Care Management Billing Rules Sample Clauses

Care Management Billing Rules. The Department has developed a special care management benefit for the SSI managed care population. The benefit is defined above in Article III. B., (Care Management Model for the Medicaid SSI Population). The Department will reimburse HMOs for the care management services (outlined in Article III. B.) outside of the regular capitation payment. The Department will continue to cover other care management activities as an administrative component of the capitation rate or as an integral and inseparable component of another Medicaid covered benefit, as appropriate. The Department has identified specific procedure codes to represent the Medicaid SSI care management benefit. HMOs will be required to use these procedure codes to identify SSI care management activities provided by the WICT and / or SSI care management staff. HMOs will be required to submit member-specific claims via encounter records for the SSI care management benefit. The HMO must maintain documentation for each member that supports the claimed services in their care management system. The HMO must submit member-specific claims via encounters no later than 365 days after the date of service of the claim. If an HMO encounter is denied within the Department’s Medicaid Management Information System (MMIS), the HMO has 90 days to resolve the encounter to priced status within the system.
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Care Management Billing Rules. The Department has developed a special care management benefit for the SSI managed care population. The benefit is defined above in Article III. B., (
Sample 1Sample 2Sample 3
Care Management Billing Rules. The Department has developed a special care management benefit for the SSI managed care population. The benefit is defined above in Article III. B., (Care Management Model for the Medicaid SSI Population). The Department will reimburse HMOs for the care management services (outlined in Article III. B.) outside of the regular capitation payment. The Department will continue to cover other care management activities as an administrative component of the capitation rate or as an integral and inseparable component of another Medicaid covered benefit, as appropriate. The Department has identified specific procedure codes to represent the Medicaid SSI care management benefit. HMOs will be required to use these procedure codes to identify SSI care management activities provided by the WICT and / or SSI care management staff. HMOs will be required to submit member-specific claims via encounter records for the SSI care management benefit. The HMO must maintain documentation for each member that supports the claimed services in their care management system.
Sample 1
Care Management Billing Rules. The Department has developed a special care management benefit for the SSI managed care population. The benefit is defined above in Article III. C., (Care Management Model for the Medicaid SSI Population). The Department will reimburse HMOs for the care management services (outlined in Article III. C.) outside of the regular capitation payment. The Department will continue to cover other care management activities as an administrative component of the capitation rate or as an integral and inseparable component of another Medicaid covered benefit, as appropriate. The Department has identified specific procedure codes to represent the Medicaid SSI care management benefit. HMOs will be required to use these procedure codes to identify SSI care management activities provided by the WICT and / or SSI care management staff. HMOs will be required to submit member-specific claims via encounter records for the SSI care management benefit. The HMO must maintain documentation for each member that supports the claimed services in their care management system. The HMO must submit member-specific claims via encounters no later than 365 days after the date of service of the claim. If an HMO encounter is denied within the Department’s Medicaid Management Information System (MMIS), the HMO has 90 days to resolve the encounter to priced status within the system. Non-Duplication of Care Management Services The Department developed the care management services defined in Article III. C., as a separate and distinct benefit for the Medicaid SSI managed care population. As a distinct benefit, the care management requirements defined in Article III. C., must be reported as such using encounter records. HMOs must not report these care management activities using the financial template typically used to report the HMO’s administrative activities. HMOs must have a process to ensure that care management activities provided to the SSI managed care population are identified and accurately reported as either a benefit or as an administrative activity. A specific care management activity must never be deemed both a benefit and an administrative activity. For example, a general reminder call to SSI members about the availability of seasonal influenza vaccines cannot be reported both as an encounter and as an administrative activity. The HMO is responsible for ensuring that these activities are clearly defined and categorized. Services outside the allowed Medicaid-covered services and the ...
Sample 1

Related to Care Management Billing Rules

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