Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP (NY): ABA Services Coverage update DOS 10/01/21 and thereafter

This blog post applies to physicians that are providing ABA ( Applied Behavior Analysis) services to MVP Managed Medicaid Patients.

Earlier this year MVP sent a notice to patients and Physicians that ABA (Applied Behavior Analysis) services will be covered for patients under 21 years old that have the MVP Managed Medicaid Plan, effective 10/01/2021

However, NY DOH (NY Department of Health) changed that for DOS 10/01/2021 and thereafter.

As of now ABA services are NOT COVERED FOR MVP Managed Medicaid Plans (for patients 21 years old and younger).

NY DOH will continue to cover the ABA Services for only Medicaid fee-for-service members, 21 years old and younger.

MVP is monitoring NY DOH and will make timely updates available as applicable.

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Posted in Insurance, My services, Training, Updates

Aetna Better Health of Louisiana (ABHLA)-Specialized Behavioral Health Claims-Reimbursement update

This policy applies to services performed in a facility: HCPCS and CPT codes

Aetna Better Health of Louisiana would like to remind providers that its Behavioral Health Reimbursement policy is aligned with the Louisiana Department of Health’s Medicaid Services. Providers need to check the Provider Manual regarding the proper billing practices for Behavioral Health Services. If the manual requires additional guidance for appropriate reimbursement, the details will be outlined by ABHLA in a supporting reimbursement policy.

To check the compliance with billing practices of the Louisiana Department of Health’s Medicaid Services, Aetna Better Health of Louisiana conducted an internal audit. ABHL found that many of the claims did not have the INDIVIDUAL PROVIDER as RENDERING provider but instead a FACILITY was listed as a rendering provider.

In order to comply with the proper billing and coding for these services, done in a facility setting, please put an INDIVIDUAL RENDERING PROVIDER NPI in the box 24J on the HCFA 1500.

Below are just some codes that might have been paid previously (with a facility NPI):

Claims with the Facility NPI listed as the rendering provider will be denied and paid claims may
be recovered by the health plan. Should you receive denials for this reason, you may rebill your
denied claim(s) as a corrected claim with the Individual Provider NPI listed as rendering for
ABHLA to reprocess and pay the claim(s).

Please note that providers may see reimbursement impacted if not aligned to the Louisiana
Department of Health’s Medicaid services manual within 30 days of the date of this notification.

Below is just a partial list of the Louisiana Department of Health’s Medicaid Services: Behavioral Health Services Fee Schedule:

For a full list of the Fee Schedule, please click here

Posted in Training, Updates

Aetna Reminder: Care Coordination is reimbursable.

As per September 2020 Aetna Provider Correspondence- Care Coordination is Reimbursable.

In order to qualify for payment for care coordination, patient must have a behavior health diagnosis.

Care coordination includes communication between the following:

+Behavioral health providers, such as therapists and psychiatrists

+Behavioral health and medical providers, such as psychiatrists and primary care physicians

Although, care coordination is available to Aetna Members at no cost, there are exceptions:

All Medicare plans and any high deductible health plan with a health savings account, until members meet the deductible.