MN-ITS Interactive 837P Mental Health billing session
Transcription
MN-ITS Interactive 837P Mental Health billing session
MN-ITS Interactive 837P MENTAL HEALTH BILLING SESSION Presenter: Lisa Domzalski Minnesota Department of Human Services Provider Relations—Training and Communications Winter 2004 AGENDA F DHS Provider Web Site F HIPAA Overview F MN-ITS F Paper Claim Requirements F Remittance Advice DHS Provider Web Page http://www.dhs.state.mn.us/provider DHS Provider Web Page http://www.dhs.state.mn.us/provider What is HIPAA? F Health Insurance Portability & Accountability Act of 1996 3 Federal law 3 Administrative simplification 3 Cost reduction Who is Affected? F Covered Entities 3 3 3 Health care providers; People or businesses that conduct electronic HIPAA transactions; and Businesses/individuals conducting any transactions electronically with a health plan covered under HIPAA. HIPAA Components F Privacy 3 Paper, oral, and electronic F Security F EDI 3 Transactions 3 Code Sets 3 Unique Identifiers Electronic or Not? F Discs/CD F Data lines/Internet F Mail F Fax F Phone HIPAA Transactions F Eligibility inquiry & response F Authorization F Claim submission F Claim status request & response F Remittance advice Medical Code Sets F CPT F CDT-4 F NDC/NCPDP F HCPCS F ICD-9 CM Non-Medical Codes F Place of Service F Claim Adjustment Reason F Claim Status F Remittance Remark Codes F Revenue Codes F Zip Code Who Enforces HIPAA? The federal government F CMS-Security/EDI F OCR-Privacy 3 Complaint driven 3 Voluntary compliance sought 3 Penalties last resort HIPAA Bottom Line F HIPAA is the law F Deadlines for compliance F Civil and criminal penalties Paper Claim F New required fields on paper CMS1500 MN-ITS F MN-ITS Registration F Eligibility Inquiry/Response (270/271) F MN-ITS Interactive Claim (837P) F Claim Status Request/Response (276/277) Remittance Advice F Remittance Advice (835) F Supplemental Section Additional Resources DHS Provider Call Center (651) 282-5545 or 1-800-366-5411 Provider Help Desk Provider Enrollment MN-ITS Registration Thank you! Please complete the evaluation before you leave Lisa Domzalski Provider Training [email protected] 651-297-1048 Minnesota Department of Human Services Provider Relations—Training and Communications Winter 2004 Mental Health Providers MN–ITS Home Page DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 1 of 23 Mental Health Providers MN–ITS Registration MN–ITS Administrator User Information MN–ITS Organization Information DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 2 of 23 Mental Health Providers MN–ITS Registration EDI Biller Agreement DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 3 of 23 Mental Health Providers MN–ITS Registration Summary Page DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 4 of 23 Mental Health Providers MN–ITS Administrator MN–ITS Welcome Page My Identity DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 5 of 23 Mental Health Providers MN–ITS Administrator Modify My Identity DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 6 of 23 Mental Health Providers MN–ITS Interactive Home Page DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 7 of 23 Mental Health Providers MN–ITS MN–Eligibility Inquiry (270) DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 8 of 23 Mental Health Providers MN–ITS MN–ITS Eligibility Response (271) DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 9 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Subscriber Tab DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 10 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Providers Tab DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 11 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Coordination of Benefits (COB) Tab DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 12 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim COB Tab – Page 2 DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 13 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Claim Information Tab DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 14 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Claim Information Tab – Page 2 DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 15 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Services Tab DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 16 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Services Tab – Page 2 DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 17 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Validate Response DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 18 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Submit Response DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 19 of 23 Mental Health Providers Professional (837P) MN–ITS Interactive Claim Alternate Submit Page Copy Feature DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 20 of 23 Mental Health Providers MN–ITS Claim Status Request (276) Find the Payer Claim Control Number using the Look-up Search Engine. Enter the required information on the Custom Tab. DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 21 of 23 Mental Health Providers MN–ITS Claim Status Response (277) DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 22 of 23 Mental Health Providers Paper CMS 1500 Claim Form DHS Provider Relations—Training & Communications MN–ITS for Mental Health Providers Winter 2004 Page 23 of 23 MINNESOTA HEALTH CARE PROGRAMS 444 LAFAYETTE ROAD SAINT PAUL, MN 55155 PAYER ID # 1411674742 CONTACT: PROVIDER HELP DESK (651) 282-5545 OR 1-800-366-5411 PAYEE: MENTAL HEALTH CLINIC PAYEE ID: 2222222 00 CLA IM STATUS : LAST: PATIENT DOC ID NBR: 543210 VENDOR NBR: 1234567 PROD DATE : 01-23-04 PAGE: 1 CHK/ EFT NBR: 111111111 CHK/ EFT DATE : 01-27-04 REVERSAL FIRST: IM MI: A ID NBR: 33333333 MAJOR PGM: MA PAT CTRL NBR: 2222 PAYER CLM NBR: 2-03344-00-000-1002-00 LI FROM DT TO DATE PROC CD 01 11-13-03 11-13-03 90846 MODIFIER CHARGES O UNITS ADJ GRP - 150.00 2 CR ADJ REASON ADJ AMOUNT 42 A UNITS - 74.40 CLAIM TYPE: HCFA -1500 P UNITS PAYMENT AUTH NBR 2 REMARKS - 75.60 R PROV NBR: 3333333 00 TOTAL CHARGE: CLAIM STATUS : LAST: DOE - 150.00 TOTAL ADJUSTMENT: - 74.40 TOTAL PAYMENT: - 75.60 ORIG REF NBR: 2-03329-00-000-0000-00 PAID-PRIMARY FIRST: JANE LI FROM DT TO DATE 01 10-01-03 10-01-03 MI: B ID NBR: 11111111 MAJOR PGM: MA PAT CTRL NBR: JDOE1 PAYER CLM NBR: 9-03345-00-000-0000-00 CLAIM TYPE: HCFA-1500 PROC CD MODIFIER 90806 CHARGES 100.00 O UNITS 1 ADJ GRP CO ADJ REASON 42 ADJ AMOUNT A UNITS 24.40 0 P UNITS 1 PAYMENT 75.60 R PROV NBR: 3333333 00 TOTAL CHARGE: 100.00 TOTAL ADJUSTMENT: 24.40 TOTAL PAYMENT: 75.60 AUTH NBR REMARKS MINNESOTA HEALTH CARE PROGRAM PAYEE: MENTAL HEALTH CLINIC PAYEE ID: 2222222 00 CLAIM STATUS : LAST: PATIENT DOC ID NBR: 543210 VENDOR NBR: 1234567 PAGE: 2 PROD DATE : 01-23-04 CHK/ EFT NBR: 111111111 CHK/ EFT DATE : 01-27-04 PAID-PRIMARY FIRST: IM LI FROM DT TO DATE 01 11-13-03 11-13-03 MI: A ID NBR: 33333333 PROC CD MODIFIER MAJOR PGM: MA PAT CTRL NBR: 2222 PAYER CLM NBR: 2-03344-00-000-2002-00 CHARGES 90847 O UNITS 150.00 ADJ GRP 2 ADJ REASON CO ADJ AMOUNT 42 74.40 A UNITS P UNITS 0 CLAIM TYPE: HCFA -1500 PAYMENT 2 AUTH NBR REMARKS 75.60 R PROV NBR: 3333333 00 TOTAL CHARGE: CLAIM STATUS : LAST: