BH Bulletin
“MITS BITS” is being replaced with “BH Bulletin” as the newsletter to Medicaid behavioral health provider agencies and stakeholders. The BH Bulletin will continue to be an “as needed” communication vehicle offering updates, policy clarification, technical assistance, and useful news to community behavioral health agencies and other stakeholders. Current MITS BITS subscribers will automatically receive the new BH Bulletin. New subscriptions may be requested at BH.Medicaid.ohio.gov.
ODM recently became aware of a MITS claims payment error that caused underpayments for some Medicaid service codes when a certain number of units were exceeded. This affected claims with dates of service on or after October 1, 2022. Behavioral health codes listed below were impacted when billed with more than the specified number of units.
CPT/HCPCS
|
Service Name
|
Units Greater Than
|
H0004
|
SUD Individual Counseling
|
4
|
H0005
|
SUD Group Counseling
|
2
|
H0036
|
CPST
|
4
|
H0038
|
Peer Support
|
8
|
H2012
|
TBS Group Service Hourly
|
3
|
H2015
|
Intensive Home-Based Treatment/Functional Family Therapy
|
4
|
H2017
|
Psychosocial Rehabilitation
|
4
|
H2019
|
Therapeutic Behavioral Service
|
4
|
H2033
|
Multi-Systemic Therapy
|
8
|
Limits on the number of service units for these codes were implemented in error. MITS billing logic for fee-for-service (FFS) claims has been corrected to match ODM policy. ODM is working with Medicaid managed care organizations (MCO) to assess and correct any affected claims for MCO members. Agencies with affected FFS claims may void and resubmit the claims or submit claims adjustments. ODM has posted User guidance on how to void or adjust claims on the BH.Medicaid.Ohio.gov website. Agencies needing additional assistance may call the ODM Provider Call Center at 800-686-1516 Option 7 to speak with an agent.
Effective for dates of service January 1, 2023, and after, ODM will be increasing the payment rate for CANS assessments. The updated rates will be reflected in the revised Appendix to OAC rule 5160-27-03, the Medicaid Behavioral Health Provider Manual and the OhioRISE Provider Enrollment and Billing Guidance prior to January 1, 2023.
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