Minnesota Minnesota

Provider Manual

Provider Manual


MHCP Provider Manual

2014 Provider 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.

12-31-2014
Addition(s)/Revisions

Moving Home Minnesota (MHM)

  • · Moving Home Minnesota (MHM) Provider Enrollment – Added the required assurance statements to the enrollment page.
  • · Moving Home Minnesota Supported Employment Services (MHM SES) – Created a new Moving Home Minnesota Supported Employment Criteria Manual Page for additional information on providing services.

    • 12-19-2014
    Addition(s)/Revisions

    Provider Basics
    Programs and Services

  • · MHCP Benefits at-a-glance – Added Hospital In-reach Service Coordination (IRSC) to the list.

    • 12-12-2014
    Addition(s)/Revisions

    Mental Health

  • · Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) – Additional detail added to the Eligible Recipient and Authorization sections.

    • Provider Basics
    Billing Policy

  • · Payment Methodology - Non-Hospital – Updated rate methodology for outpatient, DME & medical supplies, dental, transportation, pharmacy, vaccines and 2014 legislative rate increases and decreases.

    • 12-02-2014
    Addition(s)/Revisions

    Provider Basics

  • · Prepaid Minnesota Health Care Programs (PMHCPs) and Managed Care Organizations (MCOs) – Clarified in the Overview section that people enrolled in MA or MinnesotaCare must enroll in one of the managed care products listed unless they are excluded. In Changing MCOs, we clarified that recipients may change MCOs within the first 90 days of initial MCO enrollment when they are initially enrolled. We deleted MNDHO from the enrollees who may change plans monthly.

    • 12-01-2014
    Addition(s)/Revisions

    Provider Basics
    Provider Requirements

  • · Provider Screening Requirements
  • 1. Clarified in the Application Fees section that the fee applies to the calendar year during which we receive your application.
  • 2. Clarified information about multiple practice locations under Multiple Provider Files. If you have multiple practice locations, you must enroll and pay a fee for each location.
  • 3. Clarified information in Paying the Fee about who is required to pay or is exempt from paying the application fee.

    • 11-25-2014
    Addition(s)/Revisions

    Anesthesia Services – Effective November 1, 2014, CRNAs will separately bill their professional services on the 837P rather than having their charges billed by the hospital and included in the DRG payment.

    Hospital Services

  • · Hospital In-reach Service Coordination (IRSC) – Services for children with a diagnosis of Severe Emotional Disturbance (SED) is now covered.

    • Immunizations & Vaccinations – Added codes 90687 6-35 months, 90688 3years and older, 90688 19 years and older and 90644 6-18 months.

    11-24-2014
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • · Record Keeping and Documentation – Clarified Record Retention to clarify that the 5 year retention schedule may differ from other agencies. Schools should review their record retention schedule.

    • 11-21-2014
    Addition(s)/Revisions

    Dental Services

  • · Authorization Requirement Tables for Non Pregnant Adults – Removed 365 days reference and replaced with Calendar year, removed MCO temporary language for D1110.
  • · Non-Pregnant Adults – Removed prophylaxis criteria hyperlink from prophylaxis and created a separate link for prophylaxis criteria.

    • Laboratory/Pathology, Radiology & Diagnostic Services

  • · Laboratory/Pathology Services – Clarified reference or outside lab services policy change January 1, 2015, effects claim formats 837I and 837P.

    • PCA Services

  • · PCA Provider Agency Enrollment – Changed the enrollment process so they would need to go to SFS first and then pay the enrollment fee and then fill out the forms.

    • 11-17-2014
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • · Doula Services – Indicated that six doula sessions are billable under the Covered Services section.

    • 11-14-2014
    Addition(s)/Revisions

    Reproductive Health/OB-GYN – Added link to Doula Services.

    11-13-2014
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • · Doula Services – New section.

