SUD Practices in MH-WIN - Detroit Wayne Mental Health Authority
Contents
1. SUD Practices in MH WIN There are several items that must be in place before one can bill for SUD TX services in MH WIN 1 Users must have access to MH WIN See your designated SFM System File Maintenance person to get your username and password Regardless of your role with a Provider Agency your permissions should include both billing and clinical to have access to all that is required a NEVER share your login with anyone this is for your protection Sharing is a HIPAA violation and is non compliant with your agency s contract with DWMHA SUD Every 60 days you will be required to change it Password resets can be maintained by your SFM or by clicking on the hyperlink for forgetting your password Note the username and password will be the same when reset Please check your spam folder for notification if you do not see it in your IN box of your email No activity of your account in 90 consecutive days equates to an inactive login so use it Please refer to the MH WIN Getting Started Quick Reference Guide located in your packet for reference which is available through the Help navigation button at the top of your screen when logged in If you have access to MH WIN for mental health you will need a separate login for access to the SUD module which is to be used for all SUD activity in accordance with 42CFR patient confidentiality 2 ALL clinical staff that will be rendering services must be entered into MH WIN in t2. Provider Network Reference Change Level of Care for guidance iii The discharge date MUST be the last date of treatment service this is a State requirement In cases where a discharge and re admission occurs the discharge date is still the last date of treatment for that service category iv Providers have a choice in using the Change in Level of Care form or discharging and re admitting however once the business practice is established it must be followed consistently within the license number by ALL users Failure to comply will result in loss of privilege for the entire Provider Network v Because Recovery Support Services is not a traditional level of care accommodations have been made to support this transition in one s stage of recovery Please review How to Process Recovery Support Services in MH WIN and the DWMHA SUD Recovery Plan for managing 9 An Initial Assessment is then performed to determine stage of consumer and to develop a customized treatment plan with the consumer s involvement a In most cases the LOC Level of Care determined by Pioneer s screening will be confirmed however in the event it does not i Provider can utilize a different LOC if appropriate and is contracted for that LOC ii IF the Provider is NOT contracted for the LOC which is the best way to address a consumer s issues then Provider must contact Pioneer to get consumer seen elsewhere iii Keep in mind we are here
3. News Flashes i ii iii iv v Will contain breaking news Will alert you to areas that require your special attention Will provide you with upcoming trainings Will clarify and provide guidance in the SUD Realm Will remain and clog up your whole screen until you clear acknowledging you have read and you are accountable Page 8 of 8
4. Technicians Jennifer Miller iii Billing Issues Claim Adjudication Dept Janice Latimer Tracy Lee iv Financial Issues Finance Dept Patti Garbacz Keisha Barnett v System Issues MH WIN Help Desk Michael Anthony Level I vi Technical Issues Samy Ganesan Level II vii Operational Procedural Technical Lynn Somenauer Level III viii Policy Clinical Judy Davis ix Contractual Overall Darlene Owens Do NOT contact several people about the same issue because response time is not to your liking or the answer you receive is not what you want to hear This is a waste of everyone s time and time is a precious commodity Only escalate an issue up the chain in appropriate manner when resolution cannot be accomplished Please understand that MH WIN is a large complex forever evolving system that is growing with us When reference materials are published to assist users in addressing Page 6 of 8 SUD Practices in MH WIN issues it is expected this method has been exhausted before an email is sent requesting help or contacting the Help Desk in MH WIN While this may be the easier thing to do it is not the most productive and it takes away from enhancements collective collaboration and other responsibilities that require our time Page 7 of 8 SUD Practices in MH WIN 17 Additional reference materials include a SUD MH Win Reference Manual b MH WIN General User Manual c MH WIN
