2016 Archived MO HealthNet Provider Hot Tips

The MO HealthNet Division provides hot tips to providers to assist them in receiving timely reimbursement for services provided. Please share these hot tips with your billing staff.

Hospice

The MO HealthNet Division (MHD) Provider Education Unit is offering a Hospice Provider Workshop December 16, 2016.  This workshop is from 9:00 A.M. to 4:00 P.M.

Please contact the Provider Education Unit at MHD.PROVTRAIN@dss.mo.gov  (preferred method) or (573)751-6963 with any questions or training needs.

Contacting Provider Education

Provider Education staff are now part of the Clinical Services Unit. Requests for provider training may be directed to the Provider Education representatives by calling (573) 751-6963 or by email: mhd.provtrain@dss.mo.gov. The Provider Education representatives offer training and education on proper billing methods and procedures for MO HealthNet claims.

Your request should include the Provider's Name, National Provider Identifier (NPI), the reason for the inquiry, and the type of training needed. By providing this pertinent information, your request for assistance can be directed to the appropriate staff.

Inquiries regarding claim filing, claim denials, Remittance Advice, and participant eligibility should still be directed to the Provider Communications Unit at (573) 751-2896.

Each of the Provider Education representatives and some of their training programs are listed below:

Adult Dental Benefits: MO HealthNet Managed Care Participants

June 01, 2016

The MO HealthNet Division (MHD) fee-for-service (FFS) program will reimburse enrolled FFS providers for adult Managed Care participants for dates of service January 1, 2016 through June 30, 2016.

MO HealthNet Managed Care Plans will begin to reimburse adult dental services for eligible participants effective July 1, 2016.

As stated in the Adult Dental Bulletin dated May 6, 2016, the MHD FFS program began paying enrolled providers for certain adult dental services effective for dates of service on and after January 1, 2016. The specific covered services are listed and described in the bulletin.

MHD Managed Care Plans include Home State Health™, Aetna Better Health of MO™, and Missouri Care™. Providers are responsible for checking patient eligibility for each date of service before providing services to MHD participants.

The MHD FFS program will manually process dental claims for Managed Care adult participants for January 1, 2016 through June 30, 2016 dates of service. Providers must submit paper dental claim forms to receive payment specifically for these services to the following address:

MO HealthNet Division
Attn: Clinical Services
PO Box 6500
Jefferson City, MO 65102

Please reference the May 6, 2016 bulletin noted above for detailed requirements and limitations for specific procedure codes. For questions, providers may contact the Provider Communications Unit by calling 573-751-2896.

Inpatient Hospital: Validation Review

April 29, 2016

Inpatient hospital admissions must be pre-certified as medically necessary by the MO HealthNet Division (MHD) review authority, Xerox Care and Quality Solutions. In addition to precertification of inpatient stays, Xerox's responsibilities include validation reviews described in 13 CSR 70-15.020(9) and in Section 13.29.F(5) of the MO HealthNet hospital provider manual available at: http://manuals.momed.com/manuals/.

Xerox Care and Quality Solutions requests records on a quarterly basis for validation reviews, which confirms that the information provided at the time of the certification request is consistent with the documentation and clinical findings in the medical record. Xerox selects a statistically valid sampling of certifications from each hospital which includes certified admissions and continued stay reviews. Xerox performs a utilization and quality of care review on those admissions chosen in the sampling. All admissions may be subject to focused validation review if a potential quality of care issue was identified by the nurse reviewer.

For admissions subject to review, Xerox requests medical records. Providers have 30 calendar days from the date of request to submit documentation. Records not received within the 30 calendar days may result in the admission being denied and or the claim being recouped for payment. A validation review determination that an inpatient stay was not medically necessary results in recovery of MHD payments in accordance with state regulation 13 CSR 70-3.030. Overpayment determinations may be appealed to the Administrative Hearing Commission.

Radiology/Imaging: Diagnostic Site Certification Requirement

April 27, 2016

As previously stated in our Radiology Bulletin dated January 15, 2016 (Volume 38, Number 25), Diagnostic Site is a standardized medical imaging safety and quality program designed to assess and credential medical imaging equipment, personnel, and policies of facilities that perform diagnostic imaging services.

