Provider Type 30 and 83 Personal Care Services - 8/15/20* Provider Type 32. For telehealth policies and FAQs, see Telehealth on this page. Pharmacy. How do I notify SEBB that my loved one has passed away? See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. (02 / 12) Billing Guide for PROMISe Behavioral Health Rehabilitation Services (BHRS) BSC, BSC-ASD, MT, and TSS Providers: Billing Guide: Choice 3 : Mobile Therapy Providers: 837 Professional / CMS-1500 . 4 0 obj Rural Health Clinics (RHC) and Federally Qualified Health (FQHC) Ground Ambulance Upper Payment Limit (UPL) In 2017 the NV Legislature passed Assembly Bill 108 which, starting in 2018, requires NV Medicaid to perform a comprehensive rate review for each provider type at least once every four . Hospice Reimbursement. x]rFwa.-WUdQ$es$jI@)5@J$f5t"K$I~}l$g\gtFW,/&/zY2s1|)foxm9Za Respond to provider requests for more step-by-step reference materials for ProviderOne. For best results, bookmark this page so that you are always using the most up-to-date version of the guide. Receive accurate payments for covered services. lock Official websites use .govA This does mean it has become more important for Salient features of FuseMail to Office 365 Migrator Quick and selective migration of emails using filters . Note: We make updates as needed to reflect current policy, program updates, and ProviderOne system enhancements. Arizona Complete Health-Complete Care Plan has noticed a significant increase in provider claims denying for the servicing provider's Provider Type being invalid to bill for the procedure code (s). How do I notify PEBB that my loved one has passed away? 14 Podiatrist 140 Podiatrist 15 Chiropractor 150 Chiropractor 16 Nurse 160 Registered Nurse Ambulatory Surgical Centers (ASC) Ambulance Services. Provider Billing and Resource Guide Volume 1 San Joaquin County HPSJ Headquarters 7751 South Manthey Road French Camp, CA 95231-9802 Phone 888.936.7526 Fax 209.942.6305 www.HPSJ.com Provider Billing and Resource Guide 1 Table of Contents Introduction HPSJ Policies and Procedures The ProviderOne Billing and Resource Guide gives step-by-step instruction to help provider billing staff: The appendixes below are included in the complete guide. Subsequent requests for concurrent review are to be submitted on FA-14. The Apple Health PDL can be found on the agency's Apple Health PDL page. endobj Nursing Home Providers. An official website of the United States government MSM Chapter 400 covers policy for Behavioral Health providers. endstream endobj startxref Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims. The agency's Provider Relations team hosted two webinars focused on billing electronically through the ProviderOne portal to assist those providers who have not transitioned to electronic billing. .gov Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims. 3]V8b{i 23NfnC~9SfqgV-y It is commonly referred to as autism or, in the context of a professional diagnosis, autism spectrum disorder ( ASD ). See Access to Baby and Child Dentistry (ABCD). Nursing services, physician services, and drugs and biologicals must Providers may seek approval to submit paper claims if they are in a temporary or long-term situation outside of their control that precludes submission of claims electronically. Hospital Providers. See Physician-related/professional services for information regarding vision exams and related services. Questions? Provider Type. https:// Provider Type 64 Billing Guide Updated 04/21/2021 Provider Type 64 Billing Guide pv 12/03/2019 1 / 4 Hospice The Hospice program is designed to provide support and comfort for Medicaid-eligible recipients who have a terminal illness and have decided to receive end of life care. Revised: 12/5/2011 Provider Type 14 Billing Guide 4 / 11 . Behavioral Health Outpatient Treatment and Behavioral Health Rehabilitative Treatment . If this occurs, please refer to the most recent guide. View the complete guide. Some organizational providers are required to pay an application fee. Acute Inpatient Prospective Payment System (IPPS) Hospital; Ambulance; . %PDF-1.7 648 0 obj <> endobj <>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 19 0 R 20 0 R 26 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 41 0 R 42 0 R 43 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This requirement applies to all provider types and all Part B bill types. Strengthen the current instructions that apply to nearly all types of providers. For fee schedule and rate questionsEmail:ProfessionalRates@hca.wa.gov, For all other provider questionsMedical Assistance Customer Service Center (MACSC)Online: secure formPhone: 1-800-562-3022, Website feedback: Tell us how were doing, Copyright 2022 Washington Health Care Authority, I help others apply for & access Apple Health, Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. Do you need a PA form? For outpatient and other Part B services, the UPIN must be present if the "From" date is January 1, 1992, or later. 