| To: | Participating Physicians, Participating Community Mental Health Centers |
| Date: | October 13, 2016 |
| Re: | Psychiatric Services Provided Within Community Mental Health Centers (CMHCs) |
The purpose of this notice is to inform participating physicians partnering with participating Community Mental Health Centers and billing the Department of Healthcare and Family Services (HFS) that the Department is adding an enhanced payment for certain fee-for-service psychiatric services.Physicians who render services in a community mental health setting are eligible to receive the enhanced payments for dates of service July 1, 2016 – June 30, 2017. In order to receive the enhanced payments, physicians must bill the applicable procedure code with the “UB” modifier and designate the community mental health center as the payee.Please note the community mental health center must be listed as a valid payee on the physician’s provider file.
The updated Practitioner fee schedule includes a tab with the enhanced payment to providers for fee-for-service psychiatric services provided between July 1, 2016 and June 30, 2017.
Resolution for claims with dates of service on or after July 1, 2016 that were submitted and paid, or are pending payment, prior to programming implementation for the add-on payments:
Providers may submit a void & rebill or a replacement claim. The Department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.
Replacement Claims – To replace a single service line or entire claim, enter Claim Frequency “7.” Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.
Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.
1.) To electronically void a single service line or an entire claim, enter Claim Frequency “8”. Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292 (pdf), instructions for which may be found in Chapter 100, Appendix 6.
2.) Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.
Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Felicia F. Norwood
Director