    • 11-06-2014
    Addition(s)/Revisions

    Moving Home Minnesota (MHM)

  • · Moving Home Minnesota Demonstration and Supplemental Services Table (PDF) – MHM Demonstration and Supplemental Services will have its own PDF page.

    • 11-04-2014
    Addition(s)/Revisions

    Mental Health Services

  • · Adult Rehabilitative Mental Health Services (ARMHS) – Clarified Medication Education Providers.

    • 10-31-2014
    Addition(s)/Revisions

    Moving Home Minnesota (MHM)

  • · Moving Home Minnesota (MHM) Provider Enrollment – New section

    • 10-29-2014
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • · Personal Care Assistance Services – Updated information identifying who may provide PCA supervision in schools, and identified the qualifications of a designated coordinator.

    • 10-28-2014
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Clarified text for provider standards and qualifications under Customized Living Services.

    10-21-2014
    Addition(s)/Revisions

    Mental Health Services

  • · Diagnostic Assessment (DA) Report Components – Added WHODAS information and resources.
  • · Neuropsychological Services – Under Eligible Neuropsychological Providers, we clarified the criteria for enrolling as an eligible provider. We also defined “qualified neuropsychologist.”
  • We replaced the term “cognitive remediation training” with “cognitive rehabilitation.”
  • In the chart in the Billing section:
  • · In the second bullet in the first row of the “Service Limitations” column, we explained that all assessment components must be complete for the assessment to be considered complete.
  • · We deleted the row for procedure code 97535.

    • 10-20-2014
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Recent MMIS changes:

  • · Clarified language for the following sections: Assessments, Authorization of Services and SAL, Chore Services, CDCS, Environmental Accessibility Adaptations, Home delivered meals, Homemaker Services, Respite Care, EW and AC Transportation, Multiple Providers
  • · Recipient eligibility-Updated links.
  • · Payment Rates- Added information for services after 07/01/14
  • · Companion services- added clarification for provider standards and qualifications
  • · Customized Living Services- CLS and 24hr CLS is considered one service. Clarified language under additional information and provider standards and qualifications.
  • · Family Caregiver section - included assessment and clarified language.
  • · Specialized equipment and Supplies- removed references to county contracts and clarified language
  • · Transitional Services- Clarified language and added Unforeseen Circumstances.
  • · Reimbursement for Overhead Expenses- clarified language and added link

    • 10-17-2014
    Addition(s)/Revisions

    Mental Health Services

  • · Psychiatric Consultations to Primary Care Providers – Added eligible mental health professionals: Licensed Psychologist; Nurse Practitioner; Clinical Nurse Specialist

    • 10-13-2014
    Addition(s)/Revisions

    Hospital Services

  • · Hospital In-reach Service Coordination (IRSC) – MHCP enrolled community-based providers may now work with their local hospitals that provide In-reach Service Coordination (IRSC) to also provide IRSC services. All qualified community-based providers who want to participate in the IRSC program must first submit a completed Community-based Providers IRSC Applicant Assurance Statement (DHS-3898).

    • 10-10-2014
    Addition(s)/Revisions

    Hospital Services

  • · Critical Access Hospital (CAH) Services – We:
  • · Added the subsection heading "Critical Access Outpatient Billing" before the paragraph about outpatient billing
  • · Split that paragraph into two and added the revenue code 0250 to the list of Healthcare Common Procedure Coding System (HCPCS) codes in the second paragraph

    • 10-08-2014
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • · Covered and Noncovered Services IEP Health-Related Services – Under Noncovered services, the person has reached the age of 21.
  • · Interpreter Services – Separated spoken language covered services and sigh language covered service for clarity.
  • · Occupational Therapy Services (OT) Services – Clarified supervision of an Occupational Therapy Assistant under Supervision and Direction of an OTA.

    • Moving Home Minnesota (MHM) – Policy updated T2038 codes with modifiers (U6+U1), (U6+U2), and (U6+ UA) to not require description under the codes and to remove the service agreement language since there will not be a required Service Authorization to use these codes. Included a Limit Time Span under Noncovered Services.

