New Payment Edit Preventing Erroneous Payments Under Multiple Waivers

DATE: April 16, 2010

TO: Developmental Disability Community Agency Providers, ISCs, Avenues to Consumer Employer Services & $upport, Inc.

FROM: Reta Hoskin, Associate Director, Division of Developmental Disabilities

This memorandum is to inform you about a payment edit that will impact billings for any individuals authorized on or after January 1, 2010, for the Developmental Disabilities (DD) Adult Waiver, the DD Children's Residential Waiver, or the DD Children's Support Waiver, who are also enrolled to receive services under another of the State's nine Waivers.

As you know, we are unable to submit claims for federal Medicaid funds for the same individual under two or more Waivers at the same time. Our authorization letters inform individuals and providers that all services from any other Medicaid Waiver must be closed prior to the start of services from any of the DD Waivers.

Currently, Division staff has been monitoring issues regarding multiple Waivers through manual efforts. As part of our work to maximize our Medicaid resources, we are enhancing our billing system to assist us in ensuring compliance with the existing requirements.

Effective May 3, 2010, bills submitted for DD Waiver services for individuals authorized on or after January 1, 2010, will reject if the individual is enrolled in another Medicaid Waiver.

If you submit a bill for an individual who is in another Medicaid Waiver Program, you will receive one of the following Billing Reject Codes:

  • 6P Individual is in the Aging Community Waiver
  • 6Q Individual is in a DRS Waiver (Brain Injury, AIDS, or Physical Disability)
  • 6R Individual is in the DSCC Children's Waiver
  • 6S Individual is in the Supportive Living Waiver

Bills submitted for DD Waiver services for individuals whose multiple services were grandfathered in due to past Medicaid conversions will not be impacted by this new payment edit.

Thank you for your attention to this matter.