Managed Health Services Blog

Managed Health Services (MHS) uses code editing software to assist in improving the accuracy of its claims processing, payment, and reporting. MHS will begin utilizing an updated version of our code editing software effective October 5, 2009.

The updated code editing software will ensure that MHS continues to process claims in accordance with generally accepted industry coding in collaboration with Indiana Health Coverage Program requirements.

The key enhancements offered include the following:

• Edits on all outpatient hospital claims to ensure proper coding and billing;
• A tool that bundles outpatient hospital services instead of paying line by line.
  i.e. reimbursement will be provided for “lab panels” instead of individual lab services;
• Reimbursement for bilateral procedures that will no longer require a right and left modifier to be billed. (Please follow standard bilateral billing practices.);
• Explanation of payments that provide increased detail on specific edit reviews.

While this tool provides enhancements for MHS, most other industry payers are already following the guidelines this tool will provide. The upgrade and the enhancement to the MHS claims process will allow for improved consistency with other payers.

On implementation, the Clear Claims Tool (the online coding assistant), on the Web Portal will be updated. MHS encourages providers to utilize the tool as it is an excellent guide to assist in correct coding of claims. Should you have any questions about this notification, please call MHS Provider Services at (877) 647-4848.

Other Upcoming Issues
In compliance with Indiana Health Coverage Program’s Provider Bulletin BT200928, MHS will follow The Centers for Medicare & Medicaid Services (CMS) guidelines requiring Present on Admission Indicators (POA) on all qualifying inpatient claims. As outlined within the banner, some hospitals are exempt from this requirement. MHS will be required to comply with this requirement for all dates of service October 1, 2009 and following. Non-compliant claims will be denied. Providers are encouraged to follow the MHS 60 day resubmission timeline.

This entry is filed under News, Providers.

We recently mailed the following letter and billing guide to providers regarding our new incentive program, the CentAccount™ Healthy Rewards card:

Provider Letter (PDF)
Healthy Rewards Billing Guide (PDF)

Dear MHS Provider:

In a dual effort to increase member’s participation in preventive care and in the support of HEDIS measures, Managed Health Services’ new CentAccount™ Healthy Rewards program gives members a monetary incentive through a flexible spending account for completing annual well-care / well-child visits and health screenings.

Members will receive their monetary reward loaded on a Debit MasterCard® that is sent to the member only after the first eligible PMP visit or screening has been completed. The CentAccount MasterCard will be accepted at participating groceries and pharmacies, and is restricted to the purchase of health-related items, such as over-the-counter medicine. The CentAccount can also be used at www.diapers.com to purchase items such as diapers and bottles, and at doctor offices that accept Debit MasterCard® for the payment of co-pays.

The following chart shows the HEDIS status of the eligible medical visits:

Your help with this initiative is crucial to ensure members are rewarded for the completion of their eligible medical visits. In order to confirm completion of an eligible visit, we ask that you use the appropriate billing and diagnosis codes. Only claims that are paid will be eligible for claims-based rewards.

The following chart displays the appropriate billing and diagnosis codes to use in order for the member to be rewarded for their eligible medical visit:

For your convenience, we have created a quick reference billing guide with the above billing information. You can download a copy of this guide at the top of this post, or you can request copies by calling Provider Services at (877) 647-4848.

If a MHS member has any questions about their CentAccount Healthy Rewards card, please direct them to our Member Services department at 1-877-MHS-4U4U (647-4848).

This entry is filed under News, Providers.

On Tuesday, August 11th, MHS and Cenpatico sponsored and participated in the Ribbon Cutting / Open House ceremony with Lake Ridge Schools, Community Health Net, Inc. (formerly Gary Community Health Center) and Regional Mental Health Center (formerly Southlake Community Mental Health Center and Tri-City Community Mental Health Center) in the opening of (2) School-Based Health Clinics, where the students and staff are able to receive comprehensive integrated preventive and primary medical and behavioral health care services on school grounds, including dental and vision services. The event took place in Gary, Indiana at Calumet High School, which is the location for one of the clinics. The other clinic is located at Grissom Elementary School. Both clinics will open Tuesday, August 18th staffed with a pediatrician, medical assistant, licensed clinical social worker, and a receptionist.

Click on a thumbnail to view the full-size image in a new window.

You can view more pictures from this event on our event images page!

This entry is filed under Behavioral and Physical Healthcare Integration, Events, News, Press Release, Providers.

Visitors to the Hispanic Latino Music Day at the Indiana State Fair received health information, live music, and plenty of sunshine on the warmest day of the year, Sunday, August 9. MHS shared information in English and Spanish with fair-goers.

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You can view more pictures from this event on our event images page!

This entry is filed under Events, Members, News.

Shalom Health Center’s Annual Back-to-school Health and Safety Fair served a record-number of community members with health screenings, school supplies, and plenty of entertainment. Managed Health Services was a proud sponsor of this year’s event on Thursday, August 6.

Click on a thumbnail to view the full-size image in a new window.

You can view more pictures from this event on our event images page!

This entry is filed under Events, Members, News.