Accommodation Services. January 2021

Accommodation

Services

Overview

• Provider Requirements

• Provider Responsibilities

• Covered Services

• Voucher Completion

• Claim Submission

• Online Claim Submission

• Paper Claim Form

• Electronic Billing

• Claims Denial

3

Provider Requirements

Provider Participation Requirements

All Providers

• All licenses and credentials must remain current to maintain an active provider enrollment

• All providers must follow all applicable state and federal law requirements • Hotel/Motel: business license, fire/safety inspection report, food service

permit if applying to provide meals as well

Provider Enrollment

For further enrollment

instructions and to submit an application, visit:

https://medicaidalaska.com/p ortals/wps/portal/Enrollment You can also contact the Provider Enrollment

department at 907.644.6800, option 2

5

Provider Participation Requirements

(cont.)

Out-of-State Providers

• Providers offering accommodation services outside the state of Alaska must hold all certificates and licenses required by law in the state that services are provided

Non-Enrolling Providers

• The provider types listed below do not directly enroll with Alaska Medical Assistance. Their services are arranged and billed through the Medicaid Travel Office, either CTM or the Tribal travel agency that arranged the travel:

‒ Commercial and charter air carriers ‒ Ferry

7

Provider Responsibilities

Accommodation Provider must:

• Follow all applicable Medicaid service and payment regulations when submitting claims for Medicaid reimbursement

• Be an Alaska Medicaid enrolled provider for the specific services provided • Verify identity of member (patient) and their approved escort, if applicable

‒ Identity of member and escort must match approved AK-04 forms provided by the member

9

Recordkeeping

• Recordkeeping requirements are documented in the Provider Agreements

• Although most recordkeeping requirements are consistent for all providers, some requirements are provider-type specific

• Providers must maintain complete and accurate clinical, financial, and other relevant records to support the care and services for which they bill Alaska Medical Assistance for a minimum of 7 years from the date of service

• Documentation for accommodation providers includes original vouchers completed with service details and any other documentation to support services rendered, such as hotel sign-in logs

• Providers are subject to audits, reviews and investigations

Providers must ensure their staff, billing agents, and any other entities responsible for any aspect of records maintenance meet the same requirements.

11

Service Authorization

• Service Authorization (SA) is required for all emergent travel services except non-emergent ambulance services

• SAs must be obtained prior to travel for services to be covered

• SAs must be requested by the referring or receiving providers; members and travel providers cannot request service authorizations

• SAs are documented on AK-04 travel vouchers by medical providers or care coordinators and given to Medicaid members to give to accommodations providers

Accommodation Services

• Includes lodging and, where available, meals up to the maximum daily rate for the eligible member, their escort, or both

‒ Members and escorts are expected to share a room

‒ Multiple hotel units will not be authorized for the member and escort during the same overnight stay

• Authorized only in conjunction with medical transportation while member is receiving medical care at a facility outside of their community of residence

• Not authorized if round-trip transportation is available and can be completed the same day

• Alaska Medicaid covers only the basic room rate

• The department will pay a single rate per night, regardless of the number of individuals staying in the room

Members Keep In Mind!

• Non-essential expenses (tips for services, phone calls, pay-per-view, room service, etc.) are not covered and are the member’s

responsibility

• Lodging providers may require credit card or deposit to secure room if that is the provider’s policy

13

Meal Services

• Meals are reimbursed at actual cost per meal not to exceed a total of $36 per

person per authorized day

• Not all lodging providers offer meals

Pre-Maternal Home Accommodations

eligible pregnant Medical Assistance members

• Authorized only when member is receiving medical care at a facility outside of their community of residence

• Intended for members awaiting delivery of child or for short-term care of mother and infant as authorized

– Eligible members include pregnant women and infants under the age of 1 year • All services require prior service authorization

• Pre-maternal home stays are not to exceed 30 days prior to delivery – Any days beyond 30 require physician’s medical justification

15

Voucher Completion

Travel Vouchers

AK-04, Transportation Authorization and Invoice

• Accommodation providers should receive original travel vouchers prefilled with all member and, if applicable, escort information

• All vouchers are original documents

• Each voucher will have its own serial number

• Payment will not be made for copied, scanned, emailed or faxed vouchers.

