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MHCP Provider Manual

2012 Manual Revisions

Updates cited below do not include minor grammatical or formatting changes that otherwise do not have bearing on the meaning of the policy contained herein. Refer to Provider Updates that may contain additional MHCP coverage policies or billing procedures. MHCP incorporates information from these updates into the Provider Manual on an ongoing basis. Sign up to get email notices of section changes.

12/28/2012
Addition(s)/Revisions

Immunizations & Vaccinations – Updated the Immunization and Vaccination manual section to clarify information, and update the immunizations/vaccinations available through MDH MnVFC and Adult vaccines

12/24/2012
Addition(s)/Revisions

Mental Health Services – Overview

  • Psychiatric Consultations to Primary Care Providers – Revised the service description in the billing chart
  • 12/20/2012
    Addition(s)/Revisions

    Mental Health Services – Overview

  • Neuropsychological Services – Updated section according to MH rule 47
  • 12/14/2012
    Addition(s)/Revisions

    Hearing Aid Services – Added information and links to new Cochlear Implants page

  • Cochlear Implants – New page
  • 12/13/2012
    Addition(s)/Revisions

    HCBS Waiver Services

    Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Added instructions for using form 6638 to enroll or add services to a waiver or AC enrollment record and also instructions for submitting assurance statements as appropriate

    Physician and Professional Services – Revised billing codes listed for Genetic Counselor

    12/06/2012
    Addition(s)/Revisions

    Provider Basics
    Billing Policy Overview

  • Out-of-State Providers – Clarified billing paper claims under Billing
  • 12/05/2012
    Addition(s)/Revisions

    HCBS Waiver Services – Added Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) under MHCP Enrollment

    12/04/2012
    Addition(s)/Revisions

    Hospital Services – Updated/removed information under Mental Health Partial Hospitalization

    12/03/2012
    Addition(s)/Revisions

    Provider Basics
    Authorization

  • Drug Authorizations – Updated with 2011 Legislative changes for Authorization requirements when the recipient has other coverage
  • 11/28/2012
    Addition(s)/Revisions

    Mental Health Services – Overview

  • Psychiatric Consultations to Primary Care Providers – Psychiatrist and PCP providers will bill separately effective 4/1/12. PM is being change/updated to reflect the new policy and billing requirements.
  • 11/21/2012
    Addition(s)/Revisions

    Dental Services (Overview)

  • Children and Pregnant Women – Added Guidelines on Behavior Guidance for the Pediatric Dental Patient related to general anesthesia by the American Academy of Pediatric Dentistry
  • Non-Pregnant Adults – Corrected Subd to Subp and linked legal resources to the MN Rules in the revisor. Made changes to covered services for denture and partials.
  • 11/14/2012
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) - Clarified requirements and criteria for C&TC Development Mental Health Screening

    11/13/2012
    Addition(s)/Revisions

    Health Care Homes - Effective 12/6/12, the process to notify MHCP of your Health Care Homes status has changed

    11/06/2012
    Addition(s)/Revisions

    Hearing Aid Services – Corrected hearing aid service provider definition

    11/05/2012
    Addition(s)/Revisions

    Rehabilitative Services – Removed Authorization Criteria text

    11/02/2012
    Addition(s)/Revisions

    Rehabilitative Services

    11/01/2012
    Addition(s)/Revisions

    Rehabilitative Services

  • Casting & Strapping Services/Supplies – Updated chart to continue the temporary exemption of the statutory authorization requirement for services provided by PTs, OTs, and SLPs until October 1, 2013
  • Orthotic Procedures – Updated code charts to continue the temporary exemption of the statutory authorization requirement for services provided by PTs, OTs, and SLPs
  • Rehabilitative Services Procedure Codes (was Service Thresholds) – Updated code charts to continue the temporary exemption of the statutory authorization requirement for rehabilitative services to October 1, 2013
  • 10/24/2012
    Addition(s)/Revisions

    Hearing Aid Services – Removed Claims with DOS 12-31-08 and earlier, use modifier RP and Claims with DOS 1-1-09 and later, use modifier RB under Repair Claims