DOE 150.00 00 TOTAL ADJUSTMENT: 74.40 TOTAL PAYMENT: 75.60 ORIG REF NBR: 2-03329-00-000-0000- PAID-SECONDARY FIRST: JACK LI FROM DT TO DATE 01 09-03-03 09-03-03 MI: B ID NBR: 66666666 MAJOR PGM: MA PAT CTRL NBR: JDOE2 PAYER CLM NBR: 9-03345-00-000-0000-00 CLAIM TYPE: HCFA-1500 PROC CD MODIFIER CHARGES 90806 O UNITS 100.00 ADJ GRP 1 ADJ REASON CO CO PI ADJ AMOUNT 42 23 87 24.40 80.05 -4.05 A UNITS P UNITS PAYMENT 1 0.00 0 AUTH NBR REMARKS R PROV NBR: 3333333 00 TOTAL CHARGE: CLAIM STATUS : LAST: SMITH 100.00 TOTAL ADJUSTMENT: 100.00 TOTAL PAYMENT: 0.00 DENIED FIRST: LARRY MI: P LI FROM DT TO DATE 01 11-02-03 11-02-03 PROC CD ID NBR: 99999999 MODIFIER 90801 MAJOR PGM: MA PAT CTRL NBR: 1234 CHARGES 200.00 O UNITS PAYER CLM NBR: 6-03343-00-000-0000-00 ADJ GRP ADJ REASON CO 24 2 ADJ AMOUNT 200.00 A UNITS 2 CLAIM TYPE: HCFA-1500 P UNITS PAYMENT 0 0.00 R PROV NBR: 1111111 00 TOTAL CHARGE: PRIORITY PAYER: PMAP INSURANCE 200.00 PRIORITY PAYER ID: 4057139 00 TOTAL ADJUSTMENT: 200.00 TOTAL PAYMENT: 0.00 AUTH NBR REMARKS MINNESOTA HEALTH CARE PROGRAMS PAYEE: MENTAL HEALTH CLINIC PAYEE ID: 2222222 00 DOC ID NBR: 543210 VENDOR NBR: 1234567 PROD DATE : 01-23-04 PAYEE TAX ID: 41-0000000 PROVIDER SPECIFIC FINANCIAL TRANSACTIONS: PROV ADJ REASON PAYMENT AMOUNT: PROV ADJ AMOUNT 5.00 PROV ADJ ID 528 4-03326-00-994-0000-06 70.60 *** END OF REPORT *** PAGE: 3 CHK/ EFT NBR: 111111111 CHK/ EFT DATE : 01-27-04 PROVIDER SUPPLEMENTAL DATA PAYEE: MENTAL HEALTH CLINIC PAYEE ID: 2222222 00 DOC ID NBR: 543210 VENDOR NBR: 1234567 PROD DATE : 01-23-04 PAGE: 1 CHK/ EFT NBR: 111111111 CONTACT: PROVIDER HELP DESK (651) 282-5545 OR 1-800-366-5411 E-MAIL CONTACT: ** FINANCIAL SUMMARY INFORMATION ** NUMBER OF CLAIMS NUMBER OF PAID CLAIMS: PAID ORIGINAL CLAIMS: PAID GROSS ADJUSTMENTS: DENIED ORIGINAL CLAIMS INFO: DENIED ADJUSTMENT CLAIMS INFO: BEGINNING CREDIT BALANCE: ENDING CREDIT BALANCE: BEGINNING RECOUPMENT BALANCE: ENDING RECOUPMENT BALANCE: 3 2 1 BILLED AMOUNT 350.00 200.00 -5.00 200.00 0.00 REIMBURSEMENT AMOUNT 151.20 75.60 -5.00 0.00 0.00 0.00 0.00 0.00 0.00 CHK/ EFT DATE : 01-27-04 PROVIDER SUPPLEMENTAL DATA PAYEE: MENTAL HEALTH CLINIC PAYEE ID: 2222222 00 CLAIM STATUS : LAST: SMITH LI FROM DT 01 12-01-03 DOC ID NBR: 543210 VENDOR NBR: 1234567 PAGE: 2 PROD DATE : 12-12-03 CHK/ EFT NBR: 111111111 CHK/ EFT DATE : 12-16-03 SUSPENDED FIRST: LARRY TO DATE PROC CD 12-01-03 96150 R PROV NBR: 111111100 MI: P MODIFIER ID NBR: 55555555 CHARGES 150.00 MAJOR PGM: MA PAT CTRL NBR: 1234 O UNITS AUTH NBR 1 STATUS 046 PAYER CLM NBR: 1-03337-00-652-0047-62 CLAIM TYPE: HCFA-1500 HIPAA MN-ITS Workshop Acronym List Claim form types providers currently use to bill DHS: ADA—American Dental Association claim form CMS 1500—Centers for Medicare and Medicaid Services claim form (formerly known as HCFA 1500—Health Care Financing Administration claim form) RSI—Residential Services Invoice claim form UB-92—Universal Biller claim form MN-ITS Electronic Transactions (ANSI X12 Transaction Sets): Interactive transactions processed through MN-ITS are already in a HIPAA required format. Providers using the Interactive functions are meeting HIPAA compliance if they fill in the required information. Batch providers or billers will need to make sure their transactions are HIPAA-compliant before submitting information electronically to DHS. 270—eligibility inquiry 271—eligibility response 276—claim status inquiry 277—claims status response 278—referral and authorization (prior authorizations and service agreements—DOES NOT include waiver and day training and habilitation service agreements at this time) 820—premium payment 834—enrollment transaction 