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Services
Provider Notice Issued 02/05/2019
Date: February 5, 2019
To: Participating Behavioral Health Clinics and Community Mental Health Centers
Re: Submission of Claims for Multiple Units of the Same Service Rendered to a Participant at Different Locations on the Same Date
Healthcare and Family Services (HFS) has become aware of a billing issue that community mental health centers (CMHCs) and behavioral health clinics (BHCs) face when providing multiple units of the same service (procedure/modifier combination), to one participant at different places of service (POS) on the same day. The billing guidance below applies to claims submitted for patients in a HealthChoice Illinois managed care organization, as well as traditional fee-for-service Medicaid.
While it has always been the Department’s policy for providers to “roll up” claims for services with the same procedure and modifier, recipient identification number (RIN), date of service (DOS), and POS combination, the system is not programmed to accept the multiple POS codes introduced effective with the August 1, 2018 CMH fee schedule on the same DOS. The HFS system is programmed to recognize only one “on-site” and one “off-site” POS per procedure/modifier and RIN combination per day.
Providers needing to submit multiple units of the same procedure/modifier combination rendered to one participant on the same DOS at different locations should use the following table to determine the appropriate POS code for use in claim submission:
|
Two or more different ‘On-Site’ POS on the same day |
Two or more different ‘Off-site’ POS on the same day |
CMHCs |
53 |
99 |
BHCs |
11 |
99 |
HFS will provide guidance at a later date regarding the selection of POS codes for “rolled up” claims once additional system updates have been completed.
Note: When submitting a claim for a single service rendered (i.e. not “rolled up” services), providers must utilize the true POS consistent with the policies detailed in the Community Based Behavioral Services (CBS) Provider Handbook. Additionally, when utilizing the interim guidance provided in this notice, the provider remains responsible for documenting the true POS in the participant’s clinical record.
Questions regarding this notice should be directed to the Bureau of Behavioral Health at
217-557-1000 or HFS.BHCompliance@illinois.gov.
Kelly Cunningham
Interim Medicaid Director