NY Medicaid Mental Health Billing -- Linda Please Help!

[Tilbrook]

Hi Linda,

I know that you do a lot of mental health billing in NY.  I have not been able to get a single Medicaid claim paid yet.  I am set up for electronic billing through my clearinghouse and the claims are being accepted, but then Medicaid denies for reason codes that I've never seen before.

Any helpful tips that you could share with a newbie like me?  What are some of the tricks to get Medicaid to pay for mental health?

Thanks in advance!
Lorraine

[PMRNC]

What are the reason codes?  Need more information on the denials!

[Michele]

We get ny medicaid to pay mental health all the time.  Like Linda said, what are the denials?

[PMRNC]

Yeah the reimbursement STINKS but I don't have any billing problems with them.

[Tilbrook]

Here's one of them:
01164: Recipient not QMB; Services not reimbursable for enrollment COS.
Some of the other errors have been due to using an 90801 code, which was denied.

I determined that some of the clients were not straight Medicaid, but Medicaid Managed Care, so I tried to send the claims to the appropriate insurer.  But then one was rejected and the denial code said to send it to Medicaid.  I'm so confused by this.  I don't have problems with any other insurer!

Thanks again!

[Michele]

Some of the Medicaid Managed Cares have a carve out for mental health services, those would be billed to straight Medicaid. 

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