    10/18/2012
    Addition(s)/Revisions

    Rehabilitative Services

  • Service Thresholds – Removed duplicate codes (97532 and 97533)
  • 10/17/2012
    Addition(s)/Revisions

    Dental Services (Overview)

  • Authorization Requirement Tables for Children and Pregnant Women – Language added for clarification of orthodontic authorizations. Bill gingivectomy or gingivoplasty using Medical CPT codes.
  • 10/15/2012
    Addition(s)/Revisions

    Provider Basics
    Billing Policy Overview

  • Billing the Recipient – Added link to the spenddown information in the Programs and Services section. Added two items referencing copays.
  • 10/11/2012
    Addition(s)/Revisions

    Mental Health Services – Overview

  • Adult Rehab MH Services (ARMHS) – Added clarification of units and authorization requirements to the billing chart for Transition to Community Living Services
  • Provider Basics
    Programs and Services

  • Emergency Medical Assistance – Clarified EMA policy
  • 10/10/2012
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • Abortion Services – Removed reference to GAMC. Changed references from ICD-9 CM to ICD-CM.
  • Minnesota Family Planning Program (MFPP) – Removed reference to GAMC. Changed references from ICD-9 CM to ICD-CM.
  • Obstetric Services – Changed references from ICD-9 CM to ICD-CM
  • Presumptive Eligibility for Breast/Cervical Cancer Services – Removed reference to GAMC
  • Sterilization – Removed reference to GAMC
  • Hospital Services – Removed reference to GAMC

    Provider Basics
    Billing Policy Overview

  • Minnesota-defined U Modifiers – Added new definitions for substance abuse, EMT-CP, Money Follows the Person. New and revised U modifier definitions.
  • Renal Dialysis Overview

  • Renal Dialysis Method 1 - Changed references from ICD-9 CM to ICD-CM
  • 10/08/2012
    Addition(s)/Revisions

    Pharmacy Services – Examples provided of proper usual and customary price submission for OTC medications

    10/04/2012
    Addition(s)/Revisions

    Mental Health Services – Overview

  • Dialectical Behavior Therapy (DBT) – Added requirements for updating team member information
  • 09/28/2012
    Addition(s)/Revisions

    Hearing Aid Services – Clarified language related to billing aids that are unsatisfactory and removed reference to GAMC

    09/26/2012
    Addition(s)/Revisions

    Home Care Services

  • Home Health Aide Services – Removed reference to GAMC
  • Private Duty Nursing (PDN) Services – Removed reference to GAMC
  • Rehabilitation Therapy Services – Removed reference to GAMC
  • Skilled Nurse Visit (SNV) Services – Removed reference to GAMC
  • Immunizations & Vaccinations – Removed reference to GAMC

    Mental Health Services – Overview

  • Telemedicine Delivery of Mental Health Services – Revised/clarified text about service exceptions
  • Personal Care Assistance (PCA) Services – Removed references to GAMC

    Pharmacy Services – Removed references to GAMC

    Physician and Professional Services – Added code 98960 for 1:1 NPP education/counseling. Updated Sleep Testing section to remove the authorization requirement. Removed reference to GAMC

    Provider Basics
    Programs and Services

  • Program HH (HIV/AIDS) Covered Services – Removed reference to GAMC
  • Provider Basics
    Provider Requirements

  • Provider Participation Requirements – Rule 101 – Removed reference to GAMC
  • Renal Dialysis Overview – Removed reference to GAMC

    Tribal and Federal Indian Health Services – Removed reference to GAMC

    09/24/2012
    Addition(s)/Revisions

    Provider Basics

  • Provider Requirements – Removed General Assistance Medical Care (GAMC) Program under the MHCP (Minnesota Health Care Programs) definition
  • 09/18/2012
    Addition(s)/Revisions

    Mental Health Services – Overview

  • LOCUS – Clarified text and removed broken links
  • 09/14/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Urological Supplies – Removed Excess Quantities of Indwelling Catheters/Insertion Trays information
  • Provider Basics

