Provider Notice issued 10/27/11

​Update Regarding Mental Health Direct Billing to HFS

Pursuant to Public Act 096-1405, HFS began accepting DHS-DMH funded community mental health services claims on July 1, 2011. During the week of October 10, 2011, the department completed its implementation of the Mental Health Direct Billing Project by beginning to adjudicate the provider submitted claims. During these initial adjudication runs, HFS processed over $11 million dollars in services that are being submitted to the Comptroller to be issued to providers.

Following the adjudication cycles, HFS performed an analysis of claims that rejected and identified an unexpectedly high occurrence of the error codes identified below. Of these codes, the error codes G82 and G85 occurred more frequently than other codes. Upon further review, it was determined that issues with the submission of authorization data resulted in this increased occurrence rate. To resolve this matter, HFS is working with DHS-DMH to remediate the problem. Until this issue has been addressed, the department will hold claims received after 10/24/2011 that would have rejected with G82 and G85 errors to reduce the rejection rate and minimize the impact on providers' billing systems. Once the issue has been remediated, HFS will begin to adjudicate these bills again, using the updated authorization data.

In an effort to alleviate the burden upon community mental health centers, HFS will work with DHS-DMH to re-process claims that were rejected prior to 10/24/2011 with the errors of: G82, G85, and H03. The departments jointly estimate that the claims will be reprocessed and sent to the Comptroller by mid-November.

All other claims adjudicated prior to 10/24/2011 that rejected for an error code other than G82, G85, and H03 will need to be reviewed by the submitting provider; have the issues causing the rejection addressed; and, resubmit the rejected claim to HFS for adjudication and reimbursement.

Common Rejection Codes

Providers should take this opportunity to review their billing processes and ensure they are utilizing the appropriate taxonomy code for community mental health services and they have all of the appropriate National Provider Identification Numbers on file with the HFS Provider Participation Unit. Addressing these issues along with ensuring that all necessary information is on file with HFS will result in fewer claim rejections.

Providers seeking assistance with billing issues should contact the HFS Bureau of Comprehensive Health Services (BCHS), during regular business hours, at 877-782-5565. When prompted, providers should select "Option 0" and, when speaking to an operator, request to speak to, "A community mental health support representative." Additional resources may be found at the Community Mental Health Centers Web site.

DHS-DMH has established a limited pool of funds available to assist community mental health providers that may be experiencing cash flow hardships. DHS-DMH providers may request an advance payment to bridge the processing delays by contacting their DHS Regional Office. These advance payment requests should not exceed the estimated payable value of invoices submitted to HFS. Any advance payment made shall be recouped in full at a future time, pursuant to the terms agreed upon between DHS-DMH and the provider at the time the payment is issued.

Theresa A. Eagleson, Administrator Division of Medical Programs

Lorrie Rickman Jones, Ph.D., Director DHS/Division of Mental Health