IMA
IMA Admin Update
May 29, 2013
 

OMH Claims Readjudication is finally here
OMH has announced that APG Claims reprocessing for service dates 10/1/2010 - 12/31/2011 will begin on the remittance for 6/3/2013. They say they will reprocess two weeks of services at a time for 33 weeks.

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.
  • System Administration: Review activity code definitions of activities in effect for those dates of service and confirm that they are set for APG billing and have the correct APG rate codes.  
  • Billing for services not previously billed (either health services or secondary services that had been previously excluded)
    • Exclusions: Use the Denial/Exclusion tool to "Re-open" Medicaid excluded claims for date range of re-adjudication. This will allow them to be added to the Medicaid claims. Use the selection criteria in the module to list all applicable services and re-open them in a single update.

    • New Services: Update the date ranges for the IMA "Add-on" services module to create after hours billing for these dates of services. This can be done with the help of the IMA helpdesk. If you do not use this module, then the configuration of the legacy after-hours function needs to be updated

  • IMA Grouper: The IMA grouper will be used to create new claims or adjustments to existing claims for the date range that Medicaid has re-adjudicated
    • Use "Add/Update claims" for date range of readjudication to create new claim records
    • Use the "Check status" button to automatically mark these new claims as paid if they were already readjuducated
    • Use the "Check for adjustments" button to find claims that now need to be adjusted in order to add services.
    • Over 90 reason codes: Set the over90 reason code to "11" for these adjustments   
  • APG Billing Batches: Create billing batches as needed for these old dates of services. 
These instructions are based on what we expect to happen. We will monitor your feedback over the next few weeks and update everyone accordingly.

Please contact the helpdesk if you have further questions or if you would like to schedule some consulting time to help with this process.

 

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