Medicaid
What is the weekly cap for hours per client with Medicaid?
40 hours on a rolling week.
How do you add medicaid as the secondary insurance?
Edit client > insurance company > add medicaid behind primary. Add medicaid id, referring provider name/NPI/medicaid provider ID, and diagnosing provider and date.
What does awaiting submission mean?
Plan has entered queue for bot submission.
A new staff reports they are having trouble with evv. What tools can you give them?
1) EVV user guide located on the help page or in the home page bot.
2) Set up call to review how to use if still having issues.
How long do you have once a auth request gets pended for information?
48 hours
What code must be billed to use 97155?
97153 must be billed to utilize 97155
Do you need to open the medicaid secondary auth for billing?
No, BIPs/auths/billing are done behind the scenes.
What does this error in submission mean and what do you do? Curricular Assessment Needed - Vineland - 3 Comp Parent/Caregiver Form w/Maladaptive Bx AND Motor Skills - This client's Vineland assessment is the Domain-Level Parent/Caregiver Form.
The incorrect Vineland was completed and uploaded. Request correct Vineland from parent and upload to file then select to resubmit.
A student reports their evv location isn’t working, what are some ways you can help them troubleshoot the issue?
1) Ensure client location is correct and add new one if needed
2) Use cellphone data plan if on wifi
3) Try wifi if on cellphone data
4) Ensure you are not using a VPN
5) Drop a pin on the location, using Google Maps, and see if a different address is generated that gets you closer to where services are being held
How long can plans stay in Level 1 review?
5 business days
When can you manually enter a request on eQ?
When entering a modification request.
If you have a client with United as the primary and Medicaid as the secondary, can you place a behavior assistant on the case?
No, we must follow Medicaid rules if we are billing secondary.
My BIP was approved but it’s not in the queue, what should you do?
Ensure plan was signed, ensure auth expiration was less than 90 days ago, connect with CD for support.
-50pts if first response was go to Taylor
A BCBA tried to bill but is getting an overlap issue with the RBT, what issue may have caused this block?
BCBA may not have completed evv session within 48 hours so RBT session was coded as direct and not supervision.
What do you do if you get a transmit error?
Review auth request to see if there are any issues (ex: overlapping dates) then submit an eQ help desk ticket to get assistance correcting the authorization. They will respond within 24 hours typically and can help get an auth number generated. Follow up as needed until completed.
Is telehealth allowed for FL Medicaid?
Yes, for 2 hours per week.
You have a client with Aetna primary and Medicaid secondary. The parent wants the analyst be utilize telehealth which is allowed by Aetna. Can we allow telehealth in this scenario?
Telehealth can only be used for 97156 for 2 hours per week. We must follow the stricter guidelines of Medicaid.
What can cause an error before submission?
50pt bonus for each extra correct answer.
Client not active in sharepoint, incorrect Medicaid ID, documents are incorrect file format, plan contains non-medicaid codes, plan contains medicaid codes more than once
An analyst forgot to use EVV live and is now getting an overlap error with the RBT. Should the RBT submit a request to delete their entry?
No
What do you do if you get partial or full denial of hours?
Review feedback, update plan with needed rationale and revisions, submit for reconsideration to overturn denial. CD and clinical excellence can help with plan review if needed.
A family does not have the required documentation to get authorization for services and what to know if they can private pay until their appointment. Is this allowed?
No, we can not bill a family with Medicaid.
A client has BCBS and Medicaid. BCBS has denied authorization due to the CDE not meeting criteria. Medicaid approved the authorization. Can we bill Medicaid instead?
No, we are not able to bill Medicaid as secondary if the primary has provided an administrative denial (i.e., paperwork issue)
Where can you pull the pend letter to reference?
Regional health > authorization management > eQ submissions pended for information > view pend > attachments
What SharePoint tool can be used to determine which employees may be struggling to use EVV successfully?
Regional health > Time entry > evv reason code usage list
My plan was denied and upheld at recon. What do I do next?
50pt Bonus: Where/how can you find the helper doc for this?
Services must stop and parent can submit for fair hearing. Helper document can be found on the portal bot by typing in fair hearing.