    10-07-2014
    Addition(s)/Revisions

    Equipment and Supplies

  • · Nutritional Products and Related Supplies – Added text after Code: B4100 for Food Thickeners to clarify that one ounce equals one unit for billing purposes.

    • 10-06-2014
    Addition(s)/Revisions

    Provider Basics
    Provider Requirements

  • · Provider Screening Requirements – We have heavily revised the entire section to reflect recently implemented provisions of the federal provider screening regulations that were effective March 25, 2011. Please review the entire section.

    • 10-03-2014
    Addition(s)/Revisions

    Laboratory/Pathology, Radiology & Diagnostic Services

  • · Radiology/Diagnostic Services – Added that a traditional midwife may order/refer radiology services under Covered Services.

    • 10-02-2014
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services

  • · Covered and Noncovered Services IEP Health-Related Services – Age requirement corrected under Noncovered services.

    • 10-01-2014
    Addition(s)/Revisions

    Individualized Education Program (IEP) Services – Updated and reformatted to combine the IEP Technical Assistance Guide with the IEP section of the Provider Manual.

    09-30-2014
    Addition(s)/Revisions

    Hospice Services – Added under Billing Medical Supplies and Equipment - when claiming for supplies and services outside of the hospice benefit documentation from the hospice physician if required to indicate why it is not related to the terminal condition.

    09-25-2014
    Addition(s)/Revisions

    Equipment and Supplies – Added capped rental billing policy under Billing Policy.

    09-18-2014
    Addition(s)/Revisions

    HCBS (Home and Community Based Services) Waiver Services

  • · Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Added Assurance statements which were not linked previously - DHS-6189C, DHS-6189F, and DHS-6189M.

    • 09-17-2014
    Addition(s)/Revisions

    Provider Basics

  • · Billing Policy Overview – Adding information about 1099's.

    • 09-11-2014
    Addition(s)/Revisions

    Alcohol and Drug Abuse Services – Added information about billing for room and board for MCO enrollees. Clarified information on nonresidential clinic billing.

    09-09-2014
    Addition(s)/Revisions

    HCBS (Home and Community Based Services) Waiver Services

  • · Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Added BGS information for owners and managing employees.

    • 09-08-2014
    Addition(s)/Revisions

    Mental Health Services

  • · Diagnostic Assessment (DA) Report Components – Added new page for Diagnostic Assessment report components.

    • 09-04-2014
    Addition(s)/Revisions

    Laboratory/Pathology, Radiology & Diagnostic Services

  • · Laboratory/Pathology Services – Changed "traditional midwife" to "certified professional midwife" under covered services.

    • 08-27-2014
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – Removed "...providers control" language from the Situation columns of the Screening Exceptions table.

    Laboratory/Pathology, Radiology & Diagnostic Services

  • · Laboratory/Pathology Services – Added that a traditional midwife may order/refer for laboratory services. Updated outpatient hospital laboratory test policy. Implementation date of reference and outside lab services policy changed from October 1, 2014, to January 1, 2015.

    • 08-22-2014
    Addition(s)/Revisions

    Reproductive Health/OB-GYN

  • · Minnesota Family Planning Program (MFPP) – See lab chapter for policy changes.

    • 08-21-2014
    Addition(s)/Revisions

    Community Paramedic Services – Added MN–ITS "Treating Provider" and "Pay To" field information for billing clarification.

    08-15-2014
    Addition(s)/Revisions

    Clinic Services

  • · Federally Qualified Health Center and Rural Health Clinics – Fixed link to FQHC/RHC Global Encounters for MCO Enrollees examples. Section FQHC/RHC Medicare Crossover Claims moved. Now follows the section titled Billing Section.

    • Mental Health Services

  • · Adult Crisis Response Services – Updated according to legislation.

    • 08-13-2014
    Addition(s)/Revisions

    Rehabilitative Services – Added information about licensing requirements.

