Tips for HFS/Medicaid

1. CONSULTING Tips for HFS/Medicaid Speaker: Love McPherson, Gideon Group, Inc.

2. Credentialing / Certification MEDICAID TIPS NATIONAL PROVIDER ID (NPI) • The Treatment Facility must apply for an NPI number • All Service Providers must apply for an NPI number To apply for your NPI online, visit: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions Information Required for Individual ProvidersProvider NameSSN (or ITIN if not eligible for SSN) 2Provider Date of BirthCountry of BirthState of Birth(if Country of Birth is U.S.)Provider GenderMailing AddressPractice Location Address and Phone NumberTaxonomy (Provider Type) 4State License Information 1Contact Person NameContact Person Phone Number and E-mail Information Required for OrganizationsOrganization NameEmployer Identification Number (EIN) 3Name of Authorized Official for the OrganizationPhone Number of Authorized Official for the OrganizationOrganization Mailing AddressPractice Location Address and Phone NumberTaxonomy (Provider Type) 4Contact Person NameContact Person Phone Number and E-mail

3. Credentialing / Certification MEDICAID TIPS Provider Enrollment Application ENROLLMENT DOCUMENTATION REQUIRED FOR PROVIDERS: • Medical Provider Enrollment Application Form (HFS 2243) • Provider Agreement (HFS 1413), • Designation of Alternate Payee Form (HFS 2307) (if applicable) • Power of Attorney (HFS 2306) (if applicable), and • Enrollment Disclosure Statement Form (HFS 1513) are required documentation and verification of your eligibility to provide services. Questions re Provider Enrollment Application Provider Participation Unit - (217)782-0538.

4. Credentialing / Certification MEDICAID TIPS AGENCY CERTIFICATION PREREQUISITE = An applicant must have a written contract or proof of intent to contract for Part 132 services • DHS - Illinois Dept. of Human Services • DCFS - Illinois Dept. of Children & Family Services • DOC - Illinois Dept. of Corrections

5. Forms/Documentation MEDICAID TIPS OBTAIN CLAIM FORMS FOR BILLING • Standard forms: • the CMS 1500 • the HCFA 1500 • UB-04 • Medicaid and Private Insurance use these standard forms • Medicaid frequently denies claims To obtain a sample CMS 1500 The National Uniform Claim Committee (NUCC) http://www.cms.gov/CMSForms/CMSForms/itemdetail.asp? itemID=CMS1188854

6. Forms/Documentation MEDICAID TIPS OTHER BILLING FORMS REQUIRED • Coverage Verification • Prior Authorization Requests • Service/Treatment Notes • Continued Stay Reviews • Utilization Reviews • Collections

7. Coding MEDICAID TIPS 1. HCPCS - Healthcare Common Procedure Coding System The Centers for Medicare and Medicaid Services (CMS) develops and maintains HCPCS codes. These numbers are the codes required for billing Medicare and Medicaid. Visit the CMS website: http://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage 2. DSM Codes- Diagnostic and Statistical Manual of Mental Disorders visit: http://www.dsmiv.net/dsm-iv-codes.html 3. CPT Codes - Current Procedural Terminology The American Medical Association developed and maintains CPT Codes Visit: http://www.ama-assn.org/

8. Medicaid Mental HealthService Rates MEDICAID TIPS HIV COUNSELING AND TESTING $60.32 – PER HOUR $15.08 – PER QUARTER HOUR DASA CONTRACTUAL MANUAL 2013 DASA PROGRAM MANUAL 2013