Waiver and transportation claims to be reprocessed and mass adjusted

Waiver and transportation claims to be reprocessed and mass adjusted

The Indiana Health Coverage Programs (IHCP) has identified that waiver and transportation claims billed with modifiers U3, U7, or HW submitted on January 29, 2014, with dates of service on or after July 1, 2013, were erroneously subjected to audits 9110-9120 and 9122 and denied. The table below provides a list of the audits and the Explanation of Benefits (EOB) messages providers received. These claims will be mass reprocessed or mass adjusted. Reprocessed or adjusted claims will begin appearing on the provider Remittance Advice (RA) dated February 11, 2014, and can be identified by internal control numbers (ICNs) that begin with a region code of 56 (adjusted) or 80 (reprocessed).

Audit

EOB Message

9110

1915I CHILD HABILITATION SERVICE (INCLUDING SKILLS TRAINING AND DEVELOPMENT, PER 15 MINUTE UNIT) LIMITED TO 12 UNITS (3 HOURS) PER DAY

9111

1915I CHILD HABILITATION SERVICE (INCLUDING SKILLS TRAINING AND DEVELOPMENT, PER 15 MINUTE UNIT) LIMITED TO 120 UNITS (30 HOURS) PER MONTH

9112

1915I CHILD ROUTINE HOURLY RESPITE SERVICE (15 MINUTES PER UNIT) LIMITED TO 28 UNITS A DAY

9113

1915I CHILD ROUTINE DAILEY RESPITE SERVICE LIMITED TO 1 UNIT A DAY

9114

1915I CHILD RESPITE CRISIS DAILY SERVICE, RESPITE ROUTINE DAILY SERVICE, OR RESPITE DAILY IN MEDICAID CERTIFIED PRTF MAY NOT BE BILLED ON THE SAME DATE OF SERVICE

9115

1915I CHILD RESPITE CRISIS DAILY SERVICE LIMITED TO ONE UNIT A DAY

9116

1915I CHILD TRAINING & SUPPORT SERVICE FOR UNPAID CAREGIVER (COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES) LIMITED TO 8 UNITS A DAY

9117

1915I CHILD TRAINING & SUPPORT SERVICE FOR HOME CARE TRAINING BY A FAMILY CAREGIVER AND HOME CARE TRAINING BY A NON-FAMILY CAREGIVER ARE LIMITED TO $500 A YEAR TOTAL

9118

1915I CHILD RESPITE CARE SERVICES, UP TO 15 MINUTES AND RESPITE ROUTINE DAILY SERVICE MAY NOT BE BILLED ON THE SAME DATE OF SERVICE

9119

1915I CHILD RESPITE CARE SERVICES, UP TO 15 MINUTES AND RESPITE CRISIS DAILY SERVICE MAY NOT BE BILLED ON THE SAME DATE OF SERVICE

9120

1951 I CHILD RESPITE DAILY IN MEDICAID CERTIFIED PRTF LIMITED TO 1 UNIT A DAY

9122

T2022 HA-WRAPAROUND FACILITATION LIMITED TO 1 UNIT PER MONTH