  • Provider Requirements – Updated provider enrollment appeal rights if denied/terminated; updated links to state and federal cites
  • 09/13/2012
    Addition(s)/Revisions

    Equipment & Supplies – Updated because of the new Orthotics section

    Orthotics – New subsection

    Hearing Aid Services

  • Hearing Aid Services Codes – Updated chart
  • 09/12/2012
    Addition(s)/Revisions

    Provider Basics
    Billing Policy Overview

  • Medicare and Other Insurance – Clarified TPL header/line level, Medicare Risk and reporting TPL effective and termination dates and Medicare B crossover claim information
  • 09/11/2012
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Updated link in the billing section under Payment Rate information

    09/10/2012
    Addition(s)/Revisions

    Pharmacy Services – Added link to Specialty Drug List under Specialty Pharmaceutical Reimbursement. Removed link to Drug Quantity Limits Summary Sheet.

    08/30/2012
    Addition(s)/Revisions

    Hearing Aid Services

  • Hearing Aid Services Codes – Updated authorization requirements to reflect hearing aids on the volume purchase contract effective 9/1/12
  • Rehabilitative Services

  • Augmentative Communication Devices – Clarified when authorization is needed for purchases/repairs
  • 08/27/2012
    Addition(s)/Revisions

    HCBS Waiver Services – Added link to Reimbursement for Overhead Expenses due to Residential Absence policy to the billing instructions for billing recipient absence

    08/24/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Mobility Devices – Revised coverage policy
  • 08/17/2012
    Addition(s)/Revisions

    Mental Health Services – Overview

  • Adult Rehab MH Services (ARMHS) – Clarified Authorization section and removed concurrent situations that only apply to TCL. Simplified the Billing table.
  • 08/09/2012
    Addition(s)/Revisions

    Mental Health Services – Overview

  • MH Medication Management – Information about NCCI guidelines was added to the Billing section and text was clarified/improved throughout the document
  • 08/06/2012
    Addition(s)/Revisions

    Provider Basics

    Provider Requirements

  • Access Services – Removed waiver services from the list of excluded providers under interpreter services
  • 08/02/2012
    Addition(s)/Revisions

    HCBS Waiver Services – Linked all covered services content to Disability Services Program policy pages. Added billing examples to the Billing section.

    Hospital Services – For elective inductions done on or after 8.1.12, physicians no longer have to submit the Non-participating Facility Births Evidence-based Childbirth Program form (DHS-6469).

    Physician and Professional Services – As of 8.1.12, at hospital without a hard stop policy, physicians doing elective inductions before 39 weeks gestation on or after 8.1.12, no longer have to submit the Non-participating Facility Births Evidence-based Childbirth Program form (DHS-6469).

    Reproductive Health/OB-GYN

  • Obstetric Services – For elective inductions done on or after 8.1.12, physicians no longer have to submit the Non-participating Facility Births Evidence-based Childbirth Program form (DHS-6469).
  • 07/30/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Nutritional Products and Related Supplies – Corrected quantity limits for feeding kits under Supplies for Enteral/Parenteral Nutrition
  • 07/19/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Urological Supplies – Removed authorization requirement for indwelling catheters
  • Intermediate Care Facilities (ICF/DDs) – Added Minnesota Rules 4665.0500 Building Classification link to Legal References and removed link to Eligible Providers section for building classification

    07/17/2012
    Addition(s)/Revisions

    Hearing Aid Services – Added "wax guards" to examples of non-covered services

    07/16/2012
    Addition(s)/Revisions

    Laboratory/Pathology, Radiology & Diagnostic Services

  • Radiology/Diagnostic Services – Updated radiology authorization section to include prior authorization is no longer required for the technical component of radiology services when completed in a licensed trauma center
  • Mental Health Services – Overview

  • Adult Rehab MH Services (ARMHS) – Changed Transition to Community Living codes to require prior authorization
  • 07/03/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Incontinence Products – Moved Pull-on undergarments for children under age 4 from Authorization to Non-Covered Services
  • 06/29/2012
    Addition(s)/Revisions

    Pharmacy Services – Updated OTC policy to reflect recent legislative changes. New policy is that pharmacies MAY repackage OTCs but must still dispense the entire package quantity in nearly all cases. Added Home Infusion Therapy to the Table of Contents under Covered Services.