5. admit is a snapshot in time c While there are different ways to access a consumer s record it is important to note that one must use the SUD CA 3 SUD Referral Forms SARF Admission Discharge navigation button and link to create an admission i Search for the member ii Once located click on the blue hyperlink SUD Forms iii Click on the blue hyperlink SUD Admission Form to add or edit iv Every field except Comments is REQUIRED v Where memo boxes are provided for free text an open book with a check mark ca can be used to spell check your entry d Please refer to the Admission Guidelines when entering an admission so you understand how to answer the fields These are State REQUIRED therefore they have both State and Federal implications Page 3 of 8 SUD Practices in MH WIN It is imperative to utilize the Change in Level of Care Form in MH WIN when a consumer is changing modality within the same agency license A discharge and re admission is required when an individual is going to another site with a different license number to receive treatment i These changes must occur timely real time ii While the State allows for an admission and discharge with different service categories to occur within the same license DWMHA SUD views this as a privilege due to State Reporting Requirements Therefore professional courtesy is expected Non compliance by one site will ruin this for the entire
6. he Staff Directory with their individual NPI National Provider Identifier Your SFM is responsible for this NPI numbers identify the clinician who renders services to a consumer This is MANDATORY a The clinician is responsible for applying for their own NPI and the SFM is responsible for entering it under Credentials under PIN of the Staff Directory See Add NPI to Clinician for guidance A license is not a requirement to receiving an NPI number All credentials should be submitted to your SFM so they can be entered into MH WIN Credentials tab found in the Staff Member List under the Work Locations tab to document qualifications i e licensure etc Note once an NPI is entered the SFM cannot edit it therefore exercise caution when entering Should one need to be edited contact the MH WIN Help Desk SFM Guide MH WIN Access and Password Setup is part of your packet 3 The MH WIN Calendar must be set up for availability using the Associated Intake Staff record associated with a specific Intake site in your company s network in order for Pioneer to see when and where they can send you new referrals The set up is flexible to allow for various ways of using based upon your agencies business practices It is up to the Provider Agency to ensure there are available slots for intakes if the organization would like referrals from Pioneer Reference the Provider Intake Availability Setup Quick Reference guide for t
7. he necessary steps to set up your calendar Page 1 of 8 SUD Practices in MH WIN A consumer MUST go through the Pioneer screening in order to create a SARF and Initial Authorization Note Initial Auths are dependent upon the primary insurance of the consumer using the Medicaid Eligibility in MH WIN therefore not all Auto Auths are the same Pioneer will then use the calendar to set up the first appointment This results as a pending SARF with a future date Upon Pioneer s receipt of the signed consent form the consumer record will be released to the Provider Agency Should the SARF and Initial Authorization be released to an incorrect site STOP and immediately contact Pioneer to get it changed Putting this off and continuing working with incorrect record will only create a larger problem and will require more work on your part to correct In addition it will prevent claim submission and ultimately payment for rendered services Please note if the user s primary work location in their user account does not match the address of the admission record the user will not be able to access the record It is the responsibility of the Provider to ensure the accuracy of the demographic and financial information of the consumer is correct when the record is released to you To review and edit a consumer s demographic information access the Consumer Chart through the SUD CA navigation button a Lookup the consumer using the guide
8. lines noted in MH WIN or enter the Member ID and click on SEARCH b Click on the blue hyperlink Consumer Chart c Utilize the blue hyperlink Change Consumer Information to make changes to Demographics Guardians Contact People etc d Be sure to SAVE your changes To review and edit a consumer s financial information click on the Self pay Policy Note all fields except comments are required Run the eligibility on the consumer before completing the Self pay Policy to ensure the data entry is current as of that moment Checking eligibility also updates a members record for retros etc a ONLY mark YES to PA2 Public Act Il if your organization has a PA2 contract with the Authority otherwise enter NO b ONLY mark YES to SDA if i Your Organization is contracted for SDA and ii Your Organization is contracted for residential services and iii Your Organization is contracted for BG Block Grant noted as DWMHA GF under eligibility c SDA State Disability Assistance must be applied for by individual The Provider can assist the consumer in completing and submitting the application Please refer to the Authority s 5 2015 memo for further information Page 2 of 8 SUