Guilford Center | Provider FYI Letter from Glenna Harford

Letter from Glenne Harford

September 9, 2005

Dear Service Provider:

As you are aware, there are many changes occurring at the state level in the delivery of mental health services. The purpose of this letter is to give you an overview of how these changes affect the relationship between The Guilford Center and its provider partners. We have made some very important procedural changes that we believe will ease this transition process, so please read this information carefully! The topics discussed in this letter are:

            I. Directly Enrolled Providers of Medicaid Services;
            II. Endorsement and Medicaid Services;
           III. Billing under Contract for Medicaid, MR/MI Adult, and CMSED Services;
           IV. IPRS Funded Contracts;

Electronic Authorization and Electronic Claims Processing under CareLink;
Authorization and Submission of Opening Packets for New Clients;
On-Going Authorization Requests for Open Clients;
Update Fee Sets and Update IPRS Target Population Enrollment Forms;
Discharge Summary/Aftercare Plan;
Child Target Population Assignment with no CAFAS;
Contractors and Directly Enrolled Residential Providers Need to Register, with The Guilford Center, the Physical Location of Each Service Provided;
Invoices for Periodic and Day-Night Services should include both Duration and Units;
Services to Out-of-County Residents;
Introducing The New Guilford Center’s Website;
Please Send Us Your Official E-mail Address.

I. Directly Enrolled Providers of Medicaid Services: Currently, provider agencies can bill only two (2) categories of Medicaid services. These services are outpatient treatment services and child residential services.

A. Outpatient Treatment Services: Professionals licensed as independent practitioners must enroll directly with the Division of Medical Assistance (DMA) and bill under their own Medicaid number. Provisionally licensed individuals can not directly enroll at this time and must bill H-codes under contract with their Local Management Entity (LME). DMA plans to eliminate H-codes for outpatient therapy six months after the new service definitions go into effect.

1. Outpatient Treatment Services for Children: The directly enrolled provider determines medical necessity for outpatient therapy, and the LME will not authorize outpatient therapy for children. However, directly enrolled providers who serve children need a referral number from the LME or the child’s primary care provider in order to bill directly. If directly enrolled providers plan on getting a referral number from The Guilford Center, they should sign a non-financial Memorandum of Agreement (MOA) with The Guilford Center so they can get that referral number. Contact the Contracts Unit (Linda Earnest, 641-6749 or learnest@guilfordcenter.com) to request a MOA.

Please note that child Medicaid clients are allowed up to 26 unmanaged visits per calendar year, after which the provider must get prior authorization from the entity responsible for Medicaid utilization management (currently Value Options).

2. Outpatient Treatment Services for Adults: The directly enrolled provider determines medical necessity for outpatient therapy, and the LME will not authorize outpatient therapy nor is it necessary to get a referral number for adults. However, we encourage directly enrolled providers to have a MOA with The Guilford Center as it relates to coordination of care responsibilities. Contact the Contracts Unit (Linda Earnest, 641-6749 or learnest@guilfordcenter.com).

Please note that adult Medicaid clients are allowed up to 8 unmanaged visits per calendar year after which the provider must get prior authorization from the entity responsible for Medicaid utilization management (currently Value Options).

Child Residential Treatment Providers: Group homes licensed for 4 beds or more must enroll with DMA and bill Medicaid directly. The LME authorizes the first 120 days of service for Level III and the first 30 days for Level IV. Directly enrolled residential providers should sign a MOA with the Guilford Center before requesting authorization. Please contact the Contracts Unit (Linda Earnest, 641-6749 or learnest@guilfordcenter.com). Currently the Division of Facility Services has a moratorium on issuing new child residential licenses. The Guilford Center will accept new directly enrolled child residential providers only within the Guilford catchment area (Guilford and contiguous counties).

C. Payments for Treatment Services: Directly enrolled providers must bill treatment services directly to Medicaid. Address questions about payments to EDS Provider Services at 1-800-688-6696.

D. Payments for Room and Board: Directly enrolled residential providers may bill The Guilford Center for children in CMSED or CMECD target populations only if the child is not in DSS custody. Effective immediately, invoices for room and board must include an authorization number and should be submitted to The Guilford Center, Attn: Steve Hess, Accounts Receivable, 3rd floor, 232 N. Edgeworth Street, Greensboro, NC 27401. (If you elect to hand deliver your invoices, ring the bell next to the 3rd floor door, and someone will assist you.) Address questions about room and board payments to the Provider Help Desk: ProviderHelpDesk@guilfordcenter.com.

II. Endorsement and Medicaid Services: Eventually the State will require all Medicaid providers to enroll with and bill Medicaid services directly to the Division of Medical Assistance (DMA). Direct enrollment for most Community Intervention Services requires endorsement by the LME for each service. Alexis Underwood (telephone: 336-641-4363 or aunderwood@guilfordcenter.com) coordinates the endorsement process for The Guilford Center. After the provider completes the endorsement process, the endorsement team will notify the Contracts Unit and they will send a Medicaid Participation Agreement to the provider for signature. After the agreement is executed, the provider can then apply to DMA to be directly enrolled for the endorsed service.

III. Billing under Contract for Medicaid, MR/MI Adult, and CMSED Services:

A. Medicaid (50H) Services: Current Medicaid providers of “H-codes” will continue to bill their Medicaid services under contract with The Guilford Center. This will not alter in any way the contract responsibilities of either the Guilford Center or the provider.

B. MR/MI Adult (55S) and CMSED (54Y) Services: Providers will continue to bill these services under contract with The Guilford Center.

C. Medicaid 50H, MR/MI Adult 55S, and CMSED 54Y Contract Claims for Payment:
Effective immediately, claims under the above contracts should be submitted to: The Guilford Center, Attn: Steve Hess, Accounts Receivable, 3rd floor, 232 N. Edgeworth Street, Greensboro, NC 27401. (If you elect to hand deliver your invoices, ring the bell next to the 3rd floor door, and someone will assist you.) Address questions about contract payments to the Provider Help Desk: ProviderHelpDesk@guilfordcenter.com

Please remember that MSO/Carelink authorizations are for a specific number of units of a specific service for a specific client within a specific date range. Services not within those parameters cannot be billed and will be returned. Effective immediately, your billing event document (invoice) must include an authorization number, the physical address of treatment site with the location code assigned to that specific treatment site. In addition, your billing document must include duration and units (see Paragraph XII below), if providing a periodic or day/night service.

D. 50H, 55S, and 54Y Service Documentation:
Effective immediately, you no longer need to routinely submit copies of your service documentation with your invoice, unless otherwise requested by the Area Authority. Service documentation shall be kept on-site at agency and shall be subject to periodic review.

IPRS Funded Contracts: Heather Krauss or Elaine Parker in the Contracts Unit will continue to administer and process the billing for their respective contracts. (hkrauss@guilfordcenter.com or eparker@guilfordcenter.com) Continue to submit service documentation as required in the past.

For IPRS funded contracts, please remember that MSO/Carelink authorizations are for a specific number of units of a specific service for a specific client within a specific date range. Services not within those parameters cannot be billed and will be returned. Effective immediately, your billing event document (invoice) must include an authorization number and the address of treatment site with the location code assigned to that specific treatment site. In addition, your billing document must include duration of the event and units (see Paragraph XII below), if providing a periodic or day/night service.

Electronic Authorization and Electronic Claims Processing under CareLink: As announced during the contract review sessions, The Guilford Center will provide training to contract providers on the electronic submission of authorization requests and electronic bill submission in October. The proposed start date for electronic authorization and claims processing is November 1, 2005. Both processes require only an internet connection; they do not require any additional software.

Authorization, Opening a Client Record, Submission of Opening Packets for NEW Clients: With the exception of residential services, providers call the Access unit and request authorization to complete an evaluation of a new client. After the evaluation is complete, and if additional services are indicated, the provider will submit a re-authorization request for any subsequent services for that client.

Effective immediately, after the initial evaluation has been completed and if additional services are indicated, the provider should complete the following four forms (for new clients only). Please note that the electronic opening packet is not complete without all four forms completed and submitted. Incomplete packets will be returned to the provider:

Admission Form
Fee Setting and Insurance Information Form
Care Management Enrollment Form, and
Authorization Request Form

The above forms should be completed and e-mailed as inserts to the appropriate e-mail address below. The subject line of the e-mail should provide the client number.

(Adult MH Authorization) AdultMHAuth@GuilfordCenter.com;
(Adult DD Authorization) AdultDDAuth@GuilfordCenter.com;
(Child MH Authorization) ChildMHAuth@GuilfordCenter.com;
(Child DD Authorization) ChildDDAuth@GuilfordCenter.com;
(Substance Abuse & Inpatient Hospital) SA&HospAuth@GuilfordCenter.com

Electronic versions of the above forms are available on The Guilford Center’s web: www.guilfordcenter.com/providercornerforms . If this process is followed, the provider will no longer need to submit a hard copy of an opening packet to The Guilford Center for new clients.

Please remember, however, that the provisions of your contract apply and that you are still required to keep all opening packet information on-site at the agency, and this information will continue be subject to periodic reviews and audits.

If you do not have access to e-mail, continue to submit hardcopy forms as you have in the past.

VII. On-Going Authorization Requests for Open Clients
Providers should complete the Authorization Request Form and e-mail the form to the appropriate e-mail address below:

An electronic version of the above form is available on the Guilford Center’s website: www.guilfordcenter.com/providercorner/forms .

If this process is followed, the provider will no longer need to submit a hard copy of an authorization request to the Guilford Center for open clients.

If you do not have access to e-mail, continue to submit hardcopy forms as you have in the past.

Updated Fee Sets and Updated IPRS Target Population Enrollment Forms:

In order to submit updated fee sets and updated IPRS target population information, effective immediately, providers should complete: a) the Fee Setting & Insurance Information Form, and b) the Admission Form (Name; Client ID; new Diagnosis Information, if applicable, and the IPRS information on the bottom half of the form) and e-mail both forms to: Fees&Admit@GuilfordCenter.com.

Electronic versions of the above forms are available on The Guilford Center’s website: www.guilfordcenter.com/providercorner/forms .

If this process is followed, the provider will no longer need to submit a hard copy of the updates to The Guilford Center.

Please remember, however, that the provisions of your contract apply and that you are still required to keep all update information on-site at the agency, and this information will continue be subject to periodic reviews and audits.

If you do not have access to e-mail, continue to submit your hardcopy forms as you have in the past.

IX. Discharge Summary/Aftercare Plan: Effective immediately, providers should submit their discharge summary/aftercare plan via e-mail to: MedRecGSO@guilfordcenter.com (Greensboro consumers) or MedRecHP@guilfordcenter.com (High Point consumers).

An electronic version of the above form is available on the Guilford Center’s website : www.guilfordcenter.com/providercorner/forms .

If you do not have access to e-mail, continue to submit your hardcopy forms as you have in the past.

X. Child Target Population Assignment with no CAFAS: Effective September 1, 2005, the State of North Carolina’s license to use the CAFAS expired. It is no longer legal to use the CAFAS. Absent the CAFAS score, we have made an internal decision to modify the current target population criteria, and this will allow us to continue to enroll children until the State informs us of changes to the Child Mental Health Target Population. Please begin using the enclosed target population criteria immediately.

An electronic version of “Child Mental Health Target Population Details” is available on the Guilford Center’s website: www.guilfordcenter.com/providercorner .

XI. Contractors and Directly Enrolled Residential Providers Need to Register, with the Guilford Center, the Physical Location of Each Service Provided: For all providers, except directly enrolled outpatient treatment providers, the physical location of each service provided must be registered with the Guilford Center. (For periodic services such as CBS, case management or intensive in-home family services, the physical location is the agency address.) This means that if you provide services at a new location, you need to complete and e-mail the Agency Provider Registration form to the Provider Help Desk (providerhelpdesk@guilfordcenter.com) in order to register the new location.

An electronic version of the Agency Provider Registration form is available on the Guilford Center’s website: www.guilfordcenter.com/providercorner/forms .

Invoices submitted to the Guilford Center without the address of the treatment and assigned location code will be returned to the provider for correction.

XII. Invoices for periodic and day-night services should include both duration and units. Invoices for periodic and day-night services (anything but overnight residential services) should contain both duration of the event and units.

Most “H-codes,” those billable to Medicaid, do not round; a unit is a full fifteen minutes for most services. For example, a service of 55 minutes is 3 units; a service of 65 minutes is 4 units. Duration on the invoice must match the time reported on the service note. Do not round. Codes that bill at a full 15-minute unit are: H0001, H0004 (with modifiers), H0005, H0031, H0036 (with modifiers), H2017, H2012 (with modifiers), T1017HE and T1017HI.

There are several exceptions: H2012HA and HB bill at 1-hour/unit (55 minutes is zero units, 60-119 minutes is one unit). H0015 bills as one unit per day with a 3-hour minimum. H0020 is one unit per face-to-face visit billed as 15 minutes per visit.

Periodic and day-night services billable only to the state, including service codes beginning YA, YM and YP, follow an 8-minute rule: services of more than 8 minutes round to the next full unit. For example, a service of 55 minutes is 4 units and a service of 65 minutes is also 4 units.

Invoices submitted to the Guilford Center without duration of service and units will be returned to the provider for correction.

XIII. Services to Out-of-County Residents: The Guilford Center has reached capacity in all of our clinical areas. As a result, beginning July 1, 2005, The Guilford Center will no longer schedule intakes for new referrals when a person’s residence or Medicaid eligibility is outside of Guilford County. This will apply to all clinical services provided by The Guilford Center, including medication management and case management. This does not apply to emergency services.

Definition: Out-of-county residents are those persons who: 1) legally reside in a county other than Guilford County, or 2) physically reside in Guilford County, however, their Medicaid of origin is in a county other than Guilford County, or 3) are a minor and have a parent or guardian who legally resides in a county other than Guilford County.

New Referrals: If a service request is made for an out-of-county resident with Medicaid, the Access unit will give the caller information about directly enrolled Medicaid providers, so the caller may contact the provider directly.
If the person is not a Medicaid recipient, Access will refer the caller to the county of residence and it is the expectation that that person’s home LME will provide the needed service.

On-going Clients: The Guilford Center will continue to serve out-of-county clients who received services from The Guilford Center prior to July 1, 2005. It is expected that these out-of-county clients will attend scheduled appointments. In the event an out-of-county client misses appointments, the case will be brought to the team leader’s attention for review and possible discharge.

Questions concerning out-of-county residents should be directed to Access at 1-800-853-5163.

XIV. Introducing the new Guilford Center’s Website: The Guilford Center has a new website (www.guilfordcenter.com). This website has important provider information like the information included in this letter. The website also lists upcoming training opportunities, etc. It is our expectation that service providers will visit this website on a regular basis, in order to keep abreast of changes at the local and state level.

XV. Please Send Us Your Official E-mail Address: We are requesting that you send us your official e-mail address as soon as possible but no later than October 1, 2005. The address should be submitted to Learnest@guilfordcenter.com.

Thank you.

Sincerely,

Glenna Harford
Business Office Manager

Enclosures

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