• EFT date change due to Memorial Day holiday: The correct electronic funds transfer (EFT) date for this week is Wednesday, June 1, 2016. The MHCP Payment and Claim Cut-off Calendar incorrectly lists EFT on Tuesday, May 31. Funds will not be transferred until June 1.
• Professional and outpatient claims reprocessing: MHCP corrected a system error that incorrectly denied professional and institutional outpatient claims processed between March 9, 2016, and April 27, 2016. These claims were reported on your remittance advice with remark code N265, indicating a missing, incomplete or invalid ordering provider name. We have identified claims that were denied in error and will begin replacing them for the May 3, 2016, payment date.
CMS has corrected the 2016 Minnesota conversion factor amount from $21.50 to $21.13. MHCP identified and reprocessed claims for dates of service between January 1 and March 15, 2016. The reprocessed claims were on your May 3, 2016, remittance advice.
House calls for removable prosthesis: Effective July 1, 2016, MHCP will cover up to five house calls (D9410) each calendar year for fitting removable prosthesis. Bill both CPT codes D9410 and D5992; D9410 will pay at the current rate and D5992 will pay at zero.
Individualized Education Program (IEP)
MHCP will reprocess IEP claims that were denied in error for age requirements for ICD-10 code F94.9. You will see the reprocessed claims on your May 17, 2016, remittance advice.
Outpatient hospital laboratory services: MHCP identified several outpatient laboratory services that were incorrectly priced from Jan. 1 through Apr. 29, 2016. These have been reprocessed and will be on the June 1, 2016, remittance advice.
This group of laboratory claims does not include the outpatient laboratory services assigned a status indicator Q4. We will reprocess the laboratory services claims with a Q4 indicator separately after the systems work is completed.
Provider Travel Time: Follow these requirements to bill MHCP for mental health provider travel time:
• Document start and stop time of travel times to the minute for each service in each progress note
• Bill for the most direct route
• Enter the exact number of minutes of travel time in the units field on the claim
• Use the appropriate place of service code on the claim
• Bill travel time for only one member if the services are being delivered in a group format
• Document unusual travel conditions that may cause a need to bill for additional time
• Do not bill for detours for lunch breaks, nonmember service activities, or time for vehicle breakdowns
Members must have an individual treatment plan (ITP) specifying why the provider must travel to the member’s home, place of work, or other setting to provide services. Provider travel time covers only the time the provider is in transit to and from the member. Review the Mental Health Provider Travel Time section of the MHCP Provider Manual for more information.
Rate Increase to Mobile Crisis Services: Effective July 1, 2015, the Centers for Medicare & Medicaid Services (CMS) approved the rate increases for mobile crisis response services. MHCP will replace claims for mobile crisis services with dates of service on or after July 1, 2015. We will post a message when we know the date the replacement claims will be on the remittance advice.
Crisis providers who have billed at the published fee-for-service rate will not see an increase to adjusted claims. Claims billed for more than the allowable amount will receive the increased rate. MHCP pays claims at the lesser of the provider’s submitted charge or the MHCP allowable payment rate. Continue to bill the usual and customary charge that applies on the date you provide the service, according to Minnesota Rules 9505.0450.
Diagnostic assessment rate correction: MHCP has updated its system to reflect a rate change effective January 1, 2016. We will replace claims with procedure code 90791 or 90792 and modifier TS or TG to pay at the correct reimbursement rate for dates of service starting January 1, 2016. The adjusted claims are on the May 17, 2016, remittance advice.
We will update the system and adjust claims at a later date for procedure 90791 and 90792 with modifier 52. These adjusted claims will be on your May 31, 2016, remittance advice. Refer to the Diagnostic Assessment section of the MHCP Provider Manual for CPT codes and information.
Waiver and Alternative Care Program Providers
Restriction on adding or changing service agreements: The Minnesota Legislature authorized the following rate and limit changes for services provided on or after July 1, 2016:
• 0.2 percent rate increase for Consumer Directed Community Supports (CDCS), Consumer Support Grant (CSG) and personal care assistance services (PCA)
• 21.3 percent increase to Elderly Waiver (EW) and Alternative Care (AC) individual case-mix budget caps, Elderly Waiver customized living and 24-hour customized living service limits, and CDCS monthly case-mix limits in EW and AC
• Transition to daily rate for EW customized living services and adult foster care
DHS will run an MMIS automation process on June 13, 2016, for rate changes on Service Agreements (SAs). Lead agency (county and tribal) staff will be unable to add or make changes to some SAs from June 9 to June 14, 2015, while we update the system for this change. This does not affect ADAD and homecare SAs. DHS will notify lead agencies when they are again able to update SAs.
Training and VideoPresence Opportunities
Information about most new and ongoing training is on the Provider Training page. Any information listed in this section is for additional training sessions on special topics.