835—health care claim payment and remittance advice 837—health care claim NCPDP—National Council for Prescription Drug Programs claim Claim form types used to bill DHS on MN-ITS: 837D—Dental claim form 837I/LTC—Institutional health claim form used by long term care provider billers or RSI billers 837I—Institutional health care claim form used by UB-92 billers 837P—Professional health care claim form used by current HCFA-1500 claim form billers A—Add key ANSI—American National Standards Institute ASC X12—Accredited Standards Committee X12 N* (*N Insurance Subcommittee) CDMI—Care Delivery Management Incorporated CLIA—Clinical Laboratory Improvement Amendments CMN—Certificate of Medical Necessity CMS—Centers for Medicare & Medicaid Services COB—Coordination of Benefits COP1, COP2, etc.—Claim Level Other Payer D—Delete key DHS—Minnesota Department of Human Services DME—Durable Medical Equipment DMERC—Durable Medical Equipment Regional Carrier DX—Diagnosis EDI—Electronic Data Interchange EIN—Employer Identification Number EOB—Explanation of Benefits EOMB—Explanation of Medical Benefits EPO claim service lines—Epotin blood test results info EPSDT—Early Periodic Screening and Development Testing (this is now known as C&TC or Child and Teen Check-up) ESRD—End Stage Renal Disease EVS—Eligibility Verification System F2—International units of time for billing purposes on Services screen HCPCS—Health Care Financing Administration Common Procedural Coding System HH1, HH2, etc.—Home Health provider(s) listed on Claim Information screen in the Home Health Care Plan Information box HIPAA—Federal Health Insurance Portability and Accountability Act of 1996 ICD-9-CM—International Classification of Disease, Ninth Revision, Clinical Modification ID—Identification ITS—DHS Information Transfer System L1, L2, etc.—a billing line on the Services tab screen on a claim transaction in MN-ITS that has been saved for later submission LO—Service tab screen—Line item you want to look at to record other payer LTC—Long Term Care MHCP—Minnesota Health Care Programs (which include Medical Assistance, Minnesota Care, General Assistance Medical Care) MIA Counts—Medicare Inpatient Adjudication days MJ—minutes increment of time for billing purposes on Services screen mmddyyyy—format used to enter a date onto claim forms—example: January 1, 2003 could be 01012003 or 0101-2003 or 01/01/2003 MMIS—DHS Medicaid Management Information System MN-ITS—new DHS Web-based interactive tool for direct data entry of MHCP claims MN-ITS Interactive—The new way to bill individual claims directly to DHS via the Internet—turns the information you submit on a claim into X12 format for DHS. This electronic billing method will eventually replace ITS software billing for direct billers MOD—modifier NCPDP—National Council for Prescription Drug Programs—the HIPAA-compliant format for pharmacy services claims NDC—National Drug Code NSF—National Standard Format P1, P2, etc.—used for provider to show if there was another payer who paid something on a claim PA—Prior Authorization (also known as Authorization) PHI—Protected Health Information PMAP—Pre-paid Medical Assistance Program PO—Other payer you have listed on a line item that has gotten paid something for the service you are now billing for POS—Place of Service POS—point of sale—this is a method that pharmacies use to bill for services Provider PDF files—printer friendly files with DHS/MHCP information PROV—Provider RA—Remittance Advice RSN code—Reason code RX#--Prescription number SA—Service Agreement TCN—Transaction Control Number UN—units increment of time for billing purposes on Services screen