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Audiology Services
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Overview
• Provider Enrollment Requirements • Member Eligibility • Hearing Services • Authorization and Billing • Additional Information
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Provider Enrollment
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Alaska Medicaid Provider Enrollment
• Providers must be enrolled in Alaska Medicaid to bill for reimbursement of covered health care services rendered to eligible Medicaid members
• Enrollment starts at the Enrollment portal. Go to http://medicaidalaska.com under Providers, then Enrollment
• Audiologist Licensing: – Active license under AS 08.11 to practice audiology individually or as a group – Out-of-state providers must also have active license as an audiologist and be enrolled in
the Medicaid program in state where services are provided • Hearing Aid Dealer Licensing
– Active license under AS 08.55 as a provider of hearing services and items – Out-of-state providers must also have active license as a provider of hearing services
and items and be enrolled in the Medicaid program in state where services are provided
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Recordkeeping • Recordkeeping requirements are documented in the Individual Provider Agreement and Tax
Certification and Group Provider Agreement and Tax Certification • Although most recordkeeping requirements are consistent for all providers, some requirements
are provider-type specific • Providers must maintain complete and accurate clinical, financial, and other relevant records to
support the care and services for which they bill Alaska Medical Assistance for a minimum of 7 years from the date of service
• Providers are subject to audits, reviews and investigations
Providers must ensure their staff, billing agents, and any other entities responsible for any aspect of records maintenance meet the same requirements.
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Member Eligibility
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Member Eligibility Always verify member eligibility by using one of the following options: • Request to see the member's eligibility coupon or card that shows the current month of
eligibility; photocopy for your records • Call Automated Voice Response System (AVR):
– 855.329.8986 (toll-free) • Verify via Alaska Medicaid Health Enterprise website
– http://medicaidalaska.com • Fax complete Recipient Eligibility Inquiry Form - General
– 907.644.8126 • Submit a HIPAA compliant 270/271 electronic Eligibility Inquiry transaction • Call Provider Inquiry
– 907.644.6800, option 1 or 800.770.5650, option 1, 1 (toll-free)
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Member Eligibility
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Audiology Services
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Audiologist Services
Audiologist covered hearing services and hearing items: • Identified in 7 AAC 115.530 • Rendered within scope of the audiologist’s license • Include audiometric evaluation, diagnostic testing, audiometric screening, rehabilitative
therapy, preventive services, corrective services, hearing items, and hearing item repairs • Cochlear implantation-related services
– Cochlear implantation-related services include: a preliminary assessment, programming of the device, adjustments, member education, auditory rehabilitation and treatment sessions
– Cochlear implantation replacement parts are covered if they are prescribed by an appropriate, enrolled provider
– Covered parts include a microphone, speech processor, and transmitter
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Hearing Aid Dealer Services
Hearing Aid Dealer covered hearing services and hearing items: • Identified in 7 AAC 115.530 • Rendered within scope of the hearing aid dealer’s license • Includes hearing devices, accessories, supplies, repairs, and covered services when
prescribed by a licensed provider within the scope of their license • The department will not pay a hearing aid dealer
– For services rendered after the member waived the hearing evaluation – For a hearing test or diagnostic procedure designed to determine the cause of hearing
impairment
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Covered Services and Items
• Providers must be enrolled and services or items covered • Hearing services and items must be identified by the prescriber as medically necessary to
alleviate a disability due to hearing impairment • Services or items must be least costly service that meets member’s medical need • Providers must include a manufacturer’s warranty of no less than one year from the
original purchase date for hearing items • Delivery and dispensing costs of new item or delivery of repaired item covered if item or
repair capabilities are unavailable in member’s municipality • Trial use if supported by medical documentation and proper service authorization obtained
to be covered
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Non-covered Services and Items
• Administrative Expenses – Included in payment for covered services and items – Administrative expenses include telephone responses to questions, mileage, travel
expenses, travel time, equipment setup, installation, office inventory supply, and orientation and training regarding the proper use of equipment
• Assistive Listening Devices – Identified in HCPCS codes – Assistive listening devices include telephone amplifiers, alerters, television amplifiers,
television caption decoders, telecommunication devices for the deaf, and devices for use with a cochlear implant
• Charges submitted for adjustments, labor, repairs or replacement parts for a previously purchased hearing item when the department has purchased a newer like item
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Labor, Repair or Replacement • When a damaged hearing item is no longer under warranty, labor will be paid to assess
and repair the item • Labor and repair will be covered if necessary for the hearing item to function as intended • Repairs will not be covered if replacement of item would be more cost effective • Claims must include:
– Statement describing the cause for and nature of repair – Description of item and its serial number if available – Documentation of labor charges
• Labor, repair or replacement will not be covered if: – Item is covered under manufacturer’s warranty – Item needs repair because of manufacturer’s defect – Item is a previously purchased hearing item and the department has since purchased a
newer like item for the member
