Author Topic: Medicaid questions  (Read 2258 times)

Lisa N

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Medicaid questions
« on: July 15, 2014, 11:44:57 AM »
Hi All,

I have a few questions about billing Medicaid, but this is my first post so I'll tell you a little about my experience first. I've been doing mental health billing in NY for about 2 years and I'm doing fine with most of the local and national carriers. Now some of my providers are accepting patients that have Medicare and/or Medicaid, but I'm completely inexperienced with the government programs. I'm taking a class and doing some research, but I'm still at a loss.

One specific question is this: A provider's patient has Fidelis with her mental health benefits carved out to Medicaid. Do I need the patient's Medicaid card/ID #? I assume that I do, but I don't know if she automatically has Medicaid benefits just because the MH benefits are carved out to them. With the other carved-out carriers, I've often needed the SSN as the patient's ID, could that be the case here?

My larger questions are about how to figure out which Medicaid carrier a patient has and whether the plan is fee-for-service or a managed care organization (which I understand sometimes require preauth). NYS Dept. of Health's  website says that NY has both both kinds of plans. This seems important since I've had to fix a few situations where payment was denied for prior auth by a carrier that only handled the MH benefits. Do I just use the MEVS call line? My billing software offers 4 different Medicaid plan options and I have no idea how to determine that information for each Medicaid patient.

Thanks,

Lisa

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Re: Medicaid questions
« Reply #1 on: July 15, 2014, 12:13:01 PM »
Hi Lisa, I'm in Upstate NY, so are Alice and Michele. In my neck of woods Fidelis is big here and I see a lot of it with my MH clients as well. I have the FBH manual which was sent to one of my providers dated 2012, but I was able to find the PDF online at: http://www.fideliscare.org/Portals/0/DocumentLibrary/Providers/Provider%20Manual/PM21.pdf   This should help you out a lot with specific questions for them.

Quote
My larger questions are about how to figure out which Medicaid carrier a patient has and whether the plan is fee-for-service or a managed care organization (which I understand sometimes require preauth). NYS Dept. of Health's  website says that NY has both both kinds of plans. This seems important since I've had to fix a few situations where payment was denied for prior auth by a carrier that only handled the MH benefits. Do I just use the MEVS call line? My billing software offers 4 different Medicaid plan options and I have no idea how to determine that information for each Medicaid patient.

3 words:  Benefits, Eligibility Verification must be done. Make it a policy for all clients to require the patient present an ID card and that card is copied and benefits are verified along with eligibility and the necessary primary authorization if needed can usually be obtained at same time. I don't know if you are a business or employee so I'll assume if you are a business and you are doing the billing, it's to your advantage to provide the benefits and verifications for the initial visit with each patient, then your not getting second hand info. What my clients do is a pre-screening and it works like this: The receptionist/office manager who takes the appointment on the first call fills out a pre-screening form. This form has all the information I NEED to do an initial verification of benefits and eligibility and even obtain the first authorization if necessary. They fax it over and I have it done by the following day at the latest. It is VITAL with mental health because so many carriers carve benefits out to another TPA and 98% of the time authorizations are required. This process works like a charm for me, then I don't have to worry about getting second hand information. On the phone with the patient, the receptionist/office manager will ask the patient to take out their ID card so they can get all the information they need. My pre-screening form has all the questions they need to ask the patient.  I found you have to be very specific, for example, they will ask the patient: "Can you look at the back of the card and tell me if there is a specific number to call for outpatient mental health or substance abuse claims?" 

Hope this helps. I live and work by the old saying, if you want something done right, do it yourself :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Lisa N

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Re: Medicaid questions
« Reply #2 on: July 15, 2014, 12:37:43 PM »
Thanks very much Linda, I'll look through that manual.

I normally check benefits and eligibility, but I don't know how to do that for Medicaid. I figured it out for Medicare, but I'm not sure if MEVS is the equivalent call line for Medicaid. Compounding this is that I don't know if the provider participates with Medicaid (I've asked her to let me know), so I don't have her MMIS to use if I were to call the MEVS line to experiment.

PMRNC

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Re: Medicaid questions
« Reply #3 on: July 15, 2014, 12:48:56 PM »
Quote
I normally check benefits and eligibility, but I don't know how to do that for Medicaid. I figured it out for Medicare, but I'm not sure if MEVS is the equivalent call line for Medicaid. Compounding this is that I don't know if the provider participates with Medicaid (I've asked her to let me know), so I don't have her MMIS to use if I were to call the MEVS line to experiment.

That's why you want to have the first point of contact ask the patient for the number on the back of the card specific for mental health and substance abuse claims. Rarely do I have to call a bunch of numbers if my clients office person follows that procedure. All of the NY medicaid plans have the benefits # on them and many of them have the MH TPA right on it with adddress/phone. I didn't have a big problem with Medicaid at all besides poor reimbursement.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Lisa N

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Re: Medicaid questions
« Reply #4 on: July 15, 2014, 02:38:43 PM »
Sorry, I didn't absorb that when you wrote it the first time. Ask for the behavioral health or provider number on the back of the card and take it from there, thanks!

Michele

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Re: Medicaid questions
« Reply #5 on: July 16, 2014, 05:49:02 PM »
Lisa,

Do you have access to EPACES?  That will also be a huge help..  You can apply for access as a billing service.

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PMRNC

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Re: Medicaid questions
« Reply #6 on: July 17, 2014, 12:36:19 PM »
Quote
Do you have access to EPACES?  That will also be a huge help..  You can apply for access as a billing service.

Michele, I have not used EPACES in a long time.. have they gotten better? I only have one client with Medicaid now but only until 9/1.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: Medicaid questions
« Reply #7 on: July 18, 2014, 08:48:51 AM »
We use EPACES ALL the time.  Very helpful, especially in determining eligibility.
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