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Substance Use Disorder (SUD)

Add to Provider Service
Collecting SUD Claiming Data
Claiming MA Comprehensive Assessment & Treatment Coordination

Carrie Kisor – Nicollet County

Ranae Eichstadt – Scott County

Rose Fischer – Brown County

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ADD TO PROVIDER SERVICE

1. DHS 5259 (not 5259A) Disclosure of Ownership

Complete if there is a change. Most counties will not have to complete.

For example Brown County had an interim Director at the time. Most counties will not need to complete this.

2. DHS-3491 Behavioral Health Fund (BHS) Provider Assurance Statement

Fill in Provider data, read requirements, initial requirements (Social Services Supervisor completed in Brown County)

3. DHS 7820 SUD Provider Assurance Statement-Counties and Tribes

Fill in Provider data, initial services county will provide

4. Certificate of Insurance Coverage

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1. Disclosure of Ownership and Control Interest of an Entity DHS 5259

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DHS 5259 (continued)

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2. Behavioral Health (BHF) Provider Assurance Statement DHS-3491

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DHS-3491 (continued)

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3. Substance Use Disorder (SUD) Provider Assurance Statement-Counties and Tribes DHS-7820

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4. Certificate of Insurance Coverage—Note provider page states “Proof of general liability insurance in the amount of $2 million for each occurrence.” As per statute counties have a limit of $1.5 million per occurrence. There is an exception in SUD statute noting counties limit of 1.5.

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Helpful Information

1. DHS Assurance Statements need to be completed, sent and approved (not sure DHS notifies of approval) before signing up with MCO’s or PMAP counties
2. Add SUD (and other county topics) update emails to your DHS subscriptions (see slide 4)
3. If Provider questions call Provider Call Center 651-431-2700 or 800-366-5411

Additional Provider Information (training/updates/sign up to receive email notices, etc) on MNITS sign on screen-right column.

4. MCO claiming: contact appropriate health plan for requirements. MCO list and contact information on MNITS :

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Helpful: Subscribe to SUD (and other updates/memos)

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Go to MNITS sign on screen

Find at bottom of your current SSIS update email.

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Collecting Data to Bill CD Comprehensive Assessments

Our CD case mangers fill out a CD Treatment Assessment form when needed to bill either MA or our PMAP plans for an Assessment. This gives almost all the information needed to bill besides the clients PMAP ID which is retrieved from the PMAP websites. Make sure to verify insurance information as well.

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From there I have a master Insurance Tracking spreadsheet I use to collect all information in order to bill for the Assessments and Treatment Coordination. Below is a sample of the spreadsheet

Note: This spreadsheet needs to be updated monthly if the client workgroup is still opened due to clients flipping on and off PMAP plans.

Note: You may only bill two assessments per calendar year

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Here is another sample of the spreadsheet Scott County uses.

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To verify I received all the billing forms for the month, I also run a report in SSIS. �Some counties do not require the Comprehensive Assessment Form from the Case Managers and just bills out of SSIS instead. �

Log into SSIS
From the Main Menu Select Tools
Select: General Reports
Click on the side triangle: Healthcare Claims
Click on: Time-No Automated Potentially Billable.

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Date Range: Enter the dates you want to run the report on
HCPCS/Mod Select: H0001
Service Select: 305 Rule 25 Assessments/Rule 24 Financial Elig. Determ
Report On Select: All
Then click on Search

You can customize your header by right clicking one of the header titles and Select Field Chooser
Right click on the header again to Print or Export your grid

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From there I use another spreadsheet to track my billings. I collect the information from the Assessment Billing Form, SSIS report, and the Insurance tracking spreadsheet. From here I enter the information I used to bill and track payments. I use separate tabs for each pay source.

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Here is another sample of the billing tracking sheet from Scott County.

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Procedure Codes & Rates

H0001 Comprehensive Assessment

MA-$162.24

Blue Plus-$162.24

Health Partners-$162.24

South Country Health Alliance-$200.00

Ucare-$165.16

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Collecting Data to Bill SUD Treatment Coordination

First your county should create a County Sub Service to pull out the information from SSIS and easily know which services to bill for. We used the description of Billable Treatment Coordination.

The worker uses this County Sub Service only if the time they are coding is billable to SUD Treatment Coordination.

Would recommend doing this prior to DHS approval to bill SUD Treatment Coordination so the workers do not have to go back and fix any of their time.

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Log into SSIS
From the Main Menu Select Tools
Select: General Reports
Click on the side triangle: Healthcare Claims
Click on: Client Time Detail.

