[Provider] Submission of new Section 65 outpatient codes for authorization to APS Healthcare

[Provider Notification]

ATTENTION:  MaineCare ASO Providers

 

Important- please use the following instructions when submitting the new
Section 65 Outpatient codes for authorization to APS Healthcare.

 

Comprehensive Assessment Procedure Codes:

Codes H2000 and H2000HH

 

1. Codes H2000 and H2000HH may not be authorized simultaneously.

2. Code H2000 may not be authorized more than once, for a given member,
for a given provider billing number, in a given time period.

3. For requests submitted after 8/8/08, If a provider requests
authorization for both codes in a single request, the request will be
administratively closed,

    and the provider must resubmit the request with a single code.

 

Outpatient Therapy Individual/Family:

Codes H0004 and H0004HH

 

1. Codes H0004 and H0004HH may not be authorized simultaneously.

2. Code H0004 may not be authorized more than once, for a given member,
for a given provider billing number, in a given time period.

 

Outpatient Therapy Group:

Codes H0004HQ and H0004HQHH

 

1. Codes H0004HQ and H0004HQHH may not be authorized simultaneously.

2. Code H0004 may not be authorized more than once, for a given member,
for a given provider billing number, in a given time period.

 

If an agency is providing both individual therapy and substance abuse
therapy to a member in the same time period, with two different
therapists, the agency must request authorization for mental health and
substance procedure codes in two separate requests:

1. Assessment (H2000) and Treatment (H0004) with the appropriate mental
health Provider Billing ID in one request and

2. Assessment (H2000) and ONE of the Substance Abuse Treatment choices
(code H0004), along with the appropriate substance abuse Provider 

    Billing ID.  Two different MeCMS PA numbers will be issued for these
two requests.

 

If a Substance Abuse agency is providing outpatient substance abuse
services that alternate frequently between Non-Masters Level LADC, CADC
and/or other staff, the agency must request only a single procedure code
H0004, for that member and for that time period.  It is the provider's
choice which listed version of H0004 they select in APS CareConnection.
That choice will not affect billing.   The provider may bill for
different staff using that single procedure code, Provider Billing ID
and MeCMS PA Number.  If a Substance Abuse agency requests authorization
for H0004 more than once in a single request, the request will be
administratively closed, and the provider must resubmit the request with
a single code.

 

Re-Registration

If a member is in outpatient service prior to 8/1/08 and being
re-registered with the new procedure codes, no Assessment procedure code
will be authorized.  All requests for an Assessment procedure code for
re-registrations will be administratively closed.

 

If a provider has already submitted a request inconsistent with these
instructions, APS Healthcare Provider Relations staff will contact you
to make needed corrections.

 

Please contact the APS Healthcare Provider Relations Team if you have
questions.

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

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