Physicians or practitioners providing Early Intensive Developmental and Behavioral Intervention (EIDBI) telemedicine services from a distant site will need to use the new place–of-service code 02 starting March 1, 2018. Continue to also use modifier GT (via interactive audio and video telecommunications systems). Claims for telemedicine services must include both the code 02 and the GT modifier. If telemedicine services are billed with only place–of-service code 02 or with only the GT modifier, that service line will be denied. (pub. 2/14/18)
Effective March 1, 2018, Supported Employment Services procedure code and modifier T2019 HQ will be replaced by T2019 UP. The procedure code and modifier T2019 UP will be required for dates of service on or after March 1, 2018. This applies for all Brain Injury (BI), Community Alternative Care (CAC), and Community Access for Disability Inclusion (CADI) waivers.
MHCP has changed the end date for all existing service agreements (SA) with procedure code T2019 HQ so they have an end date of February 28, 2018. We created a new line item for T2019 UP and put a note on the comments screen with information and instructions to the lead agency (county).
The new SA line item with T2019 UP is suspended with no units so the lead agency can split the units between the previous and new SA line items and finalize the new SA line item, as appropriate. Contact the county waiver case manager if the new SA line item has not yet been approved. (pub. 2/14/18)
Providers interested in providing intensive treatment in foster care need to attend one of the Intensive Treatment in Foster Care (ITFC) Applicant Provider Information Sessions, and then be certified. You can read more in the bulletin Children’s Mental Health Announces New Service: Intensive Treatment in Foster Care.
Sign up for the training through the Adult and Children’s Mental Health link from the TrainLink information page. From the TrainLink registration page, click on Course Catalog Search and enter the course code CMH110. Click on Class Schedule for all session dates and locations. Sessions scheduled in 2018 are February 20, May 15, August 21, and November 20. Each session time will be 9:00 a.m. to 12:00 p.m. (pub. 2/12/18)
Beginning January 1, 2018, claims for X-rays taken using computed radiography must include modifier FY (X-ray taken using computed radiography technology/cassette based imaging). For calendar years (CY) 2018 through 2022, the FY modifier will result in a payment reduction of 7 percent for the technical component and the technical component of the global fee. For services furnished during CY 2023 or a subsequent year, a payment reduction of 10 percent will apply to the technical component and the technical component of the global fee. (pub. 2/12/18)
Minnesota Health Care Programs (MHCP) provider training is offering free claims help sessions for Housing Support Supplemental Service providers only. These sessions are tailored to have hands-on help to enter claims into MN–ITS.
The sessions are provided in a computer lab with computers available for you to use. You may bring and use your own laptop, if you prefer. Sessions are limited to 16 participants and are in-person only; a webinar will not be offered. Sign up early to reserve a seat.
You can find the dates and times, learning objectives and prerequisites for these sessions on the MHCP enrolled providers training page. (pub. 2/6/18)
For dates of service on and after November 1, 2017, CHW can bill for interpreter services necessary to deliver covered Minnesota Health Care Programs (MHCP) services. (pub. 2/6/18)
The following codes were discontinued and replaced with new codes effective January 1, 2018:
The Comprehensive Multi-Disciplinary Evaluation (CMDE) (DHS-7108) and Individualized Treatment Plan (ITP) and Progress Monitoring (DHS-7109) for Early Intensive Developmental and Behavioral Intervention (EIDBI) services evaluation and treatment are now available as interactive forms. DHS will continue to accept and process the previous version of these forms until April 2, 2018, but strongly encourage you to begin using the updated versions as soon as possible. After April 2, we will no longer accept the previous versions of these forms.
To access these forms, you must use the MN–ITS log-in credentials assigned to you either by DHS or your MN–ITS administrator. After you submit the forms online to DHS, you are still responsible for converting the form to a PDF document and submitting it to the review agent for authorization.
If you are a consolidated provider and submit an 837I institutional claim that requires an attending physician, you will now be able to add the attending provider on the claim level, and select the appropriate taxonomy location for this provider. This change is effective immediately and will affect claims you enter directly into MN–ITS. Refer to the MHCP MN–ITS 837I Institutional User Guides for instructions on 837I claim submissions. (pub. 1/23/18)
The Department of Human Services (DHS) received approval from the Centers for Medicare & Medicaid Services (CMS) for the Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit State Plan Amendment (SPA) December 11, 2017. Among other updates, this approval added a new way for providers to enroll as Level II EIDBI providers. DHS worked closely with the EIDBI advisory group and other stakeholders to determine this new qualification. This update will allow more people to enroll as EIDBI providers, which will give people with autism spectrum disorder (ASD) and related conditions more timely access to services.
