Technical Specifications for Billing Warning Alerts FINAL - V3.4 August 26 th, 2016

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Judith Joan Mitchell
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1 Behavioral Health Information Technology (BHIT) Program Technical Specifications for Billing FINAL - V3.4 August 26 th, 2016 For Adult Behavioral Health (BH) Home and Community Based Services (HCBS)

2 1 Initial HCBS Service to deliver Assessment and ISP 2 Case documentation approved number of visits countdown This was approved for up to (X=3) sessions within (Y=14) calendar days, considering the first day as the first visit of the HCBS recipient. There are X-1 sessions remaining and must be completed by (Y+14) This was approved for X number of hours and there are X-1 hours remaining "number of approved sessions" (X= 3) and there is a value in the field for "Start date" (Y= start date) and "End day to deliver" (Y +14) "number of approved hours" Reduce X value by 1 Indicate Y value Reduce X value by 1 Session is completed and saved Session is completed and saved to deliver Assessment and ISP 3 Service limits (duration, frequency, intensity and total number of approved hours) has This can be documented but it will not be subject as a payable claim because the number of approved sessions have been reached "number of approved sessions" equals "zero" has expired and/or reach limits 4 Service limits (total number of approved hours) is reaching its limit 75% of the total approved hours has 75% of the total approved hours has Warning message be prompted to the Direct Service Staff if allowed to 5 Service limits (total number of approved hours) is reaching its limit 90% of the total approved hours has 90% of the total approved hours has Warning message be prompted to the Direct Service Staff if allowed to Billing technical specifications for Adult Behavioral Health Home and Community Based Services (HCBS) - v3.4 Page 2

3 6 Case Documentation is needed to release a claim Case Documentation needs to be completed for this date of There is a claim in the batch but there is no case documentation completed on the date of for the HCBS recipient The individual claim in the batch be put on hold Accessing the claim batch file if 7 Service cannot be ed if Only one rate code be used on of Rate code = 7784 or 7785 or 7789 valid for ing within of if 8 Service cannot be ed if Only one rate code be used on of Rate code = 7786 or 7787 or 7788 or 7789 valid for ing within of if 9 Service cannot be ed if Only one rate code be used on of Rate code = 7796 or 7798 valid for ing within of if 10 Service cannot be ed if Only one rate code be used on of Rate code = 7799 or 7800 valid for ing within of if Billing technical specifications for Adult Behavioral Health Home and Community Based Services (HCBS) - v3.4 Page 3

4 Warning Alert Message (what appear) IF Then When 11 Service cannot be ed if Only one rate code be used on of Rate code = 7801 or 7802 or 7803 or 7804 valid for ing within of if 12 Unit limits (Claim Line 13 Unit limits (Claim Line 14 Unit limits (Claim Line 15 Unit limits (Claim Line Unit limit of 2 units per hour has been Unit limit of 4 units of 15 minutes each has been Unit limit of 6 units of 15 minutes each has been Unit limit of 8 units of 15 minutes each has been Rate code = 7801 or 7805 Rate code = 7786 or 7787 or 7788 Rate code = 7790 or 7791 or 7792 or 7793 or 7800 Rate code = 7784 or 7785 Unit limit = 2 units per hour each Unit limit = 4 units Unit limit = 6 units Unit limit = 8 units if if if if Billing technical specifications for Adult Behavioral Health Home and Community Based Services (HCBS) - v3.4 Page 4

5 16 Unit limits (Claim Line 17 Unit limits (Claim Line 18 Unit limits (Claim Line 19 HCBS Staff Transportation not applicable Unit limit of 12 units of 15 minutes each has been Unit limit of 16 units of 15 minutes each has been Unit limit of 1 unit per diem has been This HCBS onsite is not eligible for HCBS Staff Transportation Rate code = 7795 or 7799 or 7802 or 7803 or 7804 Rate code = 7794 Rate code = 7789 or 7796 or 7798 Location Type = Onsite Unit limit =12 units Unit limit = 16 units Unit limit = 1 unit per diem Transportation costs fields will not be available creation of the document if if if Direct 20 Cap for Mileage for HCBS Staff Transportation 21 Only one Staff Transportation be used for a single member (s) Mileage for HCBS Staff Transportation not exceed 60 miles per round trip Only one rate code be used for Staff Transportation cost for a single member (s) Total mileage >= 61 Set value = 60 Rate code = 7806 or 7807 valid for ing within for a single member (s) if if Billing technical specifications for Adult Behavioral Health Home and Community Based Services (HCBS) - v3.4 Page 5

Approving an Expense Voucher eform Travel Expense Voucher eform Instructions for the Approver. Introduction. Finding the eform.

Approving an Expense Voucher eform Travel Expense Voucher eform Instructions for the Approver. Introduction. Finding the eform. Introduction The Travel Expense Voucher eform must be approved by the department prior to submission to the Business Travel Office. Below are suggested steps for the department approver when reviewing