kentucky medicaid 2015. ❶ helpful links ❷ billing instruction updates ❸ icd-10 ❹ kyhealth...
TRANSCRIPT
Kentucky Medicaid
School Based Health Services
2015
Agenda
❶ Helpful Links❷ Billing Instruction Updates❸ ICD-10❹ KYHealth Net❺ Prior Authorizations❻ Contacts❼ Questions and Answers
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DMS Website
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www.chfs.ky.gov/dms
School Based Health Services
Programs and Services
DMS Website
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www.chfs.ky.gov/dms
KYMMIS Website
www.kymmis.com
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Provider Relations
Site updates
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www.kymmis.com
Provider BillingInstructions
Provider Rep. Contact Information
KYMMIS Website
KYMMIS Websitewww.kymmis.com
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PT 21 School Based
Health Services
Billing Instruction ChangesPlace of Service
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Billing Instruction UpdatesProcedure Codes
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97001 PHYSICAL THERAPY EVALUATION
97003 OCCUPATIONAL THERAPY EVALUATION
Will be added soon
Will be added soon for PT & OT:97150 -
THERAPEUTIC PROCEDURES IN A GROUP
SETTING
Billing Instruction UpdatesProcedure Codes
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Billing Instruction UpdatesProcedure Codes
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Note:1 unit equals 15 minutes except for the following procedure codes:E1399 = 1 Unit equals 1 itemA0160 = 1 unit equals 1 mile
All procedure codes require modifiers except A0160 ,E1399, T1002, T1003 and T1004
Billing Instruction ChangesModifiers
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ICD-10Go Live
In less than two months (1 month and 5 days) everyone will be switching from ICD-9 to ICD-10 coding for medical diagnoses.
10 1 2015
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ICD-10 compliance means that HIPAA-covered entities must utilize ICD-10 codes for healthcare services rendered on or after the compliance date.
WHAT does ICD-10 compliance mean?
ICD-10Compliance dates
Only ICD-9 codes
10/1/2015
Claims with date of service 10/1/2015 and after must use ICD-10 codes.Claims with date of service 9/30/2015 and before, use ICD-9 codes
ICD-10GEMS
The General Equivalence Mappings (GEMs) are a tool that can be used to convert data from ICD-9-CM to ICD-10-CM. The GEMs are a comprehensive translation dictionary that can be used to accurately and effectively translate any ICD-9-CM-based data.
The GEMs are not a substitute for learning how to use the ICD-10 codes.
More information about GEMs and their use can be found on the CMS website at: http://www.cms.gov/Medicare/Coding/ICD10/index.html 15
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ICD-10KYHealth Net Billing
ICD-10Paper Claims Billing
There is a ICD indicator in the top right corner of the Diagnosis Code field box (box 21) to indicate if the code is ICD 9 or ICD 10. Acceptable codes are: 9 for ICD 9; or 0 for ICD 10
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To obtain access to KYHealth Net:
• Complete a PIN Release form. The form and detailed instructions can be found at www.kymmis.com website.
Click on Electronic Claims, then EDI Forms Click on PIN Release Form
KYHealth NetHow to obtain access
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KYHealth NetPIN Release Form
PIN # is assigned by helpdesk
Email address
Provider #
Phone #
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Fax to: 502-209-3242 Email: [email protected] Phone (800) 205-4696
KYHealth NetWebsite address
KYHealth Net website address: https://home.kymmis.com
Your password must be reset every 30 days. An email reminder will be sent to the email address registered with KYHealth Net.
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KYHealth NetHome Page
AccountManagement
KYHealth Net
Sign Out
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Change Password
KYHealth NetAccount Management
Clicking on Account Management will open a separate window allowing you to edit My Information, Change Password and the Administrator will have options to View Agent Roles and Add Agents.
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KYHealth NetPrior Authorizations
Submit a Prior Authorization request as soon as an IEP is received.
Prior Authorizations requested after services have been delivered could result in non-payment.
Prior Authorizations are for current school year only. • KYHealth Net Prior Authorization school year runs
August through July.23
KYHealth NetGetting started
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KYHealth Net
KYHealth NetPrior Authorizations
Click on SchoolBased Services
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KYHealth NetPrior Authorizations
Click Cancel to go
backto the Home
Screen.
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KYHealth NetPrior Authorizations
Request New Prior Authorization
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KYHealth NetPrior Authorizations
28Must be full name
KYHealth NetPrior Authorizations
Once youhave clickedSubmit, the Member Name and Authorization#will populate.
Click New toBegin enteringAnother PA.
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When putting your cursor over a subject, a drop down box appears with additional topics within that subject
KYHealth NetMember Eligibility Verification
KYHealth NetMember Eligibility Verification
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Select “Eligibility
Verification”Under
Member
1. Select Lookup Type: In the drop down box, select how you would like to look up the member - Member ID# or SSN#
2. Service Type: Health Plan Coverage is Automatically selected3. Member ID: Enter member ID# or SSN#4. From and To Date of Service: Enter the dates you are checking eligibility5. Click on Search
Enter the From Date of Service and To Date of Service you would like to check Eligibility for.
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• Words in blue and underlined are Hyperlinks.
• Clicking on a Hyperlink will open more details of that subject.
• Eligibility 5 Year History • Benefit Plan
KYHealth NetMember Eligibility
Verification
KYHealth NetClaim Inquiry
Claim Inquiry • Place cursor over Claims in the Menu. • Choose “Claims Inquiry” from the drop-down.
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KYHealth NetClaim Inquiry
Search by: 1. Member ID# and dates of service or,2. ICN# only - Remove dates of service3. Claim status
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KYHealth NetClaim Inquiry
The ICN# is a hyperlink.
Click on the ICN# to view claim details, adjust or void
KYHealth NetClaim Submission
Submitting Professional Claim • Place cursor over Claims in the Menu. • Choose “Claims Submission (Professional)” from the drop-down.
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KYHealth NetClaim Submission
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KYHealth NetClaim Submission
Enter theDiagnosisCode andClick Save Code
Click Next
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KYHealth NetClaim Submission
Place of Service Code
School ID #: Employee ID#
Number of Children = Enter the number of students when billing for a group service. Valid entry is 1 - 6
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Employee ID: Employee ID #
KYHealth NetClaim Submission
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RA Viewer • Click RA Viewer on the menu.• Click Search.
KYHealth NetRA Viewer
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KYHealth NetRA Viewer
In theRun Date column, Click the date.
RA Viewer holds six months of Remittance Advice statements displaying the most current at the top of the screen. Each RA can be viewed or downloaded.
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KYHealth NetRA Viewer
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Remittance AdviceClaims Paid
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Remittance AdviceSummary
Contacts
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Provider Representative Listing
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Thank you for attendingKentucky Medicaid
School Based Presentation!
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