OASAS Update   

UT Thresholds
OASAS has announced that they will begin UT processing of claim on 7/1/2012. This means they will check all billed services between 4/1/2011 and 3/31/2012 and take back monies based on the 75/95 visit thresholds.

There is a report available in IMA to analyze your liability for these reductions for both the past year and the current year. It can be found in the Medicaid/Medicare reports section. It was previously names UT 30/50 visit threshold report (based on the OMH rules) and has now been renamed to also reflect the 75/95 visit rules).


Claim Reprocessing

OASAS has announced that APG Claims reprocessing for service dates 7/1/2011 - 12/31/2011 will begin on July 16th. They say they will reprocess two weeks of services at a time for however many weeks it takes.

The IMA strategy for handling this is as follows: 

 

Prior to the Reprocessing: Nothing needs to be done. Additional services will be sent after the claims are re-processed NOT prior. 

 

Remittance: When receiving a remittance that contains reprocessed services please note two things before updating; The dates being reprocessed and if there are any "R" errors for posting of these reprocessed claims. Do not process if there are "R" errors. Please contact the IMA helpdesk first.  

System Administration: Update the effective dates for APG billing in both the Payer and in Program definitions to reflect the new effective date for APG billing

 

Denial/Exclusion tool: "Re-open" Medicaid excluded claims for date range of re-adjudication. This will allow the IMA application to add these services to the Medicaid claims. 

 

IMA Grouper:

1. 1. Add/Update claims for re-adjudication date range: This will create the claims in "Preliminary" status
   2. Update claims to "Paid" status: Use "Medicaid already billed" exception message to indicate which should be switched to "Paid" status
   3. Mark Adjustments: Use 'Not all services billed" exception message or 'Check for adjustments" tool to mark claims needing adjustment. These should be the ones that have additional services that need to be included.