1 Provider Type 14 Billing Guide Behavioral Health Outpatient Treatment State policy The Medicaid Services Manual (MSM) is on the Division of Health Care Financing and policy (DHCFP) website at (select Manuals from the Resources webpage). Download the Pharmacy Information Authorization form (13-835A). Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Clinical Labs. ^ T`` WaT Medical Assistance Customer Service Center (MACSC)Online: secure formPhone: 1-800-562-3022, Website feedback: Tell us how were doing, Copyright 2022 Washington Health Care Authority, I help others apply for & access Apple Health, Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. Provider Type 32 Ambulance, Spec 249 Comm Paramed Provider Type 32 Ambulance, Spec 932 Ambulance Air or Ground Provider Type 33 Durable Medical Equipment, Prosthetics, Orthotics & Supplies; Provider Type 34 Therapy 678 0 obj <>/Filter/FlateDecode/ID[<460207C96267AC43B00704173EA05454>]/Index[648 72]/Info 647 0 R/Length 121/Prev 128865/Root 649 0 R/Size 720/Type/XRef/W[1 2 1]>>stream <> hZOI?e~9)(~VH)&b{pt"guW_u7X"Y#- pR)! (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. 2 0 obj For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. Receive accurate payments for covered services. On-campus facilities (within 250 yards) must follow all rules stated under Section (d). <> The links to these webinars, the waiver form, and an FAQ on the paperless policy can be accessed below: Use the provider billing guides and rates and fee schedules as companions to the billing and resource guide. lock Certain providers of BROWSE BY PROVIDER TYPE. or 1 Updated: 08/07/2018 pv04/11/2018 Provider Type 20, 24 and 77 Billing Guide 1 / 13 Physician, and Osteopath, , Advanced Practice Registered Nurses (APRN) and Physician s Assistant (PA) Provider Types 20, 24 and 77 Billing Guide Policy Nevada Medicaid and Nevada Check Up reimburse Physicians, Advanced Practice Registered Nurses (APRNs) and Physician s Assistants (PAs) for covered services that . Provider Type 14 Billing Guide Behavioral Health Outpatient Treatment State policy The Medicaid Services Manual Enrollment as a Medicaid provider includes completion of an online application and uploading supporting documentation ( i.e., W9's, licensure/certification information and other information specific to the type of provider). Date: 12/05/18. Provider Types. UB 04 - Provider identifying field instruction, a. Exhibit 14-2, Non-emergency Medical Transport Daily Trip Report Instructions; Exhibit 14-3, Tribal Contact Information; Exhibit 14-4 . This is a billing reference guide for Inpatient Psychiatric Facility (IPF) to assist providers with regulations and billing claims. For Apple Health clients and clients of the Developmental Disabilities Administration. This provider type was last subject to a rate review* on : 11/2016 Note: Specialty Proc Mod Desc Rate Rate Begin Date 300 90785 Psytx complex interactive 4.40 1/1/2013 300 90791 Psych diagnostic evaluation 139.46 1/1/2013 300 90792 Psych diag eval w/med srvcs 113.76 1/1/2013 300 90832 PSYTX W PT 30 MINUTES 57.78 1/1/2013 This guide was discontinued July 1, 2020. Vision hardware fee schedule is available through the ESD contract. Although providers may bill for services prior to receiving a provider-based designation, the main provider must meet all the criteria and requirements to qualify for provider-based billing according to the regulations stated in 42 CFR 413.65. Add Acquisitions filter . How do I notify PEBB that my loved one has passed away? Home Health. . Jump to the first list item for each letter: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z. stream For previous versions, email us applehealthpharmacypolicy@hca.wa.gov. Last Updated Thu, 27 Feb 2020 09:03:14 +0000. %%EOF See Physician-related/professional services.). <>/Metadata 1700 0 R/ViewerPreferences 1701 0 R>> 3 0 obj August 1, 2022 to present Neurodevelopmental centers billing guide, July 1, 2022 to July 31, 2022 Neurodevelopmental centers billing guide, July 1, 2021 to June 30, 2022 Neurodevelopmental centers billing guide, View all neurodevelopmental centers billing guides, July 1, 2022 to present Neurodevelopmental centers fee schedule, July 1, 2021 to June 30, 2022 Neurodevelopmental centers