member. This grant program is available through June 30, 2019; however, it may end sooner if the funding has been exhausted. For more information and to apply see the Substance Use Disorder Provider Capacity Grant Application (DHS-7604) (PDF). (pub. 9/14/17)
We made the following updates to the Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit service agreement:
The Minnesota Child and Teen Checkups (C&TC) periodicity schedule requirements will change October 1, 2017.
The revised Minnesota Child and Teen Checkups (C&TC) Schedule of Age-Related Screening Standards (DHS-3379) (PDF) (periodicity schedule) is now posted. Refer to the eDocs library to order printed copies of the revised document.
Changes in the requirements are based on the 2017 version of Bright Futures from the American Academy of Pediatrics, along with changes in U.S. Preventive Services Task Force pediatric recommendations, MN Community Measurement guidelines, and the most recent Minnesota-specific health data for the C&TC eligible population. Key changes are:
Staff from the Minnesota Departments of Health and Human Services are preparing updated C&TC Fact Sheets for primary care providers and new parent fact sheets for implementing these changes. We have revised the C&TC section of the MHCP Provider Manual.
More information and resources