UPIN—Unique Physician Identification Number X12 4010A batch format—new HIPAA compliant batch format—for providers who will do batch billing that is HIPAA compliant using non-DHS software or a clearinghouse to bill DHS X12—the new HIPAA-compliant standard format for batch health care transactions (got this from a provider update) RA—Remittance Advice A Units—Adjusted Units ADJ AMT—Adjustment Amount ADJ GROUP—Adjustment Group (there are five different valid codes for this field and they are): CO—Contractual Obligation CR—Correction and Reversal OA—Other Adjustment PI—Payer Initiated Reduction PR—Patient Responsibility ADJ REASON—Adjustment Reason AUTH NBR—Authorization Number CHK/EFT NBR—Check or Electronic Funds Transfer Doc ID Nbr—Documentation Identification Number FROM DT—From Date—beginning date of service ID NBR—Identification Number LI—Line Item number designation MI—Middle Initial P Units—Paid Units PAT CTRL NBR—Patient Control Number PAYER CLAIM NBR—Payer Claim Number PROC CD—Procedure Code PROD DATE—Production Date PROV ADJ REASON—Provider Adjustment Reason PROV CTRL NBR—Provider Control Number PYMNT—Payment R PROV NUMBER—Rendering Provider Number RENDERING NBR—Rendering Number TCN—Transaction Control Number TO DT—End date of the service VENDOR NBR—Vendor number HIPAA Websites of Interest Federal Government U.S. Department of Health and Human Services (DHHS) Administration Simplification links CMS HIPAA General Information Website CMS Medicaid HIPAA Compliant Concept Model CMS Medicaid HIPAA Information II http://aspe.os.dhhs.gov/admnsimp/ http://www.cms.hhs.gov/hipaa/ http://www.cms.hhs.gov/medicaid/hipaa/adminsim/mhccmfs.asp http://www.cms.hhs.gov/hipaa/hipaa2/ Industry X12 Standards (for batch billers only, online and downloadable from Washington Publishing Company, or WPC) WPC HIPAA Code Lists American Health Information Management Association (AHIMA) Minnesota Health Information Network (MN-HIN) Private Sector Technology Group Medicaid Home Page American Hospital Association's HIPAA Links http://hipaa.wpc-edi.com/hipaa_40.asp http://www.wpc-edi.com/codes/Codes.asp http://www.ahima.org/ http://www.mn-hin.org/ http://www.ps-tag.org/ http://www.hospitalconnect.com/aha/resource_center/links.jsp Minnesota DHS/County/Tribal Resources DHS HIPAA Website MN–ITS Home Page Minnesota HIPAA Collaborative (batch billers only) Association of Minnesota Counties Minnesota American Indian Bar Association Minnesota Counties Computer Cooperative MN Assn. of County Social Services Administrators Minnesota County Attorney’s Association http://www.dhs.state.mn.us/Hipaa/default.htm http://mn-its.dhs.state.mn.us/ http://www.mnhipaacollab.org/ http://www.mncounties.org/ http://maiba.org/ http://www.mnccc.org/hipaa http://www.mncounties2.org/macssa/ http://www.mcaa-mn.org/asp/page1.asp Privacy CMS Privacy Inquiries Office Of Civil Rights (OCR) http://cms.hhs.gov/medicaid/hipaa/adminsim/privacy.asp http://www.hhs.gov/ocr/hipaa/ Designated Standard Maintenance Organizations (DSMOs) Section 262 of HIPAA provide that the Secretary of DHHS may designate as DSMOs those organizations that agree to maintain and update the standards for health care transactions adopted by the Secretary. American Dental Association (ADA) http://www.ada.org/ Accredited Standards Committee’s X12N group http://www.x12.org/ Health Level Seven (HL&) http://www.hl7.org/ National Council for Prescription Drug Programs (NCDCP) http://www.ncpdp.org/ National Uniform Billing Committee (NUBC) http://www.nubc.org/ National Uniform Claim Committee (NUCC) http://www.nucc.org/ Workgroup for Electronic Data Interchange (WEDI) http://www.wedi.org/