Provider Notice Issued 06/17/2019

Date:   June 17, 2019           
 
To:       Participating Behavioral Health Clinics and Community Mental Health Centers
 
Re:      System Programming and Claim Submission Updates
 
 
The purpose of this notice is to update participating Behavioral Health Clinics (BHCs) and Community Mental Health Centers (CMHCs) regarding fee-for-service billing issues. This notice does not pertain to claim submissions to HealthChoice Illinois managed care plans.
 
Issue #1 – Programming of Allowable Procedure/Modifier Combinations Effective August 1, 2018 and November 1, 2018
Effective May 6, 2019, all system programming updates were finalized to allow processing the procedure code/modifier combinations added with the August 8, 2018 and November 1, 2018 Community-Based Behavioral Services (CBS) Fee Schedules. Providers should rebill procedure code H2015 with modifiers HN and HK for service dates on or after August 1, 2018 that erroneously rejected with error codes A59 (Procedure/Modifier/POS Combination Invalid) and/or C31 (Procedure Not on File or Date). Providers are encouraged to rebill these claims during the 90-day timely filing edit lift discussed under “Resolution” below.
 
Issue #2 – Programming of Add-On Payments for Certain Psychiatric Services
Effective May 6, 2019, system programming updates were completed to resolve an issue impacting claims with dates of service on and after August 1, 2018, in which add-on payments were erroneously paid or not paid for the following three procedure code/modifier combinations:
 
HCPCS
Modifier 1
Modifier 2
Issue
H0004
HO
HQ
System paid a $5.00 per unit add-on in error.
H2010
52
-
System paid a $10.00 per unit add-on in error.
H2015
HN
HK
System should have paid a $5.00 per unit add-on.
 
The Illinois Department of Healthcare and Family Services (HFS) will be adjusting claims based upon the scenarios above. Providers do not need to take any action on claims impacted by Issue #2.
 
Issue #3 – Timely Filing for Claims Impacted by Programming Delays
In a September 10, 2018 notice, HFS informed providers that the Department of Human Services’ (DHS) Social Services (SS) Special Eligibility, also known as Social Service Package B, would not be required for dates of service on or after October 1, 2017, following the completion of system programming. A notice published on February 5, 2019, informed providers that system editing had not been completed and claims were rejecting for the H01 (No DHS Service Segment), R09 (Prior Approval Required) and U58 (Provider Not Allowed to Bill for Service) error codes. To remedy the issue, all active participant eligibility files have been updated to include the DHS SS Special Eligibility Segment. Providers can rebill according to the instructions under “Resolution” below.  
 
When participants receive new or reinstated medical eligibility, the DHS SS Special Eligibility Segment will be added automatically through a systematic monthly update process. Providers will no longer need to contact DHS to manually add this eligibility. Providers should verify eligibility through the Medical Electronic Data Interchange (MEDI) for this update prior to billing. 
 
Issue #4 – Reimbursement of Mobile Crisis Response Services

4a): Claims are paying at $0.00 when Mobile Crisis Response (MCR), HCPCS S9484, is billed for participants who do not have HFS Social Service Package A eligibility, commonly referred to as Screening, Assessment, and Support Services (SASS) eligibility. HFS is investigating this issue and will notify providers when it is resolved. At this time, providers should not take any action on claims impacted by this issue.

4b): MCR claims received between April 17, 2019 and May 24, 2019, were paid at an incorrect and reduced rate for participants with SASS eligibility.  A programming update to correct this issue was completed on May 24, 2019. HFS will be adjusting claims that paid at the incorrect rate.  Providers do not need to take any action on these claims.

 
Resolution:
The timely filing edits G55 and D05 will be lifted for BHCs and CMHCs from the date of this notice through August 31, 2019, to allow providers to submit claims that could not be submitted timely due to programming delays related to Issue #1 and Issue #3. Providers should submit impacted claims during this time and do not need to contact an HFS Community Mental Health billing consultant for a manual timely filing override.
 
Claims related to Issues #2 and #4a will be reprocessed by HFS and do not require provider action. Claims related to Issue #4b do not require provider action at this time.
 
Note: Lifting of the timely filing edits is only for the purpose of rebilling claims that could not be submitted due to the issues discussed in this notice. HFS will be monitoring the submission of claims during this time. Any provider determined to be submitting claims past the timely filing window that does not meet the criteria outlined in this provider notice will be immediately referred to the HFS Office of Inspector General (OIG) for investigation. 
 
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, option sequence 1, 2, 4, then 8.
 
Doug Elwell
Medicaid Director
 

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