Virginia medicaid billing manual

Toggle navigation Navigation. Following is some information that was discussed at that meeting, and answers to questions that were asked there. Have more questions? Email admin virginiaaba. ABA starts on page This service was difficult for in-home providers since it was geared toward a clinic asking for temperature of water, number of fire extinguishers, etc.

This service was not specifically ABA and encompassed other professions in addition to behavior analysis. In January , Category 1 codes went into effect for behavior analysts. This was a behavior analyst-led initiative, and the codes are approved by the American Medical Association but put forth by a Coding Coalition made of behavior analysts. For more information, see www. One of the service enhancements is Multisystemic Therapy MST and the correct code for that service is H, the same code that is being used by Behavioral Therapy.

Follow Virginia Medicaid on YouTube for these and other trainings. These answers are accurate to the best of our knowledge and not officially approved by DMAS. If you receive conflicting information, please email admin virginiaaba. I understand that I cannot bill for indirect work, like supervision without the client present, data analysis, and materials creation. How am I supposed to keep behavior technicians if they do not get paid for that anymore? Why has the BT rate been lowered? Here are two articles that may be useful for you: Understanding the difference between operating expenses and overhead What to consider when setting salaries and hourly rates.

In the manual for public comment, LABAs were equated to Behavioral Technicians technically unlicensed persons and not able to supervise. Will this be the case when the manual is approved? Is supervision required weekly as it said in the draft manual? Will pre-existing authorizations for H be honored until their expiration date?

Or do they need to be resubmitted? Do individuals need a diagnosis of autism spectrum disorder in order to receive ABA services reimbursed by Medicaid? Will there be a new authorization form specifically for the ABA service? Are both a day and quarterly review required? How much family treatment is needed each week? With what services can and cannot ABA be authorized simultaneously? Is a letter of necessity from a physician still required?

Will ABA be reimbursable if provided in a school? Services provided by a local education agency. ABA may only be provided in the school setting when the purpose is for observation and collaboration related to behavior and skill acquisition not direct therapy and services have been authorized by the school, parent and provider and included in the ISP.

There will be more information in the FAQ about which codes will be billable by LBAs and LABAs in the schools, but will not be included and Medicaid will not cover services performed by a behavior technician in the schools. This bill led to a budget amendment that, pending approval from CMS, will expand opportunities for cost-based reimbursement to schools for covered services provided to FAMIS and Medicaid members to those who do not have IEPs and to include a broader list of services.

It is important to understand that each school make s the decision of the services for which they will seek reimbursement, if at all. In order for reimbursement to occur, all of the following conditions must be met:. Therefore, SB is NOT for private LBAs to be reimbursed in schools, but rather for schools to be reimbursed for work that their employees or contractors perform.

For current authorizations that extend past November 30th, we are seeing one code, with a bank of hours. The West Virginia Bureau for Medical Services would like to make this section of our website another helpful device for providers. BMS will list Frequently Asked Questions in an effort to provide yet another educational resource for providers.

Providers should make it a practice to consult the WV Medicaid Provider Manuals for policy and procedure information. Molina Medicaid Solutions is available to assist the provider community with billing questions, member eligibility, claim status and other inquiries regarding West Virginia Medicaid. The Molina Automated Voice Response System and Molina Web Portal are valuable tools for checking claim status, payment information, and eligibility verification.

Molina Healthcare can be reached at or or visit their website at www. How can I obtain eligibility information for a Medicaid beneficiary? At the time of service, ask the patient for all insurance information which includes primary insurance, Medicare and Medicaid.

You may also check member eligibility through the web portal www. You will need a web portal account and a Trading Partner Agreement in order to use the web portal. Can I bill the patient for services WV Medicaid denies? Medicaid eligible individuals can be billed by the provider for services West Virginia Medicaid denies under the following circumstances: 1 client was not Medicaid eligible at the time of services, 2 service rendered to the client is not a Medicaid covered service, 3 service rendered to the client exceeds Medicaid Program coverage or service limitations.

Providers who will not accept the WV medical card must tell the patient before the service is provided that they will not bill Medicaid. For your own benefit, we suggest you have the patient sign a statement acknowledging they will be responsible for the bill and want to continue treatment. Can you tell me why my claim denied? Claims can deny for numerous reasons. The access standards are located in the Virginia Premier Provider Manuals.

They are also posted annually in the Provider newsletter as well. Hard copies are available by contacting Network Development, option 6. If there are any relevant changes they are posted on the website, quarterly Provider newsletters and special notices sent to Providers. If you suspect fraud being committed by a Member or Provider, please contact our Program Integrity Manager at ext. You can remain anonymous and information will be kept confidential.

How do I enroll in a plan for myself or my family? How do I access the member portal? How do I find an in network doctor or hospital? How do I contact Virginia Premier?

What is health insurance and why is it important? Medicaid Provider Resources. Education Meetings. Moore virginiapremier. Carter virginiapremier. GrahamKemp virginiapremier.

Binga virginiapremier. Franklin virginiapremier. McPeak virginiapremier. Webb virginiapremier. Dooley virginiapremier. Keeling virginiapremier. Clarke virginiapremier. Pearsall virginiapremier. Mitchem virginiapremier. Shaw virginiapremier. Orr virginiapermier. McIntosh virginiapremier. Evans virginiapremier. Frequently Asked Questions.