Date: February 5, 2019
To: Participating Behavioral Health Clinics and Community Mental Health Centers
Re: Programming Update Regarding DHS Social Services Special Eligibility
The purpose of this notice is to update Behavioral Health Clinics and Community Mental Health Centers regarding system programming and claim adjudication related to the Department of Human Services’ (DHS) Social Services (SS) Special Eligibility Segment, also known as Social Service Package B.
In a September 10, 2018 informational notice, providers were advised that DHS SS eligibility on the participant’s eligibility file would not be required for claim adjudication for dates of service on or after October 1, 2017. However, programming to update system editing has not been completed at this time and claims are rejecting for the H01 (No DHS Service Segment), R09 (Prior Approval Required) and U58 (Provider Not Allowed to Bill for Service) error codes. DHS SS eligibility is needed until that programming update is complete.
To remedy this situation, all active participant files have been updated to include DHS SS eligibility. Until the programming update is complete, participants with new or reinstated medical eligibility will receive DHS SS eligibility via a monthly update process. Providers may verify participant eligibility via MEDI, the Automated Voice Response System (AVRS) at
1-800-842-1461, or through a REV vendor. Healthcare and Family Services (HFS) will provide an update to providers once the programming related to the DHS SS eligibility is complete.
Providers with claims for dates of service on or after October 1, 2017 that rejected with any combination of error codes H01, R09 and/or U58 should now rebill those claims. Providers requiring a time override for claims that could not be submitted timely due to this programming delay should contact an HFS Community Mental Health billing consultant at 877-782-5565. Effective with the date of this notice, claims affected by this issue will be eligible for override if resubmitted within 180 days.
Questions regarding this notice should be directed to a Community Mental Health billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565, options 1, 2, 4, and 8.
Interim Medicaid Director