• Copied, scanned, emailed, or faxed vouchers will have the word VOID appearing in the background

• Providers must complete all fields applicable to the specific service provided and retain them as part of required documentation of services rendered

• Before accepting a voucher, please review to ensure that all required information is complete and legible, and that the voucher is not a duplicate

Travel Voucher Completion

• Patient name, date of birth, recipient ID # and sex should match information on the customer’s AK Medicaid ID

19

Travel Voucher Completion

• The Prior Auth. Number (Field 8) and authorizing individual (Field 10) must be completed for accommodations providers to be reimbursed for services

• Address, phone number, EPSDT referral and signature fields should be completed for information on the form to be complete

Travel Voucher Completion

• Origin and Destinations need to be cities, not specific addresses

• Destination field should match the location where you are providing services

• The date you are providing services should fall within the dates in the Round Trip or be after the One Way date fields • Ensure the voucher reflects the proper unit number and

type of services you are authorized to provide

• You would fill in your total charges for your services in the Charges column

21

Travel Voucher Completion

• If an escort is authorized, the Escort portion of the AK-04 will be complete; otherwise, it should be very clearly “X”ed out over the entire escort portion rendering that section void

• As for the Member section, make sure the date you are providing services is within the dates in fields 15 and 16 and that the

voucher reflects the proper unit number and type of services you are authorized to provide

Travel Voucher Completion

• The fields at the bottom of the form, shown below, are for the accommodation provider to complete – medical providers should not enter their information in this area of the form

• Enter the actual date or dates you provided services in fields 26 and 27

• Enter your total charges in field 28, any amount other insurance paid in field 29, and the amount due in field 30

• If you are using account, folio or similar numbers to track accounts, enter them in field 31 10/21/20 _10/23/20 $200.00 $200.00 Amazing Hotel 123 4th _{Ave, Anchorage, AK} 907-123-4567

Billing Manager

23

Travel Voucher Completion

• Enter your provider name and information in the field indicated

Member Information

• The information on the back of the vouchers is intended as travel information for members

25

Documentation Reminders

• As a reminder, accommodation providers must fully and accurately complete

these forms for documentation purposes

• Records of services to AK Medicaid members must be retained for 7 years from

the date of service

• For more information on these topics, please consider attending our Guidelines for

Record Keeping provider class

27

Claims Submission Methods

There are several billing options for submitting Professional format claims to

AK Medicaid

• Alaska Medicaid Health Enterprise Professional claim • CMS-1500 paper claim form

• 837P Transaction (electronic claim using billing software) – Companion Guide: http://medicaidalaska.com

Alaska Medicaid Health Enterprise

• Providers can submit claims through Alaska Medicaid Health Enterprise (“Health Enterprise”) • Must be enrolled with AK Medicaid and have an account on the portal

• Accessed through www.medicaidalaska.com

• When you bill through Health Enterprise, in addition to billing, you can: – Create templates for your commonly submitted claims

– Check claim status

– Adjust and void previously paid claims

29

Resources for Billing

There are resources to help you submit your claims

• Transportation/Accommodations Services Fee Schedule

• Non-Emergent Transportation and Accommodations Provider Billing Manual

Create New Claim

Starting on your Home page, hover over Claims, then over Create Claims and choose Create Professional Claim

Form View vs. 837 View

• There are 2 different views of the Health Enterprise claim form screens

• Form view is formatted to look like the CMS-1500 claim form and shows all fields in one continuous screen • 837 view has the same fields but is formatted somewhat differently and organized in tab sections

‒ There are some selections you will need to make in 837 view, though most of the claim can be completed in the CMS-1500 claim form view

33

837 View Fields

• Click the 837 View link in the upper right of the screen in order to make the

following selections:

– Billing Provider same as Rendering Provider – indicate yes

– Is the service accident related? - indicate no

Void or Replacement Claim

• Leaving the answer set to No moves you forward in creating your new claim

• The following process may be used to adjust claims that were originally submitted through Health Enterprise • If you want to adjust or void a previously paid claim, indicate Yes

