PROVIDER BULLETIN MOLINA HEALTHCARE OF OHIO MAY 2018 WWW.MOLINAHEALTHCARE.COM 2 (855) 322-4079 prevent problems related to opioid use.
Upcoming Behavioral Health Sessions Molina Healthcare is hosting BH Provider WebEx Sessions. In addition to general questions, the Q&A sessions can also be utilized for billing, claims and testing questions. Question and Answer WebEx Sessions: · Thurs., May 10, 8 to 9 a.m. meeting number 808 276 842 · Mon., May 21, 12 to 1 p.m. meeting number 801 598 161 · Tues., June 5, 1 to 2 p.m. meeting number 805 003 479 · Wed., June 20, 2 to 3 p.m. meeting number 803 439 317 Provider Portal Claims Training WebEx Sessions: · Wed., May 16, 12 to 1 p.m. meeting number 800 331 389 · Thurs., June 14, 1 to 2 p.m. meeting number 808 331 894 · Mon., June 25, 11 a.m. to 12 p.m. meeting number 808 624 834 To join WebEx, call (855) 665-4629 and follow the instructions. To view sessions, log into www.WebEx.com, click on "Join" and follow the instructions. Meetings do not require a password. BH Provider Forums: · Dayton: Mon., May 21, 10 a.m. to 1 p.m. · Toledo: Fri., May 25, 10 a.m. to 1 p.m. · Akron: Thurs., May 31, 10 a.m. to 1 p.m. · Athens: Mon., June 4, 10 a.m. to 1 p.m. · Columbus: Tues., June 5, 10 a.m. to 1 p.m. · Cleveland: Thurs., June 14, 10 a.m. to 1 p.m. Register for the forums at http://www.eventbrite.com and search "MCO BH Provider Forum." Additional provider forums will be coordinated information on the additional sessions will be announced in a MITS BITS email newsletter. Behavioral Health Frequently Asked Questions Our Behavioral Health Frequently Asked Questions (FAQ) is available to help answer questions about the Provider Portal, contracting, claims, prior authorizations, Behavioral Health (BH) Testing and more! Look for it on our website under the "Health Resources" tab. New Opioid Education Resources Available Provider Education Resources on Opioid Safety and Guidelines is now available on our website under the "Health Resources" tab for the Medicaid, MyCare Ohio and Marketplace lines of business. Information includes fact sheets, links to articles and to external trainings. These resources: · strengthen our commitment to opioid safety for our members · support our providers to aid their clinical decision making Molina Healthcare is committed to doing our part to help improve the safety of members who suffer from opioid use disorders, and to helping In This Issue May 2018 Molina BH WebEx Training Behavioral Health FAQ Opioid Education Resources Rendering Providers BH Claims Testing Common Billing Errors Provider Support Enrollment Update BH Testing Guidance PA for New Services Claims Features Training Questions? Provider Services (855) 322-4079 8 a.m. to 5 p.m., Monday to Friday (MyCare Ohio available until 6 p.m.) Email us at BHProviderServices@ MolinaHealthcare.com Visit our website at MolinaHealthcare.com/OhioProviders Visit http://bh.medicaid.ohio.gov/ manuals for updates and resources. Connect with Us www.facebook.com/MolinaHealth www.twitter.com/MolinaHealth Join Our Email Distribution List Get this bulletin via email. Sign up at MolinaHealthcare.com/ProviderEmail. Provider Support Available Molina Healthcare has multiple channels to assist BH providers with Prior Authorization (PA), billing support and claims payment issues: · Utilization Management contact (855) 322-4079 for assistance with PA requests · Molina Healthcare Rapid Response Team providers can route issues to BHProvider Services@Molinahealthcare.com and Molina Healthcare will monitor, route and track emails for quick resolution Enrollment Updates for BH Agencies It is time for Ohio BH agencies (Medicaid provider types 84 and 95) to begin enrolling dependently licensed and BH paraprofessional The Behavioral Health Special Provider Bulletin is a newsletter distributed by Molina Healthcare of Ohio. 5 PROVIDER BULLETIN MOLINA HEALTHCARE OF OHIO prevent problems related to opioid use. If you have any questions, please email our BH Provider Representative. Rendering Providers in Provider Portal The Molina Healthcare Provider Portal now has the ability to allow multiple rendering providers per claim. Example: Jane Smith, RN (NPI 9876543210) and John Jones, RN (NPI 9876543211) each provide two, 15-minute nursing services (H2019) to Betty Brown. The correct way to bill these services is by submitting two detail lines on a single claim. 1. Claim detail one would be: Jane Smith, RN, NPI in rendering provider field: 9876543210, with two units of H2019. 2. Second claim detail would be: John Jones, RN, NPI in rendering provider field: 9876543211, with two units of H2019. Providers who are not required to individually enroll in Medicaid must leave the rendering provider field blank and detail at the same date of service, same supervisor NPI, same place of service, same provider and other modifiers. Behavioral Health Redesign Claims Testing MyCare Ohio's BH Redesign went live on Jan.1, 2018. Community BH Providers will transition to billing Medicaid Managed Care plans for their services on July 1, 2018. Molina Healthcare would like to invite MyCare Ohio and Medicaid providers to test our billing systems as we finalize our preparations for the BH Redesign and Carve-In. The EDI and Provider Portal are available for BH claims testing. Test claims can be submitted by: · Completing the EDI registration process through Molina Healthcare's clearinghouse, Change Healthcare. Providers/clearinghouses without an existing Change Healthcare account can register for the cost-free service at http://providernet.adminisource.com with our payer ID 20149 · Providers can submit an excel spreadsheet with test claims to Molina Healthcare at BHProviderServices@MolinaHealthcare.com. Molina Healthcare staff will enter this information into our Provider