Q. When splitting claims in MHHIPAA, Diamond does not ask for the sequence number for the provider address. It automatically defaults. Why?
A. When you split a claim, the claim header is an exact duplicate of the original claim. If the original sequence number is incorrect, you will need to manually change it on the header screen.
Q. In MHPROD we were required to wait until 11:30 a.m. the day after we received our edit reports before we could request that the file be posted. Is this procedure the same for MHHIPAA?
A. No. You may request a post immediately. Boards no longer have to perform the duplicate claim checking that was required in MHPROD. This is due to the required roll-up of claims and the way duplicate claims are handled in MHHIPAA.
Q. Why do some claims get rolled-up and others do not?
A. Claims are rolled-up if the UPI, UCI, date of service, procedure code, modifier 1 and 2 are the same. Same-day MH Medicaid reimbursable services with the place of service codes of "09" or "51" should not be summed (rolled-up).
Q. How long will the State continue to produce the RA/ERA/RJ files?
A.The State will continue to produce these files unless staffing issues arise.
Q. I have a Medicaid only provider. I have removed the price schedules from the NON panel contract, but H0004 (MH group counseling) is still paying. Is the claim hitting the default contract?
A. No. If there is a contract with the client's panel and LOB it will never hit the default contract. What happened is you took the price schedules off the main PROVC record but not the PROVD records. The rate for H0004 (MH group counseling) is attached to the price schedule that is on the PROVD record.
Q. In MHHIPAA if a claim is denied and the provider resubmits it, will it be denied as a duplicate?
A. No. The MHHIPAA version of Diamond differentiates between denied and/or reversed claims and paid claims. This was not the case in MHPROD.