home and community-based services (hcbs) waiver program fssa.pdf · to keep them in their home and...
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Indiana Health Coverage ProgramsDXC Technology
October 2017
Home and Community-Based Services (HCBS) Waiver Program
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Agenda
– HCBS Program overview
– Member Eligibility
– Wavier Billing Information
– Provider Healthcare Portal
– Submitting electronic claims
– Searching for claims
– Remittance Advice (RA)
– Updates
– Helpful tools
– Q&A
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Indiana Health Coverage ProgramsDXC Technology
HCBS Program Overview
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What Is the Home and Community-
Based Services Waiver Program?
˗ In addition to traditional State Plan Medicaid benefits, members enrolled in an HCBS program are eligible to receive specific services within the HCBS program that address their specific person-centered goals and needs to keep them in their home and community.
˗ FSSA administers four HCBS 1915(c) waiver programs and three 1915(i) HCBS State Plan Options.
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What Is the 1915 (c) HCBS Waiver
Program?˗ Provides services to individuals who are eligible
for Medicaid and meet specific level of care criteria but wish to remain in the community.
˗ Must be cost-neutral (cost must not exceed the cost of an institutional setting).
˗ Individual cannot be enrolled in managed care.˗ There is a specific number of approved member
slots/year. When slots are full, there may be a waiting list.
˗ Funding of last resort. Member must utilize State Plan benefits first, and then use HCBS to fill in any gaps.
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Local Resources – Assessment for
Level of Care (LOC) Needs
Administered by the Division of Aging (DA)
− Aged and Disabled (A&D) Waiver
− Traumatic Brain Injury (TBI) Waiver
Administered by the Division of Disability and Rehabilitative Services (DDRS), Bureau of Developmental Disabilities Services (BDDS)
− Community Integration and Habilitation (CIH) Waiver
− Family Supports (FS) Waiver
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Indiana Health Coverage ProgramsDXC Technology
Member Eligibility
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Member Eligibility
It is the provider’s responsibility to verify a member’s eligibility prior to providing services
The following two Eligibility Verification System options are available:
Provider Healthcare Portal
The following search options are available:
Name and date of birth (DOB) Member identification number Social Security number
Interactive Voice Response (IVR) System Member eligibility verification Level of care confirmation (NF/Waiver)
Contact IVR at toll-free at 1-800-457-4584
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Provider Healthcare Portal Eligibility
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Indiana Health Coverage ProgramsDXC Technology
Waiver Billing Information
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Waiver Billing – Authorized Services
Only authorized services that appear on the members Plan of Care/Notice of Action (NOA) may be billed
˗ For services to be authorized, they must fulfill the following criteria:
− Meet the needs of the member
− Be addressed in the member’s person-centered service plan and be identified on the NOA
− Be provided as the services that are defined and established by the waiver program
− Must not duplicate other Medicaid funded services
− Must not be billed while a member is in an institutional setting, that is, a hospital, nursing facility, or group home
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Waiver Billing – Notice of Action (NOA)
When billing for HCBS services, it is important to have the NOA available in order to bill properly˗ The NOA lists the following information:
− Approved service providers
− Approved service codes and modifiers
− Approved number of units and dollar
amounts
˗ Units on the NOA may be in time
increments or dollar amounts
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Waiver Billing – Notice of Action (NOA)
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Waiver Billing - Claims
Waiver providers should submit their claims:
˗ Using the 837P transaction˗ Provider Healthcare Portal˗ The CMS-1500 claim form is used
when submitting paper claims
Waiver providers submit claims using their IHCP Provider ID
− Do not report a National Provider Identifier (NPI) on claims; even if you have a NPI – Bill with your Provider ID only
− Do not report or use a taxonomy code
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Waiver Billing – Primary Diagnosis
Waiver providers should bill ICD-10 code R69 as the primary diagnosis code for all claims.
˗ Claims submitted without an ICD-10 primary diagnosis code will generate the denial error message, primary diagnosis code is required
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Indiana Health Coverage ProgramsDXC Technology
Provider Healthcare Portal
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Provider Healthcare Portal
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Provider Healthcare Portal
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Provider Healthcare Portal
Site Key is selected when registering for the Portal
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Provider Healthcare Portal
Home Page
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Indiana Health Coverage ProgramsDXC Technology
Submitting Professional
CMS-1500 Claims
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Two ways to access claim submission
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Professional Claim: Step 1
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Professional Claim: Step 1
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Professional Claim: Step 2
Add the diagnosis in the Diagnosis Code field.
Once the diagnosis is located, click
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Professional Claim: Step 2
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Professional Claim: Step 3
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Professional Claim: Step 3
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Professional Claim: Step 3
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Professional Claim: Step 3
MODIFIERS - required
Review the Notice of Action (NOA) for the required modifiers
The modifiers on the claim must exactly match the NOA.
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Professional Claim: Step 3
Add Provider ID Choose “Provider ID” from ID Type
Choose “unit” from Unit Type
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Professional Claim: Step 3
Once information is entered, click
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Professional Claim: Step 3
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Confirm Professional Claim
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Submit Professional Claim:
Confirmation
Payment/Denied
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Indiana Health Coverage ProgramsDXC Technology
Search CMS-1500 Claims
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Two ways to access Claims Submission
OR
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Search Claims
When searching for claims –you have the option to choose which type of claim to search.
Search by Claim ID, Member ID, or Service Dates and click
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Search Claims: Results
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Search Claims: Results
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Copying and Correcting Claims
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Copying and Correcting Claims
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Provider Healthcare Portal User Access
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Search Payment History
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Indiana Health Coverage ProgramsDXC Technology
Updates
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Red-and-White claim form
• Effective January 1, 2018, all claims billed on professional (CMS-1500)(02-12) and institutional UB-04(CMS-1450) claim forms must be submitted on a standard red and white claim form. The IHCP will no longer accept copied (black and white) claim forms.
• Claims not received on the red-and-white claim form on or after January 1, 2018, will be returned to the provider.
• ADA Form 1260 is available only in black and white.
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Indiana Health Coverage ProgramsDXC Technology
Helpful Tools
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Helpful Tools
• IHCP website at indianamedicaid.com– IHCP Provider Reference Modules– Medical Policy Manual
• Customer Assistance available 8am-6pm EST Monday – Friday – 1-800-457-4584
• IHCP Provider Relations Field Consultants– See the Provider Relations Field Consultants
page at indianamedicaid.com • Secure Correspondence via the Provider
Healthcare Portal
• Written Correspondence– DXC Technology Provider Written
CorrespondenceP.O. Box 7263Indianapolis, In 46207-7263
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QuestionsFollowing this session please review your schedule for the next session you
are registered to attend