Hi Everyone!

Procentive has received quite a few questions in regards to EIDBI services, billing DHS, provider registration, and other aspects of this type of care. 

We've had the opportunity to speak directly with Nicole Berning the Autism Policy Lead at Minnesota Department of Human Services (DHS) who was able to answer the most common questions we received. 

Please review the Questions and Answers (Q&A) from Nicole below. If you have any additional questions please contact DHS, submit a ticket to the Procentive Support Desk, or ask other providers on the User Community.

Q: If I have an NPI, why do I need to get an UMPI?

A: Good news - you don't! If you have an NPI you are no longer eligible for an UMPI as the criteria are mutually exclusive (source).

Q: How do I know if I qualify for an NPI or an UMPI?

A: Please review "NPI & DHS: Frequently Asked Questions" (source).

Q: Where do I go to obtain an NPI?

A: Use the National Plan & Provider Enumeration System (NPPES) to enroll for an NPI (source). Help with enrollment is available from NPPES (source).

Q: Don't I have to bill with an UMPI for EIDBI services?

A: All billing to DHS requires a licensed professional to be submitted on the claim, with their registered type 1 NPI, as either the rendering provider or the supervising provider. If you have an NPI you are not required to also obtain and bill with an UMPI.

Q: I'm registered with DHS under my UMPI, can I just use that?

A: As outlined in the Provider Requirements section of the MHCP Provider Manual, any changes in enrollment must be submitted to DHS (source). This includes obtaining a type 1 NPI.

Q: If I can use my UMPI, what is the benefit to obtaining and using an NPI?

A: With DHS, increases in certifications may change your provider level. A lower level provider with an UMPI (e.g. Level 3) may receive less reimbursement for services than a higher level provider with an NPI (e.g. Level 1) (source).

Q: What criteria are used to determine a provider level?

A: The types of providers and their criteria are outlined in EIDBI Provider Overview (source).

Q: I've heard about EIDBI and I think I qualify. Where do I get more information?

A: A great place to start is the EIDBI section of the MHCP Provider Manual (source) or the EIDBI Benefit Policy Manual (source). 

The LP at our clinic is giving away testing materials that she does not use.  If you could use these materials, I will send them to you.  We would ask that you pay for the postage.  Please email me at Paulacfcinc@gmail.com if you are interested.  Thank you!

25 copies  - Conners ADHD Rating Scale - Parents Form

25 copies - NEPSY II - Second Edition - Ages 3-4 - Record Form

25 copies - NEPSY II - Second Edition - Ages 3-4 - Response Booklet

20 copies - Wechsler Nonverbal Scale of Ability - Record Form

20 copies - Wechsler Nonverbal Scale of Ability - Response Booklet

If you only have 2 clients enrolled in a day treatment for the 3 hour group sessions. An Statute states you have to have 3 "enrolled" to be considered day treatment. Can you bill out "individual skills" for 2 hours until more clients enroll to become a group again? Low numbers are due to discharging clients and no new referrals at this time.

I was wondering if anyone else was having the same problem and if there were any suggestions on our end for this. Recently we have had two different kids have skills (H2014) deny because according to the representatives at Blue Cross PMAP "there is a waiver that the policyholder did not sign."

What does this mean? Who would then be responsible? Since it is a PMAP plan and the child has active MA, we are unable to bill the parents for not signing a waiver. If they did in-fact not sign a waiver, why would only the skills deny and not other IOP services that the child was receiving?

Good afternoon,

We recently received information from OptumPracticeFi. They presented patient financing for those patients unable to pay account balances for various reasons. They are not a collections company or a lender but the Integrator. They have partnered with a variety of lending sources which enables behavioral facilities a more dynamic and inclusive option for cash-pay patients in one simple application. The behavior facility is paid, the patient then owes the lender.

The website is: www.optimumpracticefi.com Optum Practice Financial Patient Solutions Financing

Has anyone from this community worked with this group or have any knowledge or insight? 

Debbie

What do you use within your company that is HIPAA compliant to collaborate and share documents? Options include internal servers verses cloud based computing. Obviously, these would be used in addition to Procentive. :)

BCBS claims there was a provider bulletin in November that indicated in 2017 we could no longer get paid for billing a secondary BCBS with a GY modifier when the primary was not covering the provider as well. We can find nothing on this and BCBS could not produce a copy of it. Does anyone have info on this change?

I am wondering if any of you MN facilities currently bill the counties for rule 25 assessments? We can't bill DHS directly and are wondering how you are billing the counties if at all. Thanks!

Hi everyone!

Last week we had our webinar on Direct Messaging. If you were unable to attend or are interested, you can view it below or go to our Knowledge Hub article about it here.