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• MHCP made system improvements and clarifications to the ordering and referring requirements. Refer to revised Provider Update Ordering and Referring Provider Requirements (MHP-12-05) for details. Claims that denied or paid incorrectly because of missing or invalid ordering and referring provider information for dates of service May 21, 2012, through February 11, 2013, will be replaced according to the schedule in the following table.
Claims with dates of service for: |
Replacement claims will be paid on: |
May – June 2012 |
April 23, 2013 |
July 2012 |
May 7, 2013 |
August 2012 |
May 21, 2013 |
September – October 2012 |
June 4, 2013 |
November 2012 – February 2013 |
July 2, 2013 |
• Secondary claims submitted with Claim Filing Indicator 16 (Health Maintenance Organization (HMO) Medicare Risk) and Claim Adjustment Reason Code PR3 (Patient Responsibility/Co-payment amount) between June 1, 2012, and October 25, 2012, did not process correctly. MHCP expects to reprocess these claims in the near future.
• The 2013 Minnesota Age & Disabilities Odyssey is scheduled for June 17 and 18, 2013. Registration rates and schedule information is available on the website.
• Providers who have not successfully completed 5010 syntax testing for MN–ITS Claim Status (276/277) must first do so in order to use the Claim Status transaction after January 14, 2013, due to the CORE changes. Review the 5010 X12 Batch Transaction Guidelines on the 5010/D.0 Compliance page for testing information.
• Reminder - Batch billers who use electronic funds transfer (EFT) and receive their remittance advice (RA) via 835_X12 may not receive RAs in their mailbox until 5:00 p.m. on Fridays. This does not apply to those who receive RAs by 835_PDF.
• Delete and Disable in MN–ITS User Administration are now fully functional.
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This Industry Initiatives section is intended to give you quick, easy access to current federal and state industry initiatives that potentially impact your business. Please review these pages on a regular basis. We will note changes to the right of the initiative as we update the pages.
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5010/D.0
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Review the updated 5010/D.0 page for announcements about both direct data entry (DDE) and batch transactions.
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Electronic health records
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e-Prescribing
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Health care delivery system demo
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Health care homes
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HCH Providers: Refer to the Health Care Homes Eligible Providers section in the MHCP Provider Manual about notifying MHCP of your HCH certification on or after December 6, 2012.
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ICD-10
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NCCI
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Pay-for-performance
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Pay-for-Performance (P4P) program providers may earn up to two payments of $250 dollars in 12 months for providing optimal diabetes and cardiovascular disease care to eligible recipients. This program is available to fee-for-service providers and is not included in the incentives offered by the Bridges to Excellence Program.
Providers are encouraged to review P4P program criteria and submit the necessary data to earn incentives. We ask that you distribute this information to appropriate staff within your organization who will be submitting requests for the reward payments.
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Effective March 1, 2013, MHCP requires procedure code H2035 with modifier HQ for reporting Outpatient Group Treatment on claims. Some claims were incorrectly processed. As appropriate, resubmit or replace claims that were submitted between March 1, 2013, and May 15, 2013, if the claim:
• Paid the incorrect rate, or
• Denied with remittance advice remark code M62 (Missing/incomplete/invalid other diagnosis) |
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MDH and DHS updated the C&TC FACT Sheets on Anticipatory Guidance including changes to the age groups. The changes improve health promotion references by grouping related topics by age. The new age groups are “Anticipatory Guidance, 0-5 Years” and “Anticipatory Guidance, 6-12 Years.” The third age group, “Anticipatory Guidance, 13-21 Years” was also revised and is available online.
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Youth Assertive Community Treatment (ACT) Provider Solicitation
Youth Assertive Community Treatment (or Youth ACT) has been approved by the Centers for Medicare & Medicaid Services and is now a part of Minnesota’s State Plan for Medicaid Services. MHCP is now seeking responders to provide this service. See the DHS Grants & RFPs website for more information. Review information about this service in Bulletin #12-53-03, Children’s Mental Health Division Announces New Service: Youth Assertive Community Treatment (PDF). Send questions to Martha.J.Aby@state.mn.us
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As of April 1, 2013, KePRO is MHCP’s new authorization medical review agent. Tellegen will destroy documentation they receive on or after April 1, 2013, and will not make a determination.
Send all authorization request documentation to KePRO with:
• Diagnostic quality copies of x-rays. Periapical and bitewing x-rays must be mounted. Indicate the date of exposure on all x-rays. Do not submit original x-rays; they could be lost and compromise the recipient’s care.
• A narrative and all appropriate related chart documentation that demonstrates the medical necessity for each procedure requested
A referring provider must release the patient’s health record to another provider regardless of the status of the patient’s account. Rendering providers are responsible for working with the referring provider to obtain all needed documentation to request an authorization for an MHCP-covered service.
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MHCP reprocessed claims for dates of service on and after January 1, 2012, to pay the corrected CMS Medicare Economic Index (MEI) rate of .6%. The MEI rates correction will impact supplemental payment calculations and will be reflected on MHCP claims adjustments. MHCP adjustments for RHCs were processed in the May 6, 2013, payment cycle.
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MHCP corrected a system error causing certain claims for HIV case management from April 15, 2013, to April 22, 2013, to pay zero dollars. All affected claims have been identified and were replaced on the May 7, 2013, payment.
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As of April 1, 2013, KePro will process all temporary and long term authorization requests for the following home care services:
• Skilled nursing visits
• Home health aide services
• Private duty nursing services
Continue to submit requests for these services using the MN–ITS DDE Authorization Requests (278) – Home Care transaction.
Submit all documentation for long term home care authorizations directly to KePro (fax # 1-866-889-6512), not to DHS.
Review MHCP Announces New Medical Review Agent for more information.
Fax the MA Home Care Technical Change Request (DHS-4074) with all technical changes for an approved home care authorization to 651-431-7447. Faxes sent to an incorrect number will not be processed.
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MHCP is working on a system change to accept pathology facility charges on the 837I without modifier TC. Until further notice, for claims to properly pay, submit the following pathology services with the appropriate modifier to identify the service: 88104-88125, 88160-88162, 88172, 88173, 88177, 88182, 88300-88319, 88323, 88331-88362, 88365-88368, 88380-88388
• Submit professional pathology charges on the 837P with modifier 26
• Submit facility charges on the 837I with modifier TC
Upon completion of the project, MHCP will post a Provider News message with additional billing and claim adjustment information.
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Review the Enrollment Information section of the Waiver/AC Provider home page for dates provider enrollment is processing waiver record review documents.
Review Provider Update Waiver/AC Webinar Training – Provider Record Review (WAV-13-02).
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Visit our Provider website for more comprehensive information, including these pages:
This page includes news and resources for providers enrolled to serve Minnesota Health Care Programs (MHCP) recipients. Get notices of Provider News through our free Provider Email Lists.
If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 1-800-366-5411.
Sign up to receive Provider Updates and other MHCP notices in your email account.
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