Disability Determinations/ Requests – SMRT

The Minnesota Legislature expanded the role of SMRT in collecting evidence used for disability determinations. The county continues to coordinate the initial application process, but SMRT collects any additional information that is needed. This includes working with the applicant/recipient, counties and providers to schedule exams, other tests, and transportation, as necessary.

Process

County agencies:

  • • Refer MA applicants who indicate a disability to SMRT
  • • Collect and submit SMRT forms and supporting medical evidence

  • SMRT reviews the evidence to determine if a decision can be made. If not, SMRT will work with the applicant and provider to collect any additional information needed to make the determination, including medical examination, psychological evaluation, or other applicable tests.

    Request for Additional Information

    When SMRT needs additional information to make a disability determination, SMRT case managers fax to provider(s):

  • • A notice requesting specific documents to verify the applicant's condition(s) (see SMRT Documentation Requirements (DHS-6349A) and SMRT case manager contact information
  • • A HIPAA-compliant Authorization to Disclose Information for Disability Determination (DHS-6124) signed by the applicant

  • Submit documents to SMRT using secure fax or mail for information that cannot be faxed:

    Secure fax:

    651-431-7457
    1-800-311-3137

    Mail:

    DHS – SMRT
    PO Box 64248
    St Paul MN 55155-0248

    Scheduling Exams and Transportation

    When an examination, evaluation, or other test is required, SMRT works with the applicant/recipient and provider to schedule the appointment and provide transportation, as needed, (through MNET or the county).

    Authorization

    SMRT will authorize payment for the appointment by:

  • • Obtaining the provider's NPI number for an authorization
  • • Authorize payment for the service(s) at 100% of their usual and customary charges
  • • Issue an authorization response to the provider's MN–ITS mailbox

  • Providers may retrieve the authorization letter in their MN–ITS Mailbox Miscellaneous Received PAL file type folder.

    Counties that schedule and pay for SMRT evaluations and medical records must email or call SMRT at 651-431-2493 or 1-800-235-7396 with the following information to obtain an authorization:

  • • County UMPI/NPI
  • • Recipient MHCP ID
  • • Recipient date of birth
  • • Date of service
  • • Type of service

  • Billing

    The recipients MHCP eligibility may currently show as ineligible when verified. However; the authorization approves the MHCP enrolled provider who is listed on the authorization to bill for and receive payment from MHCP for rendering exams, evaluations or other tests.

    MHCP reimbursement for CPT 99456 Disability Examination allows the claim to pay at 100% of the providers’ total submitted charge.

    The CPT code 99456 includes all components of the medical disability examination. Providers must add all of their usual/customary charges for each service performed (including ancillary services that were sent to an outside lab or other provider) to calculate the total charge amount. The authorized provider must have a contractual agreement to pay for any ancillary services sent to an outside lab or other provider.

    Counties add all payments made for medical records, transportation, and exams to calculate the total charge amount.

    Providers must bill and receive payment from primary coverage to the fullest extent possible before billing MHCP for recipients who have other health insurance.

    General billing guidelines:

  • • All services provided as part of the medical disability examination must be billed as one claim with one service line item
  • • Bill using the 837P format via X12 Batch or using MN–ITS
  • • Bill using the pay-to providers NPI listed on the approved authorizations letter
  • • Enter the approved authorization number on the electronic claim
  • • Use CPT code 99456 for all services provided (do not itemize services)
  • • Bill usual and customary charges (if multiple services, total of charges, not itemized)
  • • Include other insurance payment, adjustments and the remaining patient responsibility, if applicable

  • For billing instructions using MN–ITS, refer to the MN–ITS SMRT Disability Examination user guide.

    Additional Resources

    MS 256.01, subd. 29 Commissioner of Human Services; Powers, Duties. State medical review team.

    If you have billing questions, call the MHCP Provider Call Center at 651-431-2700 or 1-800-366-5411.

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