  • Home Infusion Therapy – New sub section under Pharmacy Services
  • 06/28/2012
    Addition(s)/Revisions

    Rehabilitative Services

  • Augmentative Communication Devices – Added language to clarify non-covered devices and clarify repair billing instructions
  • 06/26/2012
    Addition(s)/Revisions

    Hospice Services – Included reference to children's hospice benefit change, that recipients under age 21 don't have to forego curative care related to terminal illness when electing hospice benefits

    Provider Basics

    Billing Policy Overview

  • Billing the Recipient – Non-covered Service section was updated to specify signature requirement on form DHS-3640
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    06/21/2012
    Addition(s)/Revisions

    Rehabilitative Services

  • Audiology Service Thresholds – Added procedure code 92550 and removed code 92551 from audiology thresholds. Also added clarification about Hearing aid checks not being covered during the trial period
  • 06/20/2012
    Addition(s)/Revisions

    Nursing Facilities – Payments for leave days in a nursing facility to 30 percent not 60% in the Leave Days (SNF/NF/BCH) section

    Transportation Services (Overview) – Clarified definition for MNET and No Load Transportation

  • Access Transportation Services (ATS) – Clarified the coordination of ATS by MNET in 8 metro counties in the Overview section
  • Ambulance Transportation Services – Clarified out-of-state air ambulance and clarified in the Authorization section for out-of-state air and in state non-emergency ambulance that exceeds 6 transports (three round trips) during a month
  • Special Transportation Services (STS) – Removed EMA having STS; removed old statement of ending Place of Service (POS) 31 billing; removed redundant statement of no STS span for NF (nursing facility) residents
  • 06/14/2012
    Addition(s)/Revisions

    EMA Service Limitations – Added what happens to treatment with dates of service after June 30, 2013

    06/11/2012
    Addition(s)/Revisions

    EMA Service Limitations Updated to include coverage of cancer and kidney dialysis treatment as announced in EMA Announcement III

    Provider Basics

    Billing Policy Overview

  • Billing the Recipient – Clarified family deductible policy; added 'waiving recipient cost-sharing
  • 06/08/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Orthopedic and Therapeutic Footwear – Changed 12 months to calendar year for limits. Added text under Authorization for when authorization is required
  • 06/05/2012
    Addition(s)/Revisions

    Physician and Professional Services

  • Pay-for-Performance – Providers must bill using the exact clinic location of the provider rendering the service or the claim will deny
  • 05/23/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Mobility Devices – K0001-K0005 now require PA after 6 months rental and for all purchases
  • 05/17/2012
    Addition(s)/Revisions

    Physician and Professional Services – Removed place of service code information under Physician Services While Recipient is Inpatient Status. Removed duplicate bullets under Non-Covered Services/Treatment. Corrected information under Genetic Counselor or Geneticist, 3rd bullet. Updated information under Authorization Policy, 1st paragraph.

    05/16/2012
    Addition(s)/Revisions

    Hearing Aid Services

  • Hearing Aid Services Codes – Added "Claims with DOS prior to 90 days from dispensing date will deny" under code V5011
  • 05/10/2012
    Addition(s)/Revisions

    Hearing Aid Services – Added language to clarify "trial period" and services not billable during trial period. Added "Claims for monaural dispensing must include either the LT or RT modifier" under Dispensing Fee Claims. Removed "Claims with DOS 12-31-08 and earlier, use modifier RP" and "Claims with DOS 1-1-09 and later, use modifier RB" under Repair Claims. Added "Claims with DOS prior to 90 days following dispensing date will deny" under all procedure codes under Hearing Aid Checks.

