VADDTCM Healthcare Claiming Shawna Meyers State Program Administrator

VA/DD-TCM Healthcare Claiming Shawna Meyers| State Program Administrator Sr. VA/DD-TCM Healthcare Claiming | mn. gov/dhs

Fiscal Mentor Manual • SSIS Claiming Helpful Hints and Proofing Messages • Overview flow chart • Hints for each Healthcare Claim Category Claims for clients in a MA Funded Facility are limited to 180 days for VA/DDTCM, MH-TCM, and RTSC-TCM combined. The beginning of the 180 days is the Service Date of the first paid claim for VA/DD-TCM, MH-TCM, or RTSCTCM. MMIS enforces this rule and no editing is done in SSIS. • Listing of Proof Messages for each claim category • Fiscal Reports and Descriptions SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 2

VA/DD-TCM Claiming Requirements VA/DD-TCM claiming is done for Time Records meeting the VA/DD-TCM criteria for eligible clients. SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 3

Eligible Staff Activity Time Records • Services • 592 – Child (<21) DD Non-Waiver Case Management • 593 – Adult (21+) DD Non-Waiver Case Management • 604 – Adult Protection Assessment and Investigation • 607 – General Assessment • 693 – General Case Management SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 4

Eligible Staff Activity Time Records (continued) • Activities • Client contact • Collateral Contact • Contact Status • Completed • Contact Method • Face to face • Phone SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 5

Supplemental Healthcare Eligibility SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 6

MMIS Recipient Information • Must be MA Eligible • Major Program – MA Eligible – Federally-Paid Medical Assistance • Eligibility Status must be • Active • Closed • Billable Contact Date must be within the Eligibility Start Date and Eligibility End Date • The client cannot be a Waiver/AC Recipient on the Billable Contact Date SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 7

Client Information • Client age is determined as of the Billable Contact Date • Client Age must be > = 18 on the Billable Contact Date SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 8

Diagnosis Codes • A billable diagnosis code is required to submit a claim. Diagnosis is determined in the following order: • Diagnosis code on a LTC or DD Screening document • Diagnosis code entered in SSIS on the Disability/Diagnosis/Substance screen • If there is not a billable Diagnosis, a default Diagnosis of Z 60. 9 is included on the claim SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 9

Additional Rules • Maximum of one VA/DD-TCM claim can be submitted per month per client. • All eligible Time Records in a month are linked to the claim. • A separate claim is created for each VA/DD-TCM eligible client listed in the Regarding section of the Time Record. • For a month in which both a Phone and Face to face contact occur, the Face to face contact is claimed even though it may occur after the Phone contact. SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 10

Additional Rules (continued) • A telephone claim is created for a month in which only a Phone contact occurred. • A Face to face contact must occur at least once every three months. This edit ignores Face to face claims that are Denied or To be denied. • The first claimable contact must be Face to Face. SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 11

VA/DD-TCM Claim Record The healthcare claim includes: • HCPCS/Modifiers • Contact Method = Face to face • T 2023 U 1 – VA/DD-TCM, face to face • Contact Method = Phone • T 2023 U 1 U 4 – VA/DD-TCM, telephone • Units = 1 • First Service Date = Billable Contact Date • Last Service Date = Billable Contact Date • Diagnosis Code = Screening Diagnosis Code, SSIS Billable Diagnosis Code or Z 60. 9 SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 12

Miscellaneous Notes • VA/DD-TCM may be provided concurrently with an investigation of maltreatment of a vulnerable adult. Documentation for both must be completed. • VA/DD-TCM cannot be provided to a person in an institution unless it is for the purposes of transitioning/relocating from the institution to the community. Institutions are defined as hospitals, nursing facilities (including Certified Boarding Care Facilities), and Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD). SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 13

Miscellaneous Notes Continued • VA/DD-TCM expenses are included as a part of a person's spenddown for MA eligibility. MMIS does this edit. • Contact during the month can be with the adult, the adult's legal representative, family member, or primary caregiver or other relevant person identified as necessary to the development/implementation of the service plan. SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 14

Additional Edits Not in SSIS Eligibility Client must be in need of service coordination to attain or maintain living in an integrated community setting and must be a vulnerable adult in need of adult protection as defined in statute. County Practice Counties develop criteria for identifying who is in need of case management/service coordination and keep a copy of those criteria on file in case of an appeal. Counties can develop a tool to determine/document eligibility. SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 15

Generating a VA/DD-TCM Claim Batch 1. Select Claim Batch Search in the task panel. 2. Search to see if a draft batch exists. Based on your claims processes, enter as much or as little search criteria to determine if another batch exists for the time period you are working with. 3. To create a new healthcare claim batch click the Action menu and select New Claim Batch. SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 16

Generating a VA/DD-TCM Claim Batch continued SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 17

VA/DD-TCM - CLAIM TAB SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 18

VA/DD-TCM – Time Proofing Tab SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 19

2003 – No VA/DD-TCM Staff Qualifications for the worker on the activity date SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 20

2004 – No Staff-provided Rate for the HCPCS/Modifiers on the activity date SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 21

2014 – County of Service not in the region SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 22

2203 – First claimable contact must be “Face to face” SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 23

2204 – “Face to face” contact required at least once every 3 months SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 24

2202 – “Contact Status” (Attempted) is not claimable SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 25

2201 – Age (17) on the service date must be 18 or over SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 26

2017 – One or more claims already exist during the service dates SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 27

2010 – No Eligibility Span exists for the service dates SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 28

2011 – The Major Program is not valid for VA/DD-TCM SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 29

2021 – The client has no Healthcare Eligibility from MMIS SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 30

2015 – No VA/DD-TCM Supplemental Eligibility Exists for the service dates SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 31

1018 – No PMI # SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 32

107 – Est. date of birth SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 33

2008 – A Do Not Claim Determination is in effect on the service dates SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 34

2018 – “Qualified” = “No” on the VA/DD-TCM Staff Qualifications for the worker on the activity date SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 35

2051 – An Exclusion for Healthcare Claiming exists SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 36

Submitting the batch SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 37

Updates to the Submitted Batch SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 38

VA/DD-TCM Reports In addition to the general Healthcare Claim Reports that cover all claim categories there is one General Reports specific to VA/DD-TCM, the VA/DD-TCM Eligibility Report. This report is available from: • Tools>General Reports> Healthcare Eligibility • Searches/Logs>Healthcare Claiming>Healthcare Eligibility Reporting • (Treeview) Healthcare Claiming> Healthcare Eligibility Reporting The next slide will show you what the screen looks like SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 39

VA/DD-TCM Reports continued SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 40

VA/DD-TCM Eligibility Report Example SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 41

Questions VA/DD-TCM Healthcare Claiming | mn. gov/dhs 42

Thank You! Shawna Meyers Shawna. Meyers@state. mn. us 651 -431 -5927 SSIS Fiscal Mentor Meeting – 03 -15 -18 VA/DD-TCM Healthcare Claiming | mn. gov/dhs 43