Here is an update for week 2 of OMH claims re-adjudication.

 

 

The IMA Grouper

 

IMA has released a new version of it's grouper with two new buttons to help with re-adjudication.

  

The goal of these new tools is to give more visibility to Medicaid's re-adjudication process and to give the user the information needed to recognize which claims need adjusting and which do not. They can be used to resolve all issues mentioned in the previous email (CPT code changes, crisis visit units, Collaterals, and children's after hours)

 

1. Partial Re-adjudication tool

This is a tool designed to identify the specific case where a client has received payment from Medicaid on multiple services in a single day (Pre-APG) and only one of them is re-adjudicated. This tool also supports a specially designed void and adjustment process to allow medicaid to reprocess them accurately.    

 

2. Re-adjudication adjustments 

This is a broader tool that lists all paid Medicaid claims for the selected date range and shows information relevant to the re-adjudication such as CPT codes payment amounts, and exception messages and allows multiple claims to be selected and marked for adjustment.

 

The application of these tools at individual customers is somewhat complicated. Please contact barry if you would like to schedule some consulting time to review your agency's specific data. 

 

 

The 3M APG Grouper

 

Medicaid has published the APG blend and CSP rates retroactive to 10/1/2010. If you subscribe to the optional 3M grouper, please contact the helpdesk to schedule an update to your fee schedules.