Home and Community-Based Services (HCBS) Waiver Program. Indiana Health Coverage Programs DXC Technology October 2017

Transcription

1 Home and Community-Based Services (HCBS) Waiver Program Indiana Health Coverage Programs DXC Technology October 2017

2 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

3 HCBS Program Overview Indiana Health Coverage Programs DXC Technology

4 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.

5 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.

6 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

7 Indiana Health Coverage Programs DXC Technology Member Eligibility

8 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

9 Provider Healthcare Portal Eligibility

10 Waiver Billing Information Indiana Health Coverage Programs DXC Technology

11 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

12 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

13 Waiver Billing Notice of Action (NOA)

14 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

15 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

16 Provider Healthcare Portal Indiana Health Coverage Programs DXC Technology

17 Provider Healthcare Portal

18 Provider Healthcare Portal

19 Provider Healthcare Portal Site Key is selected when registering for the Portal

20 Provider Healthcare Portal Home Page

21 Submitting Professional CMS-1500 Claims Indiana Health Coverage Programs DXC Technology

22 Two ways to access claim submission

23 Professional Claim: Step 1

24 Professional Claim: Step 1

25 Professional Claim: Step 2 Add the diagnosis in the Diagnosis Code field. Once the diagnosis is located, click

26 Professional Claim: Step 2

27 Professional Claim: Step 3

28 Professional Claim: Step 3

29 Professional Claim: Step 3

30 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.

31 Professional Claim: Step 3 Add Provider ID Choose Provider ID from ID Type Choose unit from Unit Type

32 Professional Claim: Step 3 Once information is entered, click

33 Professional Claim: Step 3

34 Confirm Professional Claim

35 Submit Professional Claim: Confirmation Payment/Denied

36 Search CMS-1500 Claims Indiana Health Coverage Programs DXC Technology

37 Two ways to access Claims Submission OR

38 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

39 Search Claims: Results

40 Search Claims: Results

41 Copying and Correcting Claims

42 Copying and Correcting Claims

43 Provider Healthcare Portal User Access

44 Search Payment History

45 Indiana Health Coverage Programs DXC Technology Updates

46 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.

47 Indiana Health Coverage Programs DXC Technology Helpful Tools

48 Helpful Tools IHCP website at indianamedicaid.com IHCP Provider Reference Modules Medical Policy Manual Customer Assistance available 8am-6pm EST Monday Friday 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 Correspondence P.O. Box 7263 Indianapolis, In

49 Questions Following this session please review your schedule for the next session you are registered to attend