September 1st is the published date for a very important change in how Medicaid Managed Care Companies will be reimbursing for Mental Health Services. While documentation from the Managed Care Companies has been sparse, the little information that we do have indicates that your IMA configuration will need to be changed in a number of ways.

If you are in possession of any specifics regarding insurance plan billing or would like to discuss the IMA design for these changes, please contact Barry (zevi@imasys.com).  

Here are the details we have collected thus far. The programming changes to support all this have been incorporated in version 19.2 and the tentative release date for this version is September 4th.

This email is meant to clarify what you can expect from IMA in preparation for these changes.

Patient Billing Header
"COPS-Only" billing will end. Managed Medicaid patients should no longer have "MD" active in their billing order and the Managed Medicaid flag in the billing header will become obsolete. Please note that MD should not be deleted from the order. It should be expired so that services prior to 9/1 bill properly.

Insurance Plan definitions and payer setup

1. Institutional Format: Insurance plans will likely require that billing be in the "Institutional" format (UB04) instead of "Professional" (HCFA). This would enable them to use the 3M grouper for processing payments.  
2. Activity code switching: Activity code switching files for these plans may no longer be needed. Many of these were put in place only to handle the COPS Only billing.
3. Fee schedules: Plan fee schedules should be updated to reflect the new "government rates". Agencies who use the 3M grouper interface will soon be able to use it for these plans as well.
4. Service Billing: Institutional claims (UB) can be printed in service billing. A feature is being added to page these by date and to include a Medicaid rate code. This should allow a simplistic mode of APG billing for these payers. 
5. APG billing: Agencies should consider switching to the APG billing module for billing these services. Doing so, requires that the activity codes and payer record be changed to indicate APG billing. Please note that this module currently only supports electronic billing. It will not produce a "printed" UB04 form. We hope to add this feature in the next few weeks. This might be a good opportunity to move to electronic billing to these payers
6. Unlicensed Medicaid Service Providers: Agencies might need to send the "default" MMIS numbers to identify unlicenses providers (like is currently done for Medicaid). Within the APG module, this is configured in the "MD Unlicensed ID" fields on the Medicaid tab of the Payer record.  

If you feel you will need help in making these changes please contact the helpdesk  to schedule a time slot.         

Medicaid eligibility checking
The Medicaid eligibility checking program will be enhanced to check eligibility on Managed Medicaid clients even when they do not have "MD" in their billing order.