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). 

If you have a client whose secondary payer allows more than the primary payer and the secondary processes the claim by paying whatever the CCD was from primary but still owing CCD, do you charge the client or adjust it off, since the secondary covered a minimum of the CCD from primary? Ie. primary Health Partners has a lower allowed amount for a certain code than secondary BCBS. HP has a $25 co pay. BCBS pays the co pay, sometimes more, but then is also processing the claim with CCD up to the BCBS allowed amount (which in this case is pretty decent amount). Do you charge the client the difference or adjust it off since you were paid by primary and the secondary covered the CCD from primary? Thanks. sorry it's confusing to explain this.

Is anyone else experiencing substantial slowness with Procentive at this time?

Does anyone have any best practices that can be shared when it comes to the first of the year where benefits(not eligibility) need to be re-verified and releases in the client module need to be updated?

Currently, we end up with a tone of paperwork that ends up having to be scanned.

Thanks Much!

I've been noticing the last few Ucare PMAP ERA's have been denying every claim with a "UA" modifier. Is it something I'm doing wrong, or is it an issue with UCare? Anyone else been having these issues?

Good afternoon!

Our organization is trying to determine the most accurate report that will tell us how much we have been paid based on date of service.  For example, for services that were done during the month of July 2017 how much did we actually get paid.  We only want this to be payments, takeback credits, and credits.  How do we also take into account takebacks?  My thought is to run Report 1370 and filter by date of service and then include the fields Amount Paid, Credits, Takeback Credits, and Takebacks.  Anyone else have experience with this?

Thanks & have a great day!

Jill

Hello,

It has been brought to our attention that Dr. First is currently experiencing an issue that effects newly enrolled providers. If you have recently completed the activation process for Dr. First, but are not able log on to the medication Module, please send a trouble ticket to Procentive. This bug will only effect a newly enrolled provider’s initial log on to the Medication Module.

Any additional updates will be posted to this Known Issue as they become available.

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

Good morning!  I am wondering if anyone has advice on managing the process of reimbursement rate changes from our various payers.  Do you rely on the bulletins that are sent out or do you just watch the EOBs to know if/when rates change?  Or do I need to be going online and watching fee schedules?  If you are able to respond and let me know how this is done at your organization I would be grateful.

Thanks & have a great day!

Jill

Good afternoon!  This may be a basic question, but at the risk of sounding "un-informed" I'm going to ask it anyway :)

I was recently made aware that a modifier can be used on claims to indicate when a client has a co-occurring diagnosis.  For example, a chemical dependency diagnosis along with a mental health diagnosis.  I was told that this could potentially result in a higher payments.  Do you know if this is the case and what that modifier is?