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Max Results: Add a few zeros to the number so the report does not cut off at 500
Date Range: Enter the dates you want to run the report on
Program Select: 300-Chemical Dependency (General)
Service Select: 393-Service Coordination
Client Name: Leave Blank
Report On Select: All
Then click on Search

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��You can customize your report to your liking by right clicking on one of the header titles and Select Field Chooser. Here is what I use to pull my time.

Then use the Group By Box by right by clicking on one of the header titles.
First pull the Cnty Sub-Srv Description and then under that pull the Client Name.
Now right clicking again select View-Auto Filter.
In the filter (circled in red on example) click on it and only select: Billable Treatment Coordination

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��Another helpful tip: Have your report total all the time per client. That way you can double check that you have the correct amount to bill for the month.

Right click on the header titles again and then group footers.
Right click on the first footer and you should be able to Click on Sum

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Here is a sample of what the report would look like.
Right click on the header again to Print or Export your grid

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From there go to your master Insurance Tracking spreadsheet and update prior to billing since clients flip on and off PMAP plans.

You might remember this spreadsheet from the Assessments. I use the same spreadsheet.

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After you update your Insurance Tracker you will use another spreadsheet to track your Treatment Coordination billings. Collect the information from the Assessment Billing Form and Spreadsheet, SSIS report, and the Insurance tracking spreadsheet. From here I enter the information I used to bill and track payments. I use separate tabs for each pay source.

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Procedure Codes & Rate

T1016 HN U8- Treatment Coordination

$11.71 per Unit

1 Unit=15 min

Cannot bill over 8 units per day

There might be some days clients have 2 or more entries for that day. You will need to combine that time into 1 entry but you can bill multiple days for that month in one claim.

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Billing in MN-Its

Log in
Click Submit DDE Claims-Professional

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From the Subscriber screen enter client’s PMI# & DOB
Click Search (You should now see the client’s name)
Click Continue

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From the Claim Information Screen enter :

Place of Service
Patient Control Number (we use month/year SUD SVS) so that all these claims show up on the same area in the Remit Advice from DHS
Diagnosis Type “ICD-10”
Diagnosis Code (enter what the worker has entered is SSIS)
Click ‘Add’
Click ‘Continue’

**Make sure you have the correct POS or the claim will error out**

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From the COB screen

Click ‘continue’

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Service Screen-Enter the following:

Date of Service (From)
Date of Service (To)
Procedure Code
Line Item Charge Amount
Service Unit Count
Then click Save/View Lines
Review all Information & click validate

Procedure Codes & DHS Rates:

H0001: Comprehensive Assessments DHS Rate-$162.24

T1016 HN U8: CD Treatment Coord. DHS Rate: $11.71/unit, 1Unit=15 min

Only allowed to bill 8 units per day for CD Treatment Coordination.

Do not use Date Spans, each day = new line.

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From Services Screen Again

If you are claiming treatment coordination you can click on the Add button. This will allow you to add more dates that month but make sure you do not cross months.
After all information is entered click Validate

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Validate Screen

You want to see Claim Status “20” which means ‘Accepted for Processing.” Click ‘close’
If you see a claim status other than ’20’, you will need to look up that claim status code from Washington Publishing Company
http://x12.org/index/php/codes/claim-status-codes to find out what the error is.

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If everything looks correct—click ‘Submit’
From the Submission Response screen you will receive a message “This claim has been submitted for processing.”
In box 01 there will be a Control#, Total Charge and Paid Amt.

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If you do not have anymore claims for the client you can close.

If you have more billings for different months for the same client you can click on the Copy Icon to save a little time.

If you use the Copy button, please remember to change the date of service from and to, line item charge amount, and service units counted.

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PMAP Plans

Bill from your Clearing House
You will need the Diagnosis Code from SSIS
Make sure you do not use a date span, 1 day=1 line
When billing each line make sure you do not cross over months
Procedure Codes:

H0001 Comprehensive Assessment and T1016 HN U8-CD Treatment Coordination

Only allowed 8 units per day for Treatment Coordination

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Changes for pulling CD TX Coordination with the new release coming in SSIS (Mid Sept)

Once the new release of SSIS comes out they have added the activity of “Treatment Coordination”. Workers should be able to start coding time to this activity only if the time they are coding is billable Treatment Coordination.

Example of how workers will enter time in SSIS:

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From the Main Menu Select Tools
Select: General Reports
Click on the side triangle: Healthcare Claims
Click on: Time-No Automated Potentially Billable.

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Date Range: Enter the dates you want to run the report on
HCPCS/Mod Select: T1016 U8 HN-Treatment Coordination
Service Select: 393-Service Coordination
Report On Select: All
Then click on Search

You can customize your header by right clicking one of the header titles and Select Field Chooser
Right click on the header again to Print or Export your grid

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