    Reproductive Health/OB-GYN

  • · Free-Standing Birth Center Services – Clarified covered services and billing policy.

    • 08-05-2014
    Addition(s)/Revisions

    Provider Basics

  • · Authorization – Added link to the Emergency Medical Assistance section for information about Care Plan Certification requests.

    • 07-28-2014
    Addition(s)/Revisions

    Home Care Services

  • · Home Care Nursing (HCN) Services – Changed section name from Private Duty Nursing (PDN).

    • 07-17-2014
    Addition(s)/Revisions

    Provider Requirements – Added Certified Traditional Midwife and Free-Standing Birth Centers to Eligible Providers section.

    07-11-2014
    Addition(s)/Revisions

    Dental Services

  • · Critical Access Dental Payment Program (CADPP) – Updated Critical Access 7-1-2013 rate increase for MinnesotaCare services that wasn't added in previous updates.

    • HCBS (Home and Community Based Services) Waiver Services – Added services to CAC waiver effective 07-01-14.

    Rehabilitative Services

  • · Rehabilitative and Therapeutic Services Authorization Criteria – Deleted language "date of the order/prescription must not be more than 30 days from the requested start of care".

    • Reproductive Health/OB-GYN

  • · Minnesota Family Planning Program (MFPP) – Clarified requirements for secondary MFPP services.

    • 07-09-2014
    Addition(s)/Revisions

    Reproductive Health/OB-GYN
    Minnesota Family Planning Program (MFPP)

  • · Minnesota Family Planning Program (MFPP) Procedure Codes (PDF) – Removed CPT code 55400. Vasectomy reversals are not a covered service.

    • 07-08-2014
    Addition(s)/Revisions

    Mental Health Services

  • · Adult Day Treatment – Revised adult day treatment clinical supervision standards.

    • 07-01-2014
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – Changed the order of the Reference and Outside Lab Services and HCPCS Code S0302. Fixed Reference and Outside Lab Services link.

    06-30-2014
    Addition(s)/Revisions

    Moving Home Minnesota (MHM) – New section of the Provider Manual.

    06-27-2014
    Addition(s)/Revisions

    Provider Requirements

  • · Individual PCA Enrollment Criteria – Added additional text about ensuring background studies are correct.

    • 06-26-2014
    Addition(s)/Revisions

    Laboratory/Pathology, Radiology & Diagnostic Services

  • · Laboratory/Pathology Services – Removed coding modifier text under Genetic Mutation Testing.

    • 06-23-2014
    Addition(s)/Revisions

    Hearing Aid Services

  • · Cochlear Implants – Removed reference to ICD 9 and added definition of a cochlear implant.

    • Nursing Facilities – Updated telephone number under Individuals Under 21 Years of Age.

    06-20-2014
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – Added text surrounding AUC recommendations for allowing exceptions for missing components of a C&TC screening. Added further description to HIPAA compliant referral codes.

    06-19-2014
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – Added clarification for Lab services prior to October 1. 2014.

    06-13-2014
    Addition(s)/Revisions

    HCBS (Home and Community Based Services) Waiver Services – Added link for paying relatives and legal guardians under Eligible Providers.

    06-09-2014
    Addition(s)/Revisions

    Equipment and Supplies – Updated the Billing section.

    06-09-2014
    Addition(s)/Revisions

    Evidence of Coverage (EOC) – Removed outdated criteria from the Bariatric (weight loss surgery) services section.

    06-06-2014
    Addition(s)/Revisions

    Alcohol and Drug Abuse Services – Added billing clarification to non-hospital based residential billing.

    Elderly Waiver (EW) and Alternative Care (AC) Program

  • · Specialized Supplies & Equipment Authorization & Billing Responsibilities - Clarified text for billing.

    • 06-05-2014
    Addition(s)/Revisions

    Equipment and Supplies – Updated the Billing section and added Durable medical items are exempt from taxes.

    06-03-2014
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Added additional details on Conversion Case Management Access (AC).

    Transportation Services

    Ambulance Transportation Services – Updated information for submitting the Ground Ambulance Billing Checklist.

    05-30-2014
    Addition(s)/Revisions

    Child and Teen Checkups (C&TC) – Added Reference and Outside Lab Services information.

    Laboratory/Pathology, Radiology & Diagnostic Services

  • · Laboratory/Pathology Services – Updated reference and outside lab policy. Added direction for unlisted code. Deleted CLIA, codes and modifier directions; provider should consult CMS and AMA and AUC for these directions.
  • · Radiology/Diagnostic Services – Added date of service policy under Billing.

    • 05-23-2014
    Addition(s)/Revisions

    Equipment and Supplies

  • · Mobility Devices – Removed and added text to manual wheelchair standard and non-standard options lists.

    • 05-20-2014
    Addition(s)/Revisions

    Evidence of Coverage (EOC) – Added Psychotherapy for crisis under Psychotherapy.

    05-13-2014
    Addition(s)/Revisions

    Physician and Professional Services – Revised Authorization Policy. The MHCP Medical Review Agent uses nationally recognized medical necessity criteria.

    Provider Basics
    Provider Requirements

  • · Access Services – Recipients of Alternative Care (AC) are eligible for interpreter services.

    • Authorization – Added new local phone number for KEPRO.

    05-12-2014
    Addition(s)/Revisions

    Hospital Services

  • · Hospital In-reach Service Coordination (IRSC) – Reviewed and revised for clarity.

    • 05-07-2014
    Addition(s)/Revisions

    HCBS (Home and Community Based Services) Waiver Services

  • · Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims – Clarified text for processing time.

    • 05-06-2014
    Addition(s)/Revisions

    Pharmacy Services – Clarified Dispense as Written instructions for electronic prescriptions.

    04-30-2014
    Addition(s)/Revisions

    Pharmacy Services

  • · Point of Sale Diabetic Testing Supply Program – Updated to include customer service line numbers for requests on additional diabetic meters.

    • 04-29-2014
    Addition(s)/Revisions

    HCBS (Home and Community Based Services) Waiver Services – Added link to new section.

  • · Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims – New section.

    • 04-28-2014
    Addition(s)/Revisions

    Transportation Services (Overview) – General coverage and billing information updated.

    04-25-2014
    Addition(s)/Revisions

    Rehabilitative Services

  • · Augmentative Communication Devices – Updated policy for AC devices to include electronic tablets.

    • 04-23-2014
    Addition(s)/Revisions

    Provider Basics

  • · Authorization – Updated address for Telligen.

    • 04-22-2014
    Addition(s)/Revisions

    Laboratory/Pathology, Radiology & Diagnostic Services

  • · Laboratory/Pathology Services – Clarified policy for non-covered cytology testing.

    • 04-21-2014
    Addition(s)/Revisions

    Dental Services

  • · Non-Pregnant Adults – Technical fix- from 365 days to Calendar year. Recipients can get up to four D1110 units per calendar year.

    • Provider Basics
    Billing Policy Overview

  • · Payment Methodology – Hospital – Added covered to several calculations explanations and added definition of covered days to definitions section.

    • 04-17-2014
    Addition(s)/Revisions

    Hospital Services

  • · Inpatient Hospital Services – Clarified text about MinnesotaCare claims of the $10,000 cap on inpatient services.

    • Reproductive Health/OB-GYN
    Minnesota Family Planning Program (MFPP)

  • · Minnesota Family Planning Program (MFPP) Procedure Codes (PDF) – Added G0433 to the MFPP primary procedure code list.

    • 04-14-2014
    Addition(s)/Revisions

    PCA Provider Agency Enrollment – Added clarification regarding requirements for a revised surety bond at the time the agency renews their bond.

