MN-ITS Interactive 837P Mental Health billing session

Transcription

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
MN–ITS Registration
MN–ITS Administrator User Information
MN–ITS Organization Information
Winter 2004
Page 2 of 23
EDI Biller Agreement
Winter 2004
Page 3 of 23
Summary Page
Winter 2004
Page 4 of 23
MN–ITS Administrator
MN–ITS Welcome Page
My Identity
Winter 2004
Page 5 of 23
MN–ITS Administrator
Modify My Identity
Winter 2004
Page 6 of 23
MN–ITS Interactive Home Page
Winter 2004
Page 7 of 23
MN–ITS
MN–Eligibility Inquiry (270)
Winter 2004
Page 8 of 23
MN–ITS
MN–ITS Eligibility Response (271)
Winter 2004
Page 9 of 23
Professional (837P) MN–ITS Interactive Claim
Subscriber Tab
Winter 2004
Page 10 of 23
Providers Tab
Winter 2004
Page 11 of 23
Coordination of Benefits (COB) Tab
Winter 2004
Page 12 of 23
COB Tab – Page 2
Winter 2004
Page 13 of 23
Claim Information Tab
Winter 2004
Page 14 of 23
Claim Information Tab – Page 2
Winter 2004
Page 15 of 23
Services Tab
Winter 2004
Page 16 of 23
Services Tab – Page 2
Winter 2004
Page 17 of 23
Validate Response
Winter 2004
Page 18 of 23
Submit Response
Winter 2004
Page 19 of 23
Alternate Submit Page
Copy Feature
Winter 2004
Page 20 of 23
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.
Winter 2004
Page 21 of 23
MN–ITS Claim Status Response (277)
Winter 2004
Page 22 of 23
Paper CMS 1500 Claim Form
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
CLAIM STATUS :
LAST: PATIENT
DOC ID NBR: 543210
VENDOR NBR: 1234567
PAGE: 2
CHK/ EFT NBR: 111111111
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
DOC ID NBR: 543210
VENDOR NBR: 1234567
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
PROVIDER SUPPLEMENTAL DATA
DOC ID NBR: 543210
VENDOR NBR: 1234567
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
PROVIDER SUPPLEMENTAL DATA
CLAIM STATUS :
LAST: SMITH
LI
FROM DT
01 12-01-03
DOC ID NBR: 543210
VENDOR NBR: 1234567
PAGE: 2
CHK/ EFT NBR: 111111111
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/

MN-ITS Interactive 837P Mental Health billing session

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