Review the EIDBI Provider Enrollment section of the MHCP Provider Manual and the Overview of EIDBI providers page of the EIDBI Benefit Policy Manual for more details about the updated MHCP requirements to provide EIDBI services. The corresponding provider assurance statements have been posted with the updated requirements.
Read the updated provider qualification in the EIDBI SPA (PDF), under Provider Qualifications and Training, Level II EIDBI Providers on page 6, section B. 2. Continue checking the updates to the EIDBI Policy Manual for program revisions. (pub. 1/23/18; rev. 1/29/18)
Beginning March 1, 2018, MHCP will no longer require use of the GT modifier on claims for telehealth services. Using the telehealth place-of-service (POS) code 02 certifies that the service meets the telehealth requirements.
The GQ modifier is still required when billing for services via asynchronous telecommunication systems. (pub. 1/23/18)
For all Home and Community-Based Services (HCBS) claims submitted March 5, 2018, or later, providers must bill each date of service on a separate line. We revised the Billing for Waiver and Alternative Care (AC) Program section of the MHCP Provider Manual some time ago to reflect this change; however, the system did not yet require the change. As of March 5, 2018, if you submit a claim using a date span, the claim will deny.
Billing each date of service on a separate line promotes consistency, reduces errors and ensures the appropriate use of the codes. This helps to reduce claim denials and voids related to duplication with other claims for dates when a member is admitted into a hospital or nursing facility setting. It also ensures you receive payment for dates you provided services before the person was admitted (even if you are unaware of admission) or for after the person is discharged.
Continue to submit authorizations for HCBS following the requirements in the Authorization section of the MHCP Provider Manual. Please note that how service authorizations are approved has not changed. (pub. 1/9/18)
The implementation date is delayed for certain screening components or health services of the October 2017 version of the C&TC Schedule of Age-Related Screening Standards (Periodicity Schedule) (DHS-3379) (PDF).
Providers have until March 1, 2018, to implement the following components:
If you submitted claims for preventive health screening visits provided on dates of service of October 1, 2017, or later, but did not enter the two-letter HIPAA-compliant referral code because you had not implemented one or more of the new requirements, you may replace these claims if you provided the rest of the required screening components. Replace these claims indicating a complete C&TC visit by adding the appropriate two-letter referral code.
If you have already implemented all of the October 2017 C&TC Schedule of Age-Related Screening Standards, please continue to follow those standards between now and March 1, 2018. Continue to work toward implementation if you have not yet implemented the March 1, 2018, requirements.
Review the Child and Teen Checkups section of the MHCP Provider Manual for more details of the requirements. Review both page 1 and page 2 of the C&TC Periodicity Schedule for additional details and clarification of the October 1, 2017, revisions and the C&TC FACT Sheets for each component. (pub. 1/5/17)
DHS continues to monitor the progress to correct any long-term care (LTC) claims denied in error on the remittance advice (RA) dated Dec. 27, 2017. (See previously posted message, Retroactive denial of long-term care claims.) DHS is reprocessing these claims and will report them on the RA dated Jan. 9, 2018. To help providers quickly identify these claims, we will display the claims on a separate RA.
This means that in addition to your regularly scheduled RA01 and RA02 RAs, you will receive a second RA01 containing only the reprocessed long-term care claims from Dec. 27, 2017. Note that the first and current RA will contain a summary balance of all transactions of both RAs, including the reprocessed long-term care claims. These items will appear in your MN–ITS mailbox related to the January 9, 2018, RA.
Any claims you submitted for December 2017 dates of service will be included on the RA dated Jan. 9, 2018. To prevent those claims from appearing on that RA, you must wait to bill your December 2017 claims until Jan. 8, 2018.
The RAs you receive dated Jan 9, 2018, may show a larger than normal volume of transactions. This may require additional time for you to reconcile and determine your final account balance.
You may request to change the sequence of your RA. Available sequences include:
If you would like to change your remittance sequence for the January 9, 2018, RA, please call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411 by noon on Friday, January 5, 2018. (pub. 1/4/18)
Effective January 1, 2018, 20 acupuncture units are allowed per calendar year. The policy previously stated 20 units annually. (pub. 1/4/18)
A recent program update caused some long-term care claims for nursing facilities to retroactively deny. This caused a negative balance for affected providers. We have identified the cause and corrected the issue.
The affected claims were denied on Dec. 18, 2017, and may be for dates of service back to 2002. The claim denials were on your Dec. 27, 2017, remittance advice.
