Clarification Regarding Submission of DMH Claims and the SMART Act 180 Day Timely Filing Edit


 

ILLINOIS DEPARTMENT OF HUMAN SERVICES DIVISION OF MENTAL HEALTH MEMORANDUM

DATE: August 19, 2014

FROM: Mary E. Smith, Ph.D.
Associate Director
Decision Support, Research and Evaluation

RE: Clarification Regarding Submission of DMH Claims and the SMART Act 180 Day Timely Filing Edit


The purpose of this document is to:

(1) Review the conditions of the 180 day timely filing edit for submission of claims required as a result of the SMART Act (Public Act 097-0689) as outlined in the HFS provider notice dated July 23, 2012 (http://www.hfs.illinois.gov/assets/072312n.pdf) and

(2) Clarify questions that have arisen with regard to the submission of claims and remediation of errors in keeping with the 180 day timely filing edit.

The provider notice states the following: "To be eligible for Medicaid reimbursement, providers and suppliers must file claims within a qualifying time limit. A claim will be considered for payment only if it is received by the department no later than 180 days from the date on which services or items are provided. This time limit applies to both initial and resubmitted claims. Rebilled claims, as well as initial claims, received more than 180 days from the date of service will not be paid".

The Department of Healthcare and Family Services and the DHS Division of Mental Health expect that DMH contracted providers will meet the requirements set forth in this provider notice. Further, DMH expects providers to comply with DHS/DMH requirements for registering individuals prior to submitting claims. There are some situations however, that are occasionally encountered that may result in exceptions being made to the timely filing rule. These exceptions are described in the 7/23/12 provider notice referenced above. The exception described in the fourth bullet point of the notice is generally most applicable to DMH providers: "[For] Errors attributable to the department or any of its claims processing intermediaries which result in an inability to receive, process, or adjudicate a claim, the 180-day period shall not begin until the provider has been notified of the error". The errors to which this exception may apply for DMH contracted providers includes claim rejections for issues associated with multiple RIN issues, missing registrations, and/or authorizations as a result of data exchange issues between HFS and DMH's ASO, The Collaborative, or updates to provider/DMH contract information which are made by DMH staff.

Providers are most likely to be notified regarding these errors through the following sources:

(1) Review of remittance advice issued by HFS showing the results of claims adjudication including errors codes for claims that are rejected;

(2) Review of registration results files generated by the Collaborative which are produced within 24 hours of the submission of batch registrations, or immediately following the submission of registrations through Provider Connect;

(3) Review of "On Demand" reports that providers may create using The Collaborative ProviderConnect report generator showing client level detail and results of HFS processing of claims which is updated on a weekly basis and

(4) Through special notices issued by HFS and/or DMH. Community mental health providers will meet the criteria for an exception for the timely filing edit for DMH claims when there has been contact with an HFS billing consultant in a timely manner so that HFS can work together with The Illinois Mental Health Collaborative and DMH to resolve the issue(s).

HFS, DMH and The Collaborative have worked extensively to establish a protocol whereby data exchange issues are resolved in the most efficient manner possible so that providers may re-bill as soon as possible, typically within the 180-day timely filing deadline. However, the ability to resolve the issues in a timely matter requires prompt attention and follow-up by DMH providers on registrations, authorization, multiple RIN or claims related issues with the HFS Billing Consultants and/or The Collaborative and/or DMH when these issues are identified. Only those issues discussed with HFS through timely provider contact and addressed with VO and/or DMH on behalf of providers will qualify for an override when the 180 day timely submission period runs out during the process of resolution. Approved exceptions for these issues, and other exceptions referenced in the provider notice (if applicable) require an override authorization by HFS staff that must be entered into the MMIS by HFS staff prior to claim submission or re-submission.

If you require assistance, as previously communicated, the CMHC billing consultants at HFS may be reached at 877-782-5565. Please press '0' for the operator and ask to speak to a 'community mental health billing consultant'. Customer Service telephone numbers for issues impacting registration, authorizations, multiple RIN issues and submission of claims are displayed in the table below. Also, please note that all providers are encouraged to sign up to receive HFS provider notices directly to stay abreast of potential changes or additional information related to the submission of mental health claims. If you have not signed up, you may do so at: http://www.hfs.illinois.gov/provrel/.


Customer Service Telephone Numbers

Reasons for Call Contact Number to Use
Claims/Billing Issues

HFS Bureau of Comprehensive Health Services 877-782-5565,

Press "0"; ask for a Community Mental Health Support Consultant


HFS EDI Help Desk: 217-524-3814

Registration/Service Authorization
  • For a provider to pre-authorize care
  • Inquire about an existing authorization
  • Or for registration questions

The Collaborative (866) 359-7953, select the provider menu, then

press 1.

Technical difficulty with the Collaborative

system such as:

  • Account disabled
  • System "freezing" or crashing
  • System unavailable errors
EDI Help Desk (888) 247-9311
Utilization Management (Clinical)

The Collaborative (866) 359-7953, select the provider menu, then

press 1.

IntelligenceConnect Reporting Issues EDI Help Desk (888) 247-9311
No RIN or Social Service Package B Issues

DHS/Customer Support:

Jay Hidalgo (800) 385-0872

Multiple RIN Issues

The Collaborative (866) 359-7953, select the provider menu, then

press 1.

DMH Policy Issues DMH Regional Staff