fee schedule, January 1, 2021 to June 30, 2021 Neurodevelopmental centers fee schedule, View all neurodevelopmental centers fee schedules, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment billing guides, July 1, 2018 to December 31, 2018 Nondurable medical supplies and equipment billing guides, View all nondurable medical supplies and equipment billing guides, January 1, 2019 to March 31, 2019 Nondurable medical supplies and equipment fee schedule, October 1, 2022 to present Nursing facilities billing guide, July 1, 2022 to September 30, 2022 Nursing facilities billing guide, April 1, 2022 to June 30, 2022 Nursing facilities billing guide, View all nursing facilities billing guides, October 1, 2022 to present Orthodontic services billing guide, July 1, 2022 to September 30, 2022 Orthodontic services billing guide, June 1, 2022 to June 30, 2022 Orthodontic services billing guide, View all orthodontic services billing guides, August 1, 2022 to present Outpatient hospital services billing guide, July 1, 2022 to July 31, 2022 Outpatient hospital services billing guide, April 1, 2022 to June 30, 2022 Outpatient hospital services billing guide, October 1, 2022 to present OPPS fee schedule, July 1, 2022 to September 30, 2022 OPPS fee schedule, April 1, 2022 to June 30, 2022 OPPS fee schedule, January 1, 2022 to March 31, 2022 OPPS fee schedule, October 1, 2021 to December 31, 2021 OPPS fee schedule, August 1, 2022 to present Outpatient rehabilitation billing guide, July 1, 2022 to July 31, 2022 Outpatient rehabilitation billing guide, January 1, 2022 to June 30, 2022 Outpatient rehabilitation billing guide, View all Outpatient Rehabilitation Program billing guides, July 1, 2022 to present Outpatient rehabilitation fee schedule, July 1, 2021 to June 30, 2022 Outpatient rehabilitation fee schedule, January 1, 2021 to June 30, 2021 Outpatient rehabilitation fee schedule, View all Outpatient Rehabilitation Program fee schedules, July 1, 2022 to present Pharmacy Special Services fee schedule, July 1, 2021 to June 30, 2022 Pharmacy Special Services fee schedule, July 1, 2020 to June 30, 2021 Pharmacy Special Services fee schedule, View all pharmacy special services fee schedules, October 14, 2022 to present Physician-related services/health care billing guide, October 1, 2022 to October 13, 2022 Physician-related services/health care billing guide, August 1, 2022 to September 30, 2022 Physician-related services/health care billing guide, View all physician-related/professional services billing guides, October 1, 2022 to present Physician-related services fee schedules, July 1, 2022 to September 30, 2022 Physician-related services fee schedules, April 1, 2022 to June 30, 2022 Physician-related services fee schedules, View all physician-related/professional services fee schedules, July 1, 2022 to present Enhanced pediatric fee schedule, October 1, 2021 to June 30, 2022 Enhanced pediatric fee schedule, July 1, 2021 to September 30, 2021 Enhanced pediatric fee schedule, View all enhanced pediatric fee schedules, July 1, 2022 to present Enhanced adult primary care fee schedule, October 1, 2021 to June 30, 2022 Enhanced adult primary care fee schedule, July 1, 2022 to present Opioid use disorder fee schedule, July 1, 2021 to June 30, 2022 Opioid use disorder fee schedule, January 1, 2021 to June 30, 2021 Opioid use disorder fee schedule, View all medication for opioid use disorder fee schedules, July 1, 2022 to present Conversion factors, July 1, 2021 to June 30, 2022 Conversion factors, July 1, 2020 to June 30, 2021 Conversion factors, Centers of Excellence: organ transplant facilities directory, October 1, 2022 to present Planned home births and births in centers billing guide, June 11, 2022 to September 30, 2022 Planned home births and births in centers billing guide, April 1, 2022 to June 10, 2022 Planned home births and births in centers billing guide, View all planned home births billing guides, July 1, 2022 to present Planned home births and births in centers fee schedule, July 1, 2021 to June 30, 2022 Planned home births and births in centers fee schedule, July 1, 2020 to June 30, 2021 Planned home births and births in centers fee schedule, View all planned home births fee schedules, July 1, 2022 to present Prenatal diagnosis genetic counseling fee schedule, July 2021 to June 30, 2022 Prenatal diagnosis genetic counseling fee schedule, July 1, 2020 to June 30, 2021 Prenatal diagnosis genetic counseling fee schedule, View all prenatal diagnosis genetic counseling fee schedules, April 1, 2022 to present Prescription drug program billing guide, October 1, 2021 to March 31, 2022 