    05/03/2012
    Addition(s)/Revisions

    Laboratory/Pathology Services – Policy and editing related to blood drawns changed, modified working of INR, PAP and following of Medicare

    05/02/2012
    Addition(s)/Revisions

    Personal Care Assistance (PCA) Services – Updated table of contents. Retitled Supervision for PCA Services to Qualified Professional (QP) Supervision

    04/30/2012
    Addition(s)/Revisions

    Equipment & Supplies – Added text to clarify the Medicare guidelines for modifiers and the capped rental payment rates

    Immunizations & Vaccinations – Changed age limit IPV (90713 from 7 - 18 years to 2 months - 18 years.

    Provider Basics

  • Authorization – Changed fax number for home care services
  • 04/24/2012
    Addition(s)/Revisions

    EMA Service Limitations – Updated information about emergency medical assistance (EMA) program changes

    Mental Health Services – Overview

  • General MHCP Non-Enrollable Mental Health Provider Requirements – Removed "See General Clinical Supervision Requirements for both general and specialty-specific requirements." under Supervision. Link was expired
  • 04/17/2012
    Addition(s)/Revisions

    Equipment & Supplies – Updated due to new Electrical Stimulator section

  • Electrical Stimulation Devices – New subsection
  • Urological Supplies – New policy on Intermittent Catheters
  • 04/13/2012
    Addition(s)/Revisions

    Medication Therapy Management Services (MTMS) – Change to recipient eligibility. New criteria change for MTMS for recipients’ coverage is now allowed for recipients taking three or more prescriptions to treat or prevent one or more chronic conditions.

    Rehabilitative Services – Added language "lifting" authorization requirements retro to July 1, 2011 through December 31, 2012, per agreement btw Department and rehab professional associations (MNAPTA, MOTA, MSHA)

  • Orthotic Procedures – Updated code chart to reflect agreement btw the Department and the rehab professional associations (MNAPTA, MOTA, MSHA) to lift authorization requirements retro to July 1, 2011, through December 31, 2012
  • Service Thresholds – Added language "Lifted" authorization requirements retro to July 1, 2011 through December 31, 2012, per agreement btw Department and rehab professional associations (MNAPTA, MOTA, MSHA)
  • 04/11/2012
    Addition(s)/Revisions

    Medication Therapy Management Services (MTMS) – Changed link from DHS-4611 to DHS-4611A Provider Agreement: Individual Non Pay-To under Enrollment Applications and Agreements

    Mental Health Services – Overview

  • Dialectical Behavior Therapy (DBT) – Removed "To become certified complete the Application for Certification of Dialectical Behavior Therapy Outpatient Providers (Word doc)." under eligible providers
  • Physician and Professional Services – Clarified criteria for billing drugs administered during an outpatient visit and coordinating of benefits for private insurance payments under Outpatient Physician Administered Drugs

    04/04/2012
    Addition(s)/Revisions

    Immunizations & Vaccinations – Corrected age limit for MnVFC Meningococcal conjugate (90734) from 2 years and older to 2-18 years

    03/27/2012
    Addition(s)/Revisions

    Anesthesia Services – New MHCP anesthesia rates for 2012

    03/26/2012
    Addition(s)/Revisions

    Laboratory/Pathology Services – Clarified text, added coverage indication

    Pharmacy Services – Clarification of DAW text to reflect e-prescribing and clarification of reimbursement methodology

    03/23/2012
    Addition(s)/Revisions

    Provider Basics

  • Authorization – Added MHCP home care authorization request fax number
  • 03/21/2012
    Addition(s)/Revisions

    Equipment & Supplies – Added link to Hearing Aid section, removed information about Cranial Electrical Stimulators

    Oximeters – Clarified policy on intermittent oximeter

    03/14/2012
    Addition(s)/Revisions

    Immunizations & Vaccinations – Updated the Immunization (vaccines/toxoids) list to reflect the changes that became effective January 1, 2012 for adult vaccines and clarified age requirements for other codes

    03/13/2012
    Addition(s)/Revisions

    Acupuncture Services – Added clarifying test for limits on service under Covered Services

    03/12/2012
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Added link to HCBS Contract Template

