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Attention residential treatment providers: Modified billing codes
Effective May 3, 2015, billing codes for residential treatment services covered in Medicaid Clinical Policy 8D have been modified to comply with federal Medicaid regulations. Read more in the state's Joint MCO Communication Bulletins and in Bulletin J133.
The following Smoky benefit plan codes and contract details have changed. Existing codes for Level IV and Level III (4 beds, and 5+ beds) will be end-dated May 2, 2015. New codes are effective May 3.
|
Service |
Old code ending May 2, 2015 |
Effective May 3, 2015 | |
Level IV |
H0019 U5 |
H0019HK | |
Level 3 < 4 beds |
H0019UQ |
H0019HQ | |
Level 3 5 + |
H0019US |
H0019TJ |
Providers are required to make the following changes regarding transactions:
Claims: Providers should file claims using the old codes through date of service of May 2, 2015, and claims using the new codes beginning date of service May 3, 2015.
Authorizations: For all current or prior approved residential treatment authorizations, Smoky will end date existing authorizations and enter new authorizations for remaining units of service with these modified codes through the end of the existing authorization. Providers must use the new codes for any new Service Authorization Request effective May 3 or thereafter. A provider whose authorization request has dates both prior to and after the May 3 date should submit two separate authorizations.
For more information or questions for Care Management staff regarding authorizations, email UM@SmokyMountainCenter.com or call 828-225-2785, ext. 1902. For claims-related issues, email Claims@SmokyMountainCenter.com, 828-225-2785, ext. 2455. | 