    04-09-2014
    Addition(s)/Revisions

    Alcohol and Drug Abuse Services – Corrected Non-hospital based residential program - treatment component unit from "Hour" to "Day", and added additional billing clarification under the Revenue & Procedure Codes section.

    04-08-2014
    Addition(s)/Revisions

    Equipment and Supplies

  • · Bone Growth Stimulators – Changed coverage policy for E0747 under Covered Services.

    • HCBS (Home and Community Based Services) Waiver Services – Updated to remove language referring to contracts between providers and lead agencies/counties/tribal under Billing Recipient Absences.

    04-03-2014
    Addition(s)/Revisions

    Equipment and Supplies

  • · Oximeters – Clarified authorization requirement for Oximeters for intermittent use.

    • Laboratory/Pathology Services

  • · Radiology/Diagnostic Services – Clarified immediate response authorization information. Added provider based clinics as excluded from the Advanced Diagnostic Imaging accreditation requirements.

    • Mental Health Services – Added Psychotherapy for Crisis to covered services.

    04-01-2014
    Addition(s)/Revisions

    Mental Health Services

  • · Psychotherapy for Crisis – New section.

    • 03-27-2014
    Addition(s)/Revisions

    Community Health Worker – Clarified supervision requirement for community health workers. Removed incorrect instructions for Critical Access Hospital billing.

    Dental Services

  • · Children and Pregnant Women – Removed confusing statement that appears asking provider to bill for a service they did not provide (bill for an acrylic partial when they provided a cast partial).

    • Relocation Service Coordination—Targeted Case Management (RSC—TCM) – Updated phone numbers under Provider Certification Application Process and Authorization Requirements.

    03-20-2014
    Addition(s)/Revisions

    HCBS (Home and Community Based Services) Waiver Services

  • · Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Added clarifications about new background study requirements for some waiver providers.

    • 03-14-2014
    Addition(s)/Revisions

    Evidence of Coverage (EOC) – Removed information about the annual MinnesotaCare $10,000 inpatient hospital cap for adults and the associated $1,000 cost-sharing that was eliminated 1/1/14.

    Laboratory/Pathology Services

  • · Authorization Requirements: Imaging Services (PDF) – Clarified language regarding when outpatient imaging services do and do not require authorization.

    • 03-13-2014
    Addition(s)/Revisions

    Provider Basics
    Health Care Programs and Services Overview – The annual MinnesotaCare $10,000 inpatient hospital cap for adults and the associated $1,000 cost-sharing is eliminated effective January 1, 2014.

    03-11-2014
    Addition(s)/Revisions

    Hearing Aid Services – Clarified replacement policy and billing requirements.

    Rehabilitative Services

  • · Rehabilitative and Therapeutic Services Authorization Criteria – Updated Rehabilitation and Therapeutic Services authorization criteria.

    • 03-10-2014
    Addition(s)/Revisions

    Immunizations & Vaccinations – Updated adult vaccine section and fee schedule for 2014.

    03-06-2014
    Addition(s)/Revisions

    Provider Basics
    Billing Policy Overview

  • · Billing the Recipient – Added information on copays for non-emergency use of the emergency department.

    • Transportation Services (Overview)

  • · Special Transportation Services (STS) - Updated information related to 30/60 mile transport limits and billing of transports to nursing facilities on date of admission only.

    • 03-04-2014
    Addition(s)/Revisions

    Elderly Waiver (EW) and Alternative Care (AC) Program – Added new services that are effective 1/1/14.

    Hospital Services

  • · Inpatient Hospital Authorization – Changed the readmission criteria of Long Term Care Acute Care Facility.

    • 02-27-2014
    Addition(s)/Revisions

    Community Paramedic Services – Added Place of service is 12 (Home) bullet under Billing section.

    Hearing Aid Services – Clarified repair policy under Repair Claims.

    02-21-2014
    Addition(s)/Revisions

    Laboratory/Pathology Services – Added information about Outpatient Laboratory Tests being packaged under the Outpatient Prospective Payment System (OPPS). Added drug testing policy and coding changes. Clarified oncotype Dx testing procedure code. Clarified MHCP billing policy for drug testing effective April 1, 2014.