Prescription drug program billing guide, September 1, 2021 to September 30, 2021 Prescription drug program billing guide, June 1, 2022 to present Expedited authorization codes and criteria table, December 1, 2021 to May 31, 2022 Expedited authorization codes and criteria table, July 1, 2021 to November 30, 2021 Expedited authorization codes and criteria table, July 1, 2022 to present Private duty nursing for children billing guide, October 1, 2020 to June 30, 2022 Private duty nursing for children billing guide, July 17, 2020 to September 30, 2020 Private duty nursing for children billing guide, View all private duty nursing for children billing guides, January 1, 2020 to present Private duty nursing fee schedule, July 1, 2016 to December 31, 2019 Private duty nursing fee schedule, October 1, 2022 to present Professional administered drug fee schedule, July 1, 2022 to September 30, 2022 Professional administered drug fee schedule, April 1, 2022 to June 30, 2022 Professional administered drug fee schedule, View all professional administered drugs fee schedules, July 1, 2022 to present Prosthetic and orthotic devices billing guide, April 1, 2022 to June 30, 2022 Prosthetic and orthotic devices billing guide, October 1, 2021 to March 31, 2022 Prosthetic and orthotic devices billing guide, View all prosthetic and orthotics billing guides, July 1, 2022 to present Prosthetic and orthotics fee schedule, October 1, 2021 to June 30, 2022 Prosthetic and orthotics fee schedule, July 1, 2021 to September 30, 2021 Prosthetic and orthotics fee schedule, View all prosthetic and orthotics fee schedules, August 1, 2022 to present Respiratory care billing guide, July 1, 2022 to July 31, 2022 Respiratory care billing guide, October 1, 2021 to June 30, 2022 Respiratory care billing guide, July 1, 2022 to present Respiratory care fee schedule, October 1, 2021 to June 30, 2022 Respiratory care fee schedule, July 1, 2021 to September 30, 2021 Respiratory care fee schedule, October 1, 2022 to present Rural health clinics billing guide, August 1, 2022 to September 30, 2022 Rural health clinics billing guide, July 1, 2022 to July 31, 2022 Rural health clinics billing guide, October 1, 2022 to present RHC encounter rates, July 1, 2022 to September 30, 2022 RHC encounter rates, April 1, 2022 to June 30, 2022 RHC encounter rates, October 1, 2022 to present RHCenhancement rates, July 1, 2022 to September 30, 2022 RHC enhancement rates, April 1, 2022 to June 30, 2022 RHC enhancement rates, October1, 2022 to present SBHS billing guide, July 1, 2022 to September 30, 2022 SBHS billing guide, October 1, 2021 to June 30, 2022 SBHS billing guide, July 1, 2022 to present SBHS fee schedule, October 1, 2021 to June 30, 2022 SBHS fee schedule, July 1, 2021 to September 30, 2021 SBHS fee schedule, July 1, 2022 to present Sleep centers billing guide, October 1, 2020 to June 30, 2022 Sleep centers billing guide, January 1, 2020 to September 30, 2020 Sleep centers billing guide, July 1, 2022 to present Sleep centers fee schedule, July 1, 2021 to June 30, 202 Sleep centers fee schedule, July 1, 2020 to June 30, 2021 Sleep centers fee schedule, October 1, 2022 to Present Sterilization billing guide, July 1, 2022 to September 30, 2022 Sterilization supplemental billing guide, October 1, 2021 to June 30, 2022 Sterilization supplemental billing guide, Physician-related/Professional Services Billing Guide, Sterilization Consent Form (HHS-687) (English), Sterilization Consent Form (HHS-687) English large print, Sterilization Consent Form (HHS-687-1) (Spanish), Sterilization Consent Form (HHS-687-1) Spanish large print, October 1, 2022 to present Substance use disorder billing guide, July 1, 2022 to September 30, 2022 Substance use disorder billing guide, April 1, 2021 to June 30, 2022 Substance use disorder billing guide, View all SUD (FFS outside BHO process) billing guides, July 1, 2022 to present Substance use disorder fee schedule, October 1, 2021 to June 30, 2022 Substance use disorder fee schedule, January 1, 2021 to September 30, 2021 Substance use disorder fee schedule, View all substance use disorder fee schedules, November 2, 2022 to present - Apple Health (Medicaid) telemedicine policy and billing, August 1, 2022 to November 1, 2022 Apple Health (Medicaid) telemedicine policy and billing, August 1, 2022 to present Apple Health (Medicaid) physical health audio-only procedure codes, August 1, 2022 to present Apple Health (Medicaid) audio-only behavioral health codes, June 28, 2022 to July 31, 2022 Telehealth services billing guide audio only supplement, August 1, 2022 to present Apple Health (Medicaid) clinical