35

Patient Information

• Enter the member information from the voucher form

• In the Release of Information Code field, select Yes, provider has signed statement • In the Patient Signature Source Code field, select Sign by provider, patient not present

Third Party Liability

37

Service Authorization Number

• Enter the SA number from the voucher into the Service Authorization # field

• Enter the Voucher Control ID # in the Referral field

• The Voucher Control ID# is in the upper right corner of the Travel Voucher form

• The Voucher Control ID is the letter T followed by 7 numerical digits

Diagnosis Code

• Select ICD Version 0

• If you have a specific diagnosis code for the member, enter it in field 1 of the Diagnosis Code section

• Otherwise, use the suggested code for your provider type

Provider Type

ICD-10

Codes

Hotel/Motel Z75.3

39

Claim Detail

• Enter your Service Date begin and end dates - must enter both fields

– Hotel/motel and pre-maternal home providers can bill for span dates, other providers must bill for single dates of service only

• For place of service, select Other Place of Service

• Enter the procedure code for the service you rendered – see the Fee Schedule for the appropriate procedure code

Claim Detail

• In the Diagnosis Pointer field, select First Diagnosis

• Enter your charge for services in the Line Item Charge Amount field

41

Additional Claim Information

• Enter additional claim information as required by *

• Enter your ID number for the transaction in the Patient Account # field – if you do not have an ID number for the claim (folio number or ticket number), enter a 1

• Enter total claim amount

• Select Other Place of Service

• In the Assignment or Plan Participation Code field, select Assigned • In the Benefits Assignment Certification, select Not Applicable

43

Pay-To Address

• This field defaults to Yes as per enrollment.

Billing Provider Information

• Enter information about the billing provider in these fields

Provider

Type

Taxonomy Code

45

Creating Templates

47

Creating Templates

49

Using Templates

Claim Forms

• Providers that submit paper claims must use the original red CMS-1500 version 02-12 claim form (older or obsolete versions are not accepted)

• Optical Character Recognition (OCR) technology used to process paper claim forms is unable to read black, photocopied, or faxed claim forms

• Black, photocopied, or faxed claim forms will be returned unprocessed to the provider

• To purchase CMS-1500 claim forms, contact the US Government Printing Office at 866.512.1800, local printing companies, and/or office supply stores

• You may submit claims, free of charge, through Health Enterprise

Paper Claim Form Font and Alignment

• A large percentage of paper claims are processed through a scanner that extracts the information from the claim. It is very important that providers ensure printed paper claim forms are legible and correctly aligned to prevent processing errors. Also, do not use red ink because the scanner is designed to overlook anything in red.

• Use a font that clearly distinguishes between all characters, such as “O” vs “0”, “I” vs “1”, and “2” vs “Z”

Can you immediately tell the difference between “O” and “0” or “2” and “Z”?

• The scanner can interpret information only if it directly resides within each field. If the alignment is off, data may be lost or misinterpreted.

53

CMS-1500

The Alaska Medicaid CMS-1500 Claim Form Instructions can be reviewed

on http://manuals.medicaidalaska.com/docs/ProviderReference.html

For these claim form instructions, any

field not discussed should be left blank

Fields 1 - 10

• Field 1, (M), Medicare/Medicaid/TRICARE/etc.

‒ Select Medicaid

• Field 1a, (M), Insured’s ID Number

‒ Enter the member’s 10-digit Alaska Medical Assistance identification number • Field 2, (M), Patient’s Name

‒ Enter the Medicaid member’s name as it appears on the eligibility card or coupon • Field 6, (M), Patient’s Relationship to Insured

‒ Select Self

• Field 10a, (M), Is Patient’s Condition Related to Employment?

– Choose No

• Field 10b, (M), Is Patient’s Condition Related to Auto Accident?