    03/09/2012
    Addition(s)/Revisions

    Mental Health Services

  • Functional Assessments – Added DBT to the list of services requiring a FA
  • Provider Basics

  • Billing Policy Overview – Added MN–ITS Mailbox information, link to Minnesota-defined U modifiers, and re-added prompt payment information
  • 03/08/2012
    Addition(s)/Revisions

    Equipment & Supplies – Updated due to new subsections

  • Apnea Monitors – New subsection
  • Oximeters – New subsection
  • Mental Health Services

  • Adult Rehabilitative Mental Health Services (ARMHS) – Removed LPP with variance under Eligible Providers and removed Code H0034 under Billing
  • Provider Basics

    Billing Policy Overview

  • Medicare and Other Insurance – MN–ITS Direct Data Entry (DDE) TPL Line Level date updated
  • 03/07/2012
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • Minnesota Family Planning Program (MFPP) – As of 01-01-2012, CPT code 11975 is replaced with 11981 and 11977 is replaced with 11976
  • 03/01/2012
    Addition(s)/Revisions

    Mental Health Services

  • Functional Assessments – Listed the services that require a FA
  • Tribal and Federal Indian Health Services – Clarified language to state that drugs given as part of an outpatient or inpatient visit are included in the encounter rate. Facilities can not have a mail order pharmacy bill MHCP and then give the drug during the visit.

    02/28/2012
    Addition(s)/Revisions

    Provider Basics

  • MCO/PMAP
  • Managed Care Organization (MCO) Contacts – Updated MHP and Hennepin Health phone numbers. Updated PrimeWest dental information. Removed Midwest Dental and added Prime West Health
  • 02/27/2012
    Addition(s)/Revisions

    Dental Services (Overview)

  • Limited Authorization (LA) Dental Hygienists – Changed from previous title of Collaborative Practice Dental Hygienists
  • Rehabilitative Services – Updated to reflect the 3/1/12 legislative change ending the rehab service thresholds

    02/24/2012
    Addition(s)/Revisions

    Mental Health Services – Added a link to the Adult Mental Health Targeted Case Management (AMH-TCM) section

    02/22/2012
    Addition(s)/Revisions

    Immunizations & Vaccinations – Removed eligibility type FP from the Eligible Recipient section

    02/21/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Orthopedic and Therapeutic Footwear – Clarified language about who may fit and furnish footwear
  • 02/15/2012
    Addition(s)/Revisions

    Immunizations & Vaccinations – Updated rates for the administration of immunizations and vaccines

    Mental Health Services – Redesigned section

    02/13/2012
    Addition(s)/Revisions

    Equipment & Supplies – Added links to new sections Orthopedic and Therapeutic Footwear and Ultraviolet Light Therapy Systems and removed existing content from section

    02/10/2012
    Addition(s)/Revisions

    Equipment & Supplies

    Provider Basics

    Billing Policy

  • Out-of-State Providers – Updated to include MHCP does not cover out-of-country care
  • 02/09/2012
    Addition(s)/Revisions

    Dental Services (Overview) – New providers dental therapist and advanced dental therapist and new multiple surgery modifier requirements

    Mental Health Services – Overview

  • Clinical Supervision of Outpatient Mental Health Services – New section
  • CTSS Authorization Table – CTSS day treatment billing
  • CTSS Children’s Day Treatment – Updating information under service description, documentation, authorization and billing
  • 02/08/2012
    Addition(s)/Revisions

    Provider Basics

  • Prepaid Minnesota Health Care Programs (PMHCP) – Deleted obsolete program information (GAMC and MnDHO)
  • Mental Health Services – Overview

  • Dialectical Behavior Therapy (DBT) – Changed the authorization requirements
  • 02/07/2012
    Addition(s)/Revisions

    Dental Services (Overview)

  • Advanced Dental Therapist (DT) – New section
  • Dental Therapist (DT) – New section
  • Equipment & Supplies

  • Positive Airway Pressure for Treatment of Obstructive Sleep Apnea – Updated reference to capped rental billing period
  • Pressure Reducing Support Surfaces – Clarified information about capped rentals
  • Specialized Wound Treatment Technology – Clarified information about capped rentals
  • Transcutaneous Electrical Nerve Stimulator (TENS) – Updated references to capped rental periods
  • Mental Health Services – Overview

