Provider Notice Issued 12/17/2019

Date:    December 17, 2019
 
To:       Community Mental Health Centers and Behavioral Health Clinics
 
Re:      Mobile Crisis Response (MCR) Procedure Code S9484 Claim Adjustments
 
 
This notice provides billing instruction to providers regarding procedure code S9484 for Mobile Crisis Response (MCR) to ensure providers receive accurate payment for this service. This notice does not pertain to claim submissions to HealthChoice Illinois managed care plans.
 
Claims for S9484 for dates of service beginning August 1, 2018:
 
Non-SASS and Adult Participants:
·         A system issue identified in the June 17, 2019 informational notice allowed claims to pay at $0.00; however, these claims did not appear on a remittance advice and providers were unable to check claim status. The Department has voided these claims that paid at $0.00 and providers should have recently received remittance advices identifying these voids (19C type of adjustment, reason message “3201 – Service Void”). The Department has lifted the timely filing edit for these specific claims through May 30, 2020. Providers may rebill these claims at their usual and customary charges for payment.
 
After identifying the system problem above, the Department held any later claims received pending resolution of the issue. After the issue was resolved, those claims being held were released and processed. In the interim, the rate for MCR code S9484 was updated on October 10, 2019, so those held claims may or may not have paid at the updated amount, depending upon the provider’s usual and customary billed charges. If providers need to replace the previously paid claim, the Department will accept electronic transactions submitted through MEDI or via 837P files to replace a paid claim, if submitted within 12 months from the original paid voucher date.
 
SASS-Eligible Participants:
·         If claims were adjudicated prior to finalization of rate updates for S9484 on October 10, 2019, providers may need to submit replacement claims, if the provider’s usual and customary charges would prompt the replacement claims to adjudicate at a higher rate. The Department will accept electronic transactions submitted through MEDI or via 837P files to replace a paid claim, if submitted within 12 months from the original paid voucher date.
 
Claims for S9484 Received by the Department Between April 17, 2019 and May 23, 2019:
 
Due to an internal processing issue, the maximum quantity for this code was updated without a corresponding update to the maximum price. As claims were processed, the units priced to a lesser rate than indicated on the Community-Based Behavioral Services Fee Schedule. Any paid claims affected by this issue will also need to be replaced for accurate payment. The Department will accept electronic transactions submitted through MEDI or via 837P files to replace a paid claim, if submitted 

within 12 months from the original paid voucher date.  
 
The Community-Based Behavioral Services Fee Schedule is on the Department’s website.  Instructions for replacement claim submittal may be found in the Chapter 300 Companion Guide.  Questions regarding this notice may 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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