policy and billing for COVID-19, July 22, 2022 to July 31, 2022 Apple Health (Medicaid) clinical policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) clinical policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) clinical policy and billing, View all clinical policy and billing FAQs, June 6, 2020 to December 31, 2021 Apple Health (Medicaid) telemedicine/telehealth brief, May 10, 2020 to June 6, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, April 29, 2020 to May 9, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, August 1, 2022 to present Apple Health (Medicaid) behavioral health policy and billing, February 1, 2022 to July 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, April 29, 2021 to January 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, View all behavioral health policy and billing FAQs, July 22, 2022 to present Apple Health (Medicaid) ABA policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) ABA policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) ABA policy and billing, July 22, 2022 to present Apple Health (Medicaid) FAQ for diabetes education providers, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, View all FAQs for diabetes education providers, May 3, 2020 to present Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, November 20, 2020 to May 2, 2021 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, October 1, 2020 to November 19, 2020 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, View all home health services billing and policy FAQs, July 22, 2022 to present Telehealth requirements for physical, occupational and speech therapy, February 1, 2022 to July 21, 2022 Telehealth requirements for physical, occupational and speech therapy, January 1, 2022 to January 31, 2022 Telehealth requirements for physical, occupational and speech therapy, View all telehealth requirements for physical, occupational, and speech therapy, January 1, 2022 to present Telehealth services in long term care facilities and skilled nursing facilities, May 3, 2021 to December 31, 2021 Telehealth services in long term care facilities and skilled nursing facilities, October 1, 2020 to May 2, 2021 Telehealth services in long term care facilities and skilled nursing facilities, View all Telehealth requirements for LTC and SNF, February 1, 2022 to present Family planning only billing guide telemedicine/telehealth, January 1, 2022 to January 31, 2022 Family planning only billing guide telemedicine/telehealth, May 3, 2021 to December 31, 2021 Family planning only billing guide telemedicine/telehealth, October 1, 2022 to present Tribal health billing guide, July 1, 2022 to September 30, 2022 Tribal health billing guide, January 1, 2022 to June 30, 2022 Tribal health billing guide, View all Tribal Health Program billing guides, January 1, 2022 to present Tribal health program fee schedule, October 1, 2021 to December 31, 2021 Tribal health program fee schedule, January 1, 2021 to September 30, 2021 Tribal health program fee schedule, July 1, 2022 to present Vision hardware billing guide, January 21, 2022 to June 30, 2022 Vision hardware billing guide, January 1, 2022 to January 20, 2022 Vision hardware billing guide, Guidance for hospitals in billing MCOs for services provided to newborns.pdf, (Fee-for-service benefits provided outside of the BHO process). How do I notify SEBB that my loved one has passed away? Critical Access Hospitals. Provider Type 14 Billing Guide . Use the ProviderOne portal to see if a client is eligible for the service and the billing guides and fee schedules to determine if a PA is required. Provider Type 14 Behavioral Health Reimbursement Schedule *Rate review refers to a comprehensive review of all the rates associated with this provider type. 0 ) hbbd``b`^$[u bv $XAJtA Ab| +9bu nw,`[$@F) Nk+d+j%#88o _e For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. They are presented here for your convenience. endobj MSM Chapter 100 contains important information applicable to all provider types. It contains information on all of the below: Noridian Phone and Contact Information Join Noridian Medicare Email List 1 Day Payment Window 3 Day Payment Window How do providers identify the correct payer? % Do you need a barcode cover sheet? ( Questions? After you complete a service, you file claims through the ProviderOne portal. The autism spectrum is a range of neurodevelopmental conditions generally characterized by difficulties in social interactions and communication, repetitive behaviors, intense interests, and unusual responses to sensory stimuli.
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