Enrolled MO HealthNet providers that provide imaging services are required to participate in this program. Each facility that intends to perform high-tech and/or cardiac imaging procedures for MO HealthNet participants must receive Diagnostic Site certification from HealthHelp by May 31, 2016.

Starting February 1, 2016, all enrolled MO HealthNet rendering facilities were temporarily "certified", allowing rendering providers time to complete their Diagnostic Site certification. Each rendering provider must complete their Diagnostic Site certification by May 31, 2016, or the provider will not be a choice as a rendering provider during the imaging PA process for MO HealthNet participants. It is each facility's responsibility to comply with the Diagnostic Site certification process as further described below.

• For sites that have never been certified, enrollment began February 1, 2016.
• For sites that have already been certified through HealthHelp's Diagnostic Site process for another payer, the current certification will fulfill the MO HealthNet requirement. (Certification renewal will be the same as the existing scheduled certification renewal process for that site.)
• Providers will be responsible for reassessing their facility/equipment every two years. You will receive a 45 day notice prior to the expiration date. If your facility acquires new equipment after you are certified, you must log in and report your new equipment.
• Hospitals providing imaging services are exempt from the DiagnositcSite certification process.

Providers can complete their Diagnostic Site certification online at: https://portal.healthhelp.com/radsitenet/registration.aspx.

For more information on Diagnostic Site Certification, please contact Program Support:

• Email: SiteSupport@HealthHelp.com
• Phone: 1-800-506-2560
• Fax: 1-800-546-7081

Facilities are also encouraged to join HealthHelp's webinar every Wednesday. For more information visit: https://portal.healthhelp.com/Site/webinars.asp

Missouri Children's Trauma Network Training Summit

The Missouri Kid's First, Missouri Department of Mental Health, and the Missouri Coalition for Community Behavioral Healthcare have partnered together to provide a one day training summit focused on youth and trauma training.

The Missouri Children's Trauma Network Training Summit registration is now open (registration link below). The training summit is scheduled for May 5, 2016 at the Holiday Inn and Executive Center (address below). This training is free of cost and lunch will be provided.

Registration will begin at 7:30 a.m., and the final agenda will be sent on April 21, 2016! Below is a draft agenda.

Location:
Holiday Inn and Executive Center
2200 I-70 Drive SW
Columbia, MO 65203

To register click on the following link: 

2016 Missouri HealthNet Webinar Trainings

March 30, 2016

The MO HealthNet Division (MHD) Provider Education Unit conducts quarterly general program Webinars. The schedule may be accessed from the Provider Participant Page or the MO HealthNet Webinar Training link.  Instructions on how to register are outlined on the Webinar schedule.

If a provider has registered for a Webinar and cannot attend for any reason, contact MHD Provider Education Unit to cancel the registration. The Provider Education Unit may be contacted by phone at (573)-751-6683, or by email at: MHD.provtrain@dss.mo.gov.

Missouri Tobacco Quitline Update from Department of Health and Senior Services (DHSS)

March 24, 2016

On March 14, 2016, the Missouri Tobacco Quitline reached its maximum funding allowance for Nicotine Replacement Therapy (NRT).  Therefore, NRT is not available to participants at this time through the Quitline. Additional funding for NRT is anticipated to be available again by August 2016.

MO HealthNet participants can still receive NRT through their healthcare provider, as it is a covered MO HealthNet benefit. Please refer to the Provider Bulletin Smoking Cessation: Pharmacologic and Behavioral Interventions for covered services and resources.

The Quitline continues to provide services to assist individuals who want to quit smoking or using other tobacco products, such as:

• Telephone-based counseling with a trained quit coach.
•  Call 1-800-QUIT-NOW (1-800-7848-669).
• Stand-alone web coaching services, including learning tools, support, and information about quitting.
• Access the Missouri Quitline Tobacco webpage.

• Texting support services, including evidence-based text messages personalized to a participant's quit plan.

• To receive the texting support services, the participant would need to register for services, set a quit date, and enroll in a coaching program. The coaching can be done via telephone at 1-800-QUIT-NOW (1-800-784-8669), or via the web-only system.

