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IMA Admin Update
APGs Week 2
January 9, 2012
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IMA Admin Update
It is one week after the activation of APG billing and "so far so good". Below is a compilation of tips based on what we have learned this past week. Please make sure to notify us of any problems you encounter as you continue through this transition.
APGs
- IMA Version: If you have not done so already, please make sure to upgrade to version 19.1 ASAP. It has all the new features mentioned below
- Medicaid Restricted Recipients: The referring provider for a Medicaid Restricted Recipient must be a person and not an entity. Claim files are being rejected if any claim in the file has a referring provider as an entity (code 2). We are updating the billing programs to never send this, but meanwhile please check these collaterals to make sure they are configured properly.
- Service Billing: The regular service billing modules must still be used for for all Non Medicaid billing and even for Medicaid in a number of cases
- Medicaid billing prior to 1/1/2012: APG rates have not yet been loaded by Medicaid for services prior to 1/1/2012
- Medicaid "COPS Only" billing (for MH Clinics with client enrolled in Managed Medicaid) even for services after 1/1/2012
- Services Lookup: The IMA services lookup module has been enhanced to display on the main window, the CPT code and modifers for each billable service.
- Modifiers: If a service is to always be billed with a specific modifier, this code can now be added to the modifier table and then added to the activity code definition to be included in all billing for this service.
- Re-open billing file utility: The "Re-open billing file" utility has been modified to support APG claim files.
- MH Clinics
- Offsite services: Offsite services are to be billed with a separate set of activity codes because Medicaid is asking that they use a different rate code than the on-site services.
- Crisis Services: Please see the latest update from medicaid which indicates that Crisis services should be sent with their own rate code (not the same as all other MH Clinic Services)
Version 5010
- No known issues: A number of providers using IMA have moved to 5010 billing and there are no open issues or problems that we know of.
- Medicare forms: Medicare has indicated that an agency needs to fill out a "Trading Partner Request Form" to change over to 5010 claims and remittances.
- 5010 Remittance Denials: We have learned that in 5010 remittances, the payer is no longer sending claims with a "denied" status code (4). Instead they remit with a Paid status and an amount of zero. There is an updated version of the IMA remittance program now available that will treat this case as a denial for the purposes of posting and reporting.
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