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Rental
• Rental or rent-to-purchase will not be covered if purchase is less expensive • Rental or rent-to-purchase will be paid as follows:
– Rental period thirty days or longer, monthly rental fee will be ten percent of allowed purchase price
– Rental period less than thirty days, amount paid = rental fee (as calculated above) / number of days in the month x number of days item was rented
• Rental periods over twelve months of continuous use will not be paid • Labor, repair and maintenance will not be paid before total rental fee payments equal the
allowed purchase price; these costs must be included in the rental fee • When total rental payments reach allowed purchase price, labor, repair or maintenance will
be paid after sixty days or when warranty expires, whichever is later
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Hearing Aids - Covered
• No more than one hearing aid per ear, per member, per three calendar years • One fitting fee per ear, per purchase or rental of hearing aid • One dispensing fee per ear, per purchase or rental of hearing aid • Any type of monaural or binaural hearing aid that is worn in or behind the ear • If replacement is covered and manufacturer’s warranty is in effect, only difference between
deductible and maximum allowable will be paid
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Hearing Aids
• Hearing aid supplies included with hearing aid: – Single cord – Y-cord – Harness – New receiver – Bone-conduction receiver with headband
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Hearing Aids – Under Twenty One
• Unlimited ear mold impressions and ear molds • Unlimited hearing aid repairs if:
– Hearing aid warranty is no longer in effect and – Provider has not been paid a dispensing fee
• No more than two replacements of lost hearing aids if: – Hearing aid warranty is no longer in effect – Hearing aid was lost no more than three years after original purchase date – Written explanation of device loss is submitted with claim
• No more than two replacements of broken hearing aids if: – Hearing aid warranty is no longer in effect – Hearing aid was broken no more than three years after original purchase date – Hearing aid cannot be repaired, or cost of repairs exceeds replacement
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Hearing Aids– Over Twenty One
• No more than two ear mold impressions and ear molds per ear, per three calendar years • No more than two hearing aid repairs if:
– Hearing aid warranty is no longer in effect and – Provider has not been paid a dispensing fee
• No more than one replacement of lost hearing aid if: – Hearing aid warranty is no longer in effect – Hearing aid was lost no more than three years after original purchase date – Written explanation of device loss is submitted with claim
• No more than one replacement of broken hearing aid if: – Hearing aid warranty is no longer in effect – Hearing aid was broken no more than three years after original purchase date – Hearing aid cannot be repaired, or cost of repairs exceeds replacement
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Hearing Aids - Batteries
• Twenty hearing aid batteries a month up to one hundred and sixty a year per member • Thirty cochlear implant alkaline batteries per month • Fifty five cochlear implant zinc air batteries per month • If batteries are for hearing aid the department did not purchase, provider must record
manufacturer’s serial number and purchase date of the hearing aid
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Authorization and Billing
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Service Authorization
• Required for some services and items • Required for payment amounts that exceed the maximum allowable • Requests for replacement must show necessity of replacement and lack of warranty
coverage • Requested on a Certificate of Medical Necessity (CMN) form • Requests are reviewed on an individual basis • Factors considered include:
– Degree of member’s hearing loss – Type of hearing loss suffered – Configuration of member’s hearing loss – Management and treatment plan prepared
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Fee Schedules Fee schedules tell you: • What services are covered • Maximum allowed reimbursement • Additional documentation
requirements • Other special considerations
Fee schedules can be found on http://medicaidalaska.com in the Documents & Forms section
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Certificate of Medical Necessity
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Certificate of Medical Necessity
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Certificate of Medical Necessity
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Service Authorization Tips
• For relevant services, be sure to use a modifier to indicate the ear to which a service will be rendered
• Make sure dates are within appropriate timeframes • Must attach an audiogram test report to CMN request or complete the clinical
assessment section with great detail, including the assessment or audiogram results
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Billing
• 837P electronic transaction • Health Enterprise • Payerpath • CMS-1500, professional paper claim form
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Additional Information
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Overpayments & Repayment of Payment Errors
Providers should closely review each remittance advice (RA) to ensure it reflects accurate payment for all billed services, including correct member details and services provided. • In accordance with 7 AAC 105.220(e), Alaska Medical Assistance providers have 30 days
from the time of payment to notify the department in writing of a payment error. • Federal law (42 U.S.C. 1320(d)) requires repayment of overpayments to the department
within 60 days of identifying the overpayment. • Mail the written overpayment notification and a copy of the RA page detailing the
overpayment to the address below:
Conduent State Healthcare, LLC P.O. Box 240807 Anchorage, Alaska 99524-0807
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Additional Resources
Alaska Medicaid Health Enterprise website at http://medicaidalaska.com. • Information necessary for successful billing • Includes provider-specific Medicaid billing manuals and fee schedules You may also call: • Provider Inquiry
– Eligibility only – 907.644.6800, option 1,2 or 800.770.5650 (toll-free), option 1,1,2 – Claim status and other inquiries – 907.644.6800, option 1,1 or 800.770.5650 (toll-free),
option 1,1,1
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