For example, for people eligible for an MA, home care services (physiotherapy, occupational therapy, respiratory, and language) do not require as an AS and cannot be charged for the same right as a waiver service, such as.B. adult day services. EW and CA program providers must register with the MHCP and meet certain standards to bill for waiver services and receive payments. To connect to MHCP, to provide non-payment services or AC programs, follow the instructions in Home and Community Based Services (HCBS) Waiver and Alternative Care Provider Enrollment. For billing, claims must contain a diagnostic code. MHCP requires agencies to enter the most recent and specific primary diagnostic code when submitting claims for most waiver and CA services. Use ICD-10 diagnostic codes for services provided in October 2015 or later. Otherwise, you can use the diagnostic code displayed on the service authorization letter or agreement of the primary diagnostic field of the last approved screening document for the person registered with the MHCP. Health plans have their own service authorization systems. Service providers who contract with health plans should turn to the health plan for instructions on filing claims.
As of January 1, 2019, the South Country Health Alliance (SCHA) will no longer sign a contract with MHCP to serve as a Third Party Administrator (TPA) for the filing of claims and reimbursement of EW services. For service dates of January 1, 2019 and after January 1, 2019, contact SCHA to obtain authorization and charge for EW services. The SA allows the provider to provide services and then charge DHS to get the payment. MHCP only pays for services on the SA; However, an approved SA is not a guarantee of payment. Ultimately, the case manager is responsible for ensuring that the AS is correct when entered into MMIS. If the supplier receives the SA letter, he must verify the accuracy. Charge for the following services provided on July 1, 2014 or after the national maximum: Elderly Waiver (EW) and Alternative Care (AC) Programs fund home and community services (HCBS) for individuals aged 65 and older who need the level of care in a care home but choose to live in the community. .