Do the client’s in question have a pre-paid health plan? That would override the waiver for SNV.
KELLY RADER
INSURANCE BILLING SPECIALIST
HENNEPIN HOME HEALTHCARE
763-425-5959 EX. 44
From: billers@list.mnhomecare.org [mailto:billers@list.mnhomecare.org]
On Behalf Of Salin, Tracy M
Sent: Tuesday, February 18, 2020 2:45 PM
To: billers@list.mnhomecare.org
Subject: RE: billing DHS for MA client who has a DD waiver
Exactly! Thank you! I wish I could get the lead agency social workers to understand this.
Tracy Salin
Billing Specialist
Fairview Range Home Care and Hospice
Phone: 218-262-6982
Fax: 218-262-1723
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Kelly Rader
Sent: Tuesday, February 18, 2020 2:36 PM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: RE: billing DHS for MA client who has a DD waiver
All of my waiver clients need a Service agreement # to bill for services. The waiver over-rides straight MA and will not pay if there is not a service agreement # entered on the claim.
KELLY RADER
INSURANCE BILLING SPECIALIST
HENNEPIN HOME HEALTHCARE
763-425-5959 EX. 44
From: billers@list.mnhomecare.org [mailto:billers@list.mnhomecare.org]
On Behalf Of Tuma, Darlene
Sent: Tuesday, February 18, 2020 2:24 PM
To: billers@list.mnhomecare.org
Subject: RE: billing DHS for MA client who has a DD waiver
the DD case manager should be putting the auths in
From:
billers@list.mnhomecare.org [mailto:billers@list.mnhomecare.org]
On Behalf Of Salin, Tracy M
Sent: Tuesday, February 18, 2020 2:15 PM
To: billers@list.mnhomecare.org
Subject: RE: billing DHS for MA client who has a DD waiver
So have you billed MA for skilled nurse visits for a client who had a DD waiver without getting authorization from the county and gotten paid?
Tracy Salin
Billing Specialist
Fairview Range Home Care and Hospice
Phone: 218-262-6982
Fax: 218-262-1723
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jessica Demarais
Sent: Tuesday, February 18, 2020 2:05 PM
To: billers@list.mnhomecare.org
Subject: RE: billing DHS for MA client who has a DD waiver
We have struggled with this as well. We primarily have Medicare/Medicare Advantage clients, so when we come upon a referral/new intake with MA/ waiver, it seems each scenario has been a bit different, depending on which waiver, and if
it’s straight MA with waiver, or a PMAP/SNBC type plan through a carrier, plus Medicaid waiver.
So far, the only time we’ve needed auth directly through the county worker was when the client had straight MA with CADI. In those cases, county worker approval needs to happen prior to start of care. We just continue to reach out to
county case workers on a case by case basis to ensure we are following all appropriate DHS guidelines. It takes a bit more time with new referrals, but unfortunately the DHS manual doesn’t really seem to match what we are hearing from county case workers.
We still request auth for Skilled Nurse Visits after the 9th visit for the Medicaid clients not getting auth through county worker approval.
I wish I had a more solid answer on this, and hoping someone else does because we have the same challenge!
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Salin, Tracy M
Sent: Tuesday, February 18, 2020 1:30 PM
To: billers@list.mnhomecare.org
Subject: billing DHS for MA client who has a DD waiver
I am having a repeat issue with getting authorization for clients who have MA and a DD waiver. The DD waiver case managers do not think they need to give authorization for the skilled nurse visits. I have gone back and forth with them multiple
times regarding the information on the DHS site that says skilled nurse visits for waiver recipients must be authorized by the case manager. Am I missing something? I have looked everywhere I can think within DHS because I keep getting told by the county
I am wrong even though I called down to DHS even and asked them point blank if I can bill skilled nurse visits and get paid without authorization from the county case worker and I was told no.
Tracy Salin
Billing Specialist
Fairview Range Home Care and Hospice
Phone: 218-262-6982
Fax: 218-262-1723
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