For more information, contact the Comprehensive Tobacco Control Program at 573-522-2820 or visit the DHSS Tobacco Quitline Information webpage.

Motivational Interviewing Regional Training Program

February 22, 2016

Beginning in March 2016, the Missouri Children's Trauma Network will offer a Motivational Interviewing training program. Motivational Interviewing is a tool that will assist providers with Trauma Informed Care. This program will target six regions in the state of Missouri. It will be offered to any staff in these regions that have an interest in expanding and maintaining Motivational Interviewing within their practice or agency.

This free program will require a six to nine month commitment. The program begins with a two-day live training which will be held from 8:00 A.M to 5:00 P.M., with lunch provided each day. This will be followed by six months of webinars providing consultation on cases and then a one day follow-up live training.

In order to sign-up for Motivational Interviewing Training, please submit a registration form online. Each region has a capacity of 40 participants, so please register soon to secure your spot in one of these six learning collaborative cohorts.

Locations and dates of initial two-day trainings:

• March 02-03, 2016 | Community Counseling Center, Cape Girardeau
• March 10-11, 2016 | Coalition Office, Jefferson City
• March 17-18, 2016 | Truman Behavioral Health, Kansas City
• April 06-07, 2016 | Burrell, Springfield
• April 14-15, 2016 | Preferred Family Healthcare, Kirksville
• April 20-21, 2016 | Crider Center, St. Louis

2016 MO HealthNet Training Workshops

February 16, 2016

The MO HealthNet Division (MHD) Provider Education Unit yearly conducts general program workshops. The schedule may be accessed from the Provider Participant page or 2016 MO HealthNet Training Workshops link.  Instructions on how to register are outlined on the workshop schedule.

If a provider has registered for a workshop and cannot attend for any reason, contact MHD Provider Education Unit to cancel the registration. The Provider Education Unit may be contacted by phone at (573) 751-6683, or by email at MHD.provtrain@dss.mo.gov.

Echocardiography Procedures Will No Longer Require Precertification Effective February 1, 2016

January 29, 2016

Effective February 1, 2016, the MO HealthNet Division (MHD) will no longer require precertification for the following echocardiography procedure codes:

Any further questions can be directed to Provider Communications at 573-751-2896.

Trauma-Focused Cognitive Behavioral Therapy Learning Collaborative

January 25, 2016

Beginning in March 2016, there will be a free year-long Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Learning Collaborative, sponsored by the Missouri Children's Trauma Network.  In order to provide information to those interested in applying for this learning collaborative, the Missouri Coalition for Community Behavioral Healthcare will host a free launch event on January 28, 2016, from 2:00 PM to 4:00 PM. You may attend the launch event in person or by webinar.

Training tracks are included for:

• Clinicians, Supervisors, Organizational Leaders, & Brokers

To register for the launch event click on the following link:
http://www.surveymonkey.com/r/MoCOTFCBTLAUNCH

For more information or questions contact:

Amy Escott, LPC
MoACTS Project Director
DribinA@umsl.edu
(314) 516-8308

Desiree' Williams
MoACTS Support
WilliamsDes@umsl.edu
(314) 516-6798

The learning collaborative will be free of cost to Missouri residents. Applications for the learning collaborative will be accepted until February 15, 2016.

Funding for this training sponsored by the Missouri Department of Mental Health

Provider Medicare Notification Letters

January 12, 2016

The MO HealthNet Division (MHD) Medicare Unit is updating their system to become paperless.  The MHD Medicare Unit’s preferred correspondence method with providers will be by email or fax.

Providers need to update their email addresses and fax numbers to receive MHD Medicare letters and billing statements.  

The MHD Medicare Unit will send providers encrypted emails or faxes to the email address or fax number on file.  Please access the E-Mail Encryption Instructions for directions on how to open MHD encrypted emails.

Please contact the MHD Medicare Unit, fax us at (573) 526-1162 or call (573) 751-9312 to update this information.  Please include the following information shown below:

• Provider’s National Provider Identifier (NPI)
• Contact Person Name
• Email address
• Fax number

Alternatively, you may also contact Missouri Medicaid Audit & Compliance (MMAC) Provider Enrollment to update your email and fax information.