  • Adult Rehab MH Services (ARMHS) – Separated non-licensed from licensed/certified professionals; formatting changes
  • Certified Peer Specialist Services – New section
  • General MHCP Non-Enrollable Mental Health Provider Requirements – Updated section to comply with Rule 47
  • Intensive Residential Treatment Services (IRTS) – Removed the following sentence: increased abuse of alcohol and/or drug use under IRTS Admission Criteria
  • 02/02/2012
    Addition(s)/Revisions

    Rehabilitative Services

  • Audiology Service Thresholds – New procedure code 1/1/12
  • Casting & Strapping Services/Supplies – 3/1/12 legislative change
  • Service Thresholds – Updated code charts to reflect changes to rehab threshold effective 3/1/12
  • Mental Health Services – Overview

  • • CTSS Day Treatment Authorization Codes – Expired page
  • 02/01/2012
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • Free-Standing Birth Center Services – Added revenue code billing information and clarified MHCP does not pay for home births
  • 01/31/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Ambulatory Assist Equipment – Removed obsolete language
  • External Defibrillators – Updated information about capped rentals
  • Non-Mobility Equipment Repairs – Clarified that equipment may not be authorized if the cost to repair exceeds 90% of the purchase cost
  • 01/27/2012
    Addition(s)/Revisions

    Pharmacy Services – Removed out of date NCPDP payer sheets and added link to the D.0 payer sheets

    01/25/2012
    Addition(s)/Revisions

    EMA Service Limitations – Updated information about emergency medical assistance (EMA) program changes

    Provider Basics

    Billing Policy Overview – Updated with 2011 legislative changes

  • Billing the Recipient – Updated with 2011 legislative changes for copays, family deductible and non-covered services
  • Provider Basics
    Programs and Services
    – Updated program changes

  • MHCP Benefits-at-a-glance – Updated information about non-covered services (ARN), EMA, copays, family deductible, and other program changes
  • 01/24/2012
    Addition(s)/Revisions

    Provider Basics

    Billing Policy

  • Medicare and Other Insurance – Added TPL line level billing information and link to Authorization Requests and Medicare/TPL Coverage
  • 01/23/2012
    Addition(s)/Revisions

    Pharmacy Services

    Compound Drugs – Updated references to administration routes and changed NCPDP version from 5.1 to D.0

    01/19/2012
    Addition(s)/Revisions

    Hospital Services – Clarified Observation Billing Policy for code 762 under Outpatient Observation Services

    01/17/2012
    Addition(s)/Revisions

    Physician and Professional Services – Added Evidence-based Childbirth Program Policy information

    01/13/2012
    Addition(s)/Revisions

    Acupuncture Services – New section

    Chiropractic Services – Added link to new Acupuncture Services section

    Physician and Professional Services – Removed acupuncture information and added link in Table of Contents to the new Acupuncture Services section

    01/12/2012
    Addition(s)/Revisions

    Elderly Waiver & Alt Care – Clarified qualifications to provide adult day services

    Immunizations & Vaccinations Made change to Major program type under eligible recipients - deleted EH from eligible recipients list

    01/11/2012
    Addition(s)/Revisions

    Elderly Waiver & Alt Care – Added Specialized Supplies & Equipment Authorization & Billing Responsibilities to the drop down section in the table of contents. Changed link title under Billing to Authorization and Billing Responsibilities vs. Responsibilities

  • Specialized Supplies & Equipment Roles & Responsibilities – Added Authorization & Billing to the title
  • 01/06/2012
    Addition(s)/Revisions

    Equipment & Supplies

  • Standers – Added language about modifier U3
  • 01/05/2012
    Addition(s)/Revisions

    Immunizations & Vaccinations – Clarified age related coverage for 90649, 90650 and the Q codes

    01/04/2012
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • Obstetric Services – Added Evidence-based Childbirth Program Policy section


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