    02-18-2014
    Addition(s)/Revisions

    Alcohol and Drug Abuse Services – Updated procedure codes.

    Equipment and Supplies

  • · Lower Limb Prosthetics – Added coverage decision for new code L5969.
  • · Mobility Devices – Updated criteria for K0005.

    • 01-29-2014
    Addition(s)/Revisions

    Anesthesia Services – MHCP Anesthesia Payment Formula table updated with 2014 rate increases.

    Hearing Aid Services Codes – Added 2013 codes.

    01-23-2014
    Addition(s)/Revisions

    Hospital Services

  • · Inpatient Hospital Authorization – Deleted the option for UB-04 FL-63.
  • · Inpatient Hospital Services – Updated the Evidence-Based Childbirth Program section.

    • Pharmacy Services

  • · Point of Sale Diabetic Testing Supply Program – Updated eligible provider section and added language about day supply in Billing section.

    • 01-22-2014
    Addition(s)/Revisions

    Rehabilitative Services – Clarification on billing for Rehabilitative Services Provided in Facility Settings and for Rehabilitative Services Provided in an LTC Facility.

    01-17-2014
    Addition(s)/Revisions

    Equipment and Supplies

  • · Incontinence Products – Updated policy to reflect 2014 HCPCS code changes.

    • 01-16-2014
    Addition(s)/Revisions

    Pharmacy Services – Removed Denied Claim information under Online Claims Screening (ProDUR).

    01-15-2014
    Addition(s)/Revisions

    Provider Basics

    Billing Policy Overview – Remittance Advice Sequence options.

    Community Paramedic Services – Clarified billing units.

    01-14-2014
    Addition(s)/Revisions

    Evidence of Coverage (EOC) – Added Youth Act to mental health covered services.

    01-13-2014
    Addition(s)/Revisions

    Hospital Services

  • · Inpatient Hospital Authorization – Removed outdated text under Criteria to Determine Medical Necessity.

    • 01-08-2014
    Addition(s)/Revisions

    Mental Health Services – Added Youth Assertive Community Treatment (Youth ACT) under Covered Services.

  • · Youth Assertive Community Treatment (Youth ACT) – New section.

    • Provider Basics

    Authorization – Clarified information for review agents. Send authorization requests for medical, dental, medical supplies, home care and inpatient hospital authorizations to KePRO.

    01-07-2014
    Addition(s)/Revisions

    Evidence of Coverage (EOC) – Clarified that the pharmacy, doctor and recipient need to work together to get coverage for a prescription not usually covered by MHCP under Prescription drugs* for members who do not have Medicare.

    Pharmacy Services – Added Point of Sale Diabetic Testing Supply Program link under Medical Supplies and Equipment.

    Provider Basics
    Billing Policy Overview

  • · Billing the Recipient – Changed family deductible amount to $2.75 effective January 1, 2014.

    • 01-06-2014
    Addition(s)/Revisions

    Equipment and Supplies

  • · Diabetic Equipment & Supplies – Updated to reflect new Point of Sale (POS) billing requirements for test supplies.

    • Mental Health Services

  • · Psychotherapy – Revised Authorization requirements to include services with interactive complexity. Added information about prolonged services to the billing table.

    • Rehabilitative Services – Removed reference to ICD-9.

    01-03-2014
    Addition(s)/Revisions

    Pharmacy Services

  • · Point of Sale Diabetic Testing Supply Program – new section

    • 01-02-2014
    Addition(s)/Revisions

    HCBS (Home and Community Based Services) Waiver Services – Updated manual with new requirements effective 01/01/14.

  • · Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Updated page to include enrollment requirements effective 1/1/14.
  • · Training Requirements – new section

    • Previous Revisions

    2013 Manual Revisions

    2012 Manual Revisions

    2011 Manual Revisions

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