– Choose No

55

Fields 11d – 21

• Field 21, (M), Diagnosis or Nature of Illness or Injury – Enter 0 as the ICD indicator

– Enter the appropriate ICD-10 diagnosis code or codes – Alaska Medicaid recommends the following providers

use the following diagnosis codes when a documented diagnosis is not known

– The diagnosis pointer in field 24e refers back to this field

M = Mandatory C = Conditional O = Optional B = Leave Blank

Services

ICD-10

Hotel

Z75.3

Pre-Maternal Home

Z75.8

• Field 11d, (M), Is There Another Health Benefit Plan? ‒ Choose No

• Field 17, (M), Name of Referring Provider or Other Source ‒ Required for accommodation providers

‒ Enter the Control Number listed on the Travel Voucher in the Original Reference Number field ‒ The Travel Voucher Control Number begins with T followed by 7 numerical digits

Fields 22 - 24

• Field 23, (C), Prior Authorization Number

– All accommodation services require a Service Authorization

– Enter the alpha-numeric prior (service) authorization ID listed on the travel voucher • Section 24

57

Fields 24a – 24j

• Field 24a, (M), Dates(s) of Service

– Accommodation providers can bill for span dates, other providers must bill for single dates of service only

• Field 24b, (M), Place of Service – Enter 99

• Field 24d, (M), Procedures, Services, or Supplies

– Enter the procedure code indicating the service you are billing for • Field 24e, (M), Diagnosis Pointer

• Field 24f, (M), $Charges

• Field 24g, (M), Days or Units • Field 24i, (C), ID Qualifier

– Atypical providers – enter G2

• Field 24j, (B), Rendering Provider ID #

Fields 25 - 32

• Field 25, (O), Federal Tax ID Number • Field 26, (O) Patient’s Account No.

– If used, this provider-assigned account number will appear on the remittance advice • Field 27, (M*), Accept Assignment?

• Field 28, (M), Total Charge

• Field 31, (M), Signature of Physician or Supplier Including Degrees or Credentials • Field 32, (M), Service Facility Location Information

59

Fields 32a - 33

• Field 32a, (O) NPI# [Service Facility]

– If used, record NPI for the service location • Field 32b, (O), Other ID# [Service Facility]

– If used, record the other ID for the service location • Field 33, (M), Billing Provider’s Info & Phone #

– Submitted information should match demographics on the Medicaid Provider Agreement • Field 33a, (C),NPI# [Billing Provider]

– If the provider has an NPI, enter it here • Field 33b, (C), Other ID# [Billing Provider]

– Atypical providers must enter the G2 qualifier and billing provider’s Medicaid ID#

61

Practice Management Software

• HIPAA mandated 837 format (X12N/005010X222A1)

• Use existing practice management software to export files in a HIPAA compliant format and submit the files to Conduent electronically

• Your software vendor will know if your software can export an electronic file • Other transaction types are available as well as 837

Electronic Submission

• Service Authorization or Prior Authorization numbers are submitted in loop 2300 REF*G1*Pyyjul####

• Transportation Voucher or Referral ID are submitted in loop 2300 REF*9F*T####### • Do not use REF9* Claim Identification for Transmission Intermediaries

• Sample: CLM*acct number*14.43***99>B>1*Y*A*Y*Y REF*9F*T1234567 REF*G1*P123456789 HI*ABK>Z753 LX*1

63

Claim Denials

Claim Denials

• Edit code 1697 – indicates that there is no Voucher Control # in the Reference # field – Correct by resubmitting your claim and entering the voucher ID in the Reference #

field

• Edit code 1698 – indicates that the Voucher Control # is not the correct format

– Correct by resubmitting your claim and documenting the Voucher Control number from the voucher your client gave you in the Reference # field in the correct format

– The correct format for the Voucher Control # is the letter T followed by 7 numerical digits

• Edit code 6631 – Indicates the voucher ID # on the claim is a duplicate – Only one claim can be submitted for the services on a voucher

– If you need to add services to a claim that has been submitted for the services on a voucher, do an adjustment to add them to the already paid claim

65

Additional Resources

Additional Resources

• Alaska Medicaid Health Enterprise website at http://medicaidalaska.com

– Information necessary for successful billing

– Includes provider-specific Medicaid billing manuals and fee schedules • You may also call:

‒ Eligibility only – 907.644.6800, Option 1,2 or 800.770.5650 (toll-free), Option 1,1,2 ‒ Billing questions and all other inquiries – 907.644.6800, Option 1,1 or