DHS has already initiated adjustments on the affected claims. You can expect to see the correction on your Jan. 9, 2018, remittance advice.
If this caused a hardship for your agency, call the MHCP Provider Call Center to discuss potential options available. (pub. 12/28/17, rev. 1/2/18)
Recent issues with the MN–ITS 278 Home Health Care authorization request transaction caused the system to not retain all of the data. When homecare providers sent in a service authorization request to KEPRO through the MN–ITS portal, the system did not retain the ordering NPI, diagnosis code, and frequency. If you submitted an authorization request between Dec. 5 and noon on Dec. 27, 2017, please confirm that it was approved. If the request was approved there are no additional steps you need to take. If the request was initially denied, you need to submit a new request. We have resolved the issue and you do not need to take any additional steps at this time. (pub. 12/28/17)
Revision: The requirement for documentation of start and end times for billing PCA services using a timed study has been extended until July 1, 2018. MHCP extended the deadline to give schools more time to update their current time studies that do not meet the start and end time requirements. The effective date for all other Individualized Education Programs (IEP) or Individualized Family Service Plans (IFSP) service and evaluations and assessments remains February 1, 2018.
Effective February 1, 2018, school districts will be required to document start and end times for each IEP or IFSP health-related service covered under Medical Assistance (MA), including MA covered initial evaluations, reevaluations and assessments. The school district must have this information readily available if Minnesota Health Care Programs (MHCP) or CMS requests it. This documentation is necessary to accurately reflect the actual amount of face-to-face time the service provider spends with the child.
The documentation requirement applies to the following IEP health-related evaluations, assessments and services:
PCA Exception: Due to the frequency, multiple tasks and behavior episodes that may occur at any time during the school day, it is difficult for personal care assistance (PCA) providers to keep exact times for each task. Because of this, MHCP allows schools to use one of two methods for documenting PCA time:
Both options must now include start and end times for the face-to-face time the PCA spends with the child.
Direct service time (time spent face to face with a child) is used in calculating the cost-based daily rates schools use when billing MHCP for IEP or IFSP service. Schools are instructed to bill one unit per service per child per day. Therefore the actual time spent impacts the rate calculations. This has not changed.
Documenting actual start and end times
The only change for schools is the requirement to document actual time spent, rather than an estimated amount of time it will take to complete the service according to what is stated in the IEP or IFSP. The time needed to provide a health-related service may vary to accomplish daily goals. Reporting what is stated in the IEP or IFSP does not account for the actual time spent because it does not capture when performing that service takes a longer or shorter amount of time than what is projected in the IEP. For example, if the IEP or IFSP says that a service is expected to take 15 minutes, but it takes 23 minutes, document the 23 minutes by noting the actual start and end times of that service.
Recording start and end times provides better supporting documentation and insures that the actual time spent in the provision of the service is captured. Each school district may decide how and where they will document the start and end times for health-related services.
To meet the February 1, 2018, requirement, MHCP recommends that school districts review their current time-reporting and documentation procedures as soon as possible and determine how to implement this requirement before the effective date. Audits or reviews conducted after February 1, 2018, may request copies of this documentation. Inability to provide the correct documentation showing actual start and end times of health-related services could result in recoupment of funds you have received from MHCP. (pub. 11/1/17; rev. 12/21/17)
The Minnesota Department of Human Services (DHS), Health Insurance Recovery Unit (HIRU) will conduct an audit of long-term care (LTC) claims. The HIRU will audit claims on which occurrence code 24 was used. The reason for the audit is to determine if providers are appropriately using occurrence code 24 only after members have exhausted all other available benefits.
These claim audits will begin January 16, 2018, and will be done quarterly. The first group of claims audited will be claims with remittance advice dates from January 1 through June 30, 2015. See the table for upcoming audits and affected remittance advice dates.
Claim audit dates
|Audit begin month||Remittance advice dates|
|January 2018||January 1 – June 30, 2015|
|April 2018||July 1 – December 31, 2015|
|July 2018||January 1 – June 30, 2016|
|October 2018||July 1 – December 31, 2016|
We will send audit notices to you through both your MN–ITS mailbox and US postal mail on January 16, 2018. Only LTC facilities who have submitted claims with code 24 will receive an audit notice. If you receive an audit notice, please read and respond as the notice directs within 30 days from the date on the notice. The notice will explain what information you need to provide. If you don’t comply with this request, we will recover all funds you received for services billed under code 24 for the audit dates. (pub. 12/8/17)