Portal for processing Providers need to use active Molina Healthcare members whenever possible. Providers without Molina Healthcare members should leave the name field blank and contact Molina Healthcare when submitting a file. Molina Healthcare will populate test member information in these files. Providers may repeat 10 test members over an unlimited number of test claims. Test scenarios should: · Incorporate the new codes and requirements. · Use 2018 Dates of Service. For example, on Jan. 5, 2018, only submit claims for Jan. 1-5, 2018 · Reflect the current scope of services being offered in your practice · Align with current HIPAA billing guidance and standards · Providers submitted on test file must match the providers submitted on the testing intake form If a provider is interested in testing, email Molina Healthcare at BHProviderServices@MolinaHealthcare.com for the intake form. Once it WWW.MOLINAHEALTHCARE.COM 2 MAY 2018 practitioners in Ohio Medicaid and affiliating them with employing/ contracting community behavioral health agencies. For detailed information on how to complete this process, please see the ODM "01/31/2018 Enrollment of Dependently Licensed and BH Paraprofessional Practitioners in MITS" at http://mha.ohio.gov/, under "News & Events" and "MITS Bits Updates." Claims for services between Jan. 1 and June 30, 2018, should not include these practitioners' NPIs in the rendering field or claims will deny. BH Redesign Testing Guidance Molina Healthcare has guidance on BH Redesign claims testing on our website under the "Health Resources" tab, under "Behavioral Health." Requesting Prior Authorization for New Services Effective Jan. 1, 2018, Prior Authorization (PA) is required from Ohio Mental Health and Addiction Services (OMHAS) certified providers for the following services: · Assertive Community Treatment (ACT) · Intensive Home-Based Treatment (IHBT) · Substance Abuse Disorder (SUD) Partial Hospitalization · SUD Residential Services (when annual limit is reached) Resources on our website include: · The standard PA form developed by the Ohio Association of Health Plans (OAHP) BH Collaborative for community behavioral health services. Please fax the standard PA form along with clinical information that demonstrates medical necessity for the service to our Utilization Management (UM) team at (866) 449-6843 · A resource document developed collaboratively by Managed Care Plans containing information on the PA process, billing procedures, contracting/credentialing, and other topics requested by providers For a list of services that require PA prior to the initiation of the service or after an annual limit is reached, see the Provider Manual on the Molina (855) 322-4079 PROVIDER BULLETIN MOLINA HEALTHCARE OF OHIO is submitted, email the testing reference number to Molina Healthcare. Our claims testing team will use this number to pull the test files from Change Healthcare for processing and will notify providers individually with the results. For guidance on billing, please visit the Ohio Department of Medicaid (ODM) website at http://bh.medicaid.ohio.gov/manuals. Providers may request to join the Molina Healthcare network by completing the "NonParticipating Provider Contract Request Form" on our website under the "Forms" tab. Common Billing Errors that Cause Claims to Deny No member enrollment for claim dates of service: It is the responsibility of the providers to check eligibility at every encounter prior to rendering the service by logging into https://www.ohmits.com. Claims billed for Medicaid members: Claims for Medicaid Members should be submitted to the ODM Fee for Service (FFS) for dates of service through June 30, 2018. Providers combining type 84 (MH) and type 95 (SUD) services under one NPI: Claims cannot be processed with an incorrect NPI number. Providers must use separate NPIs for Mental Health (MH) and Substance Use Disorder (SUD) services. An NPI can be obtained by visiting https://nppes.cms.hhs.gov/NPPES/Welcome.do. Provider type 84 (MH) and 95 (SUD) using NPIs not registered or inactive in MITS: Providers must have NPIs registered as active in MITS. Providers entering a NPI on claim for dependent practitioners: Services performed by a dependent practitioner should NOT bill with an NPI number. Box 31 and 24 J on the HCFA 1500 should be left blank and a practitioner modifier should be used on the service line. Practitioner modifier or rendering practitioner NPI missing on claim: When a claim is submitted with the practitioner modifier or the rendering practitioner's NPI missing, a corrected claim can be submitted via the Provider Portal or through EDI. Please see the "MCO Resource Document for CBHC Providers" on our website for additional details. MAY 2018 Healthcare website under the "Manual" tab. The Molina Healthcare UM team can be reached for questions at (855) 322-4079. Claims Features Training The Provider Portal is secure and available 24/7. Register for the Provider Portal on our website or at http://Provider.MolinaHealthcare.com. Online Claims Features include the ability to: · Submit new claims · Submit a corrected claim · Submit claim reconsiderations · Export claims · Void a claim · Check status of claims · Build and submit batches of claims · Create a claims template · Add supporting documents Additional information is available on our website under the "Manual" tab, under `Provider Orientation and Trainings" click on "Claims Features Training." Fighting Fraud, Waste & Abuse Do you have suspicions of member or provider fraud? The Molina Healthcare AlertLine is available 24 hours a day, 7 days a week, even on holidays at (866) 606-3889. Reports are confidential, but you may choose to report anonymously. WWW.MOLINAHEALTHCARE.COM 3 (855) 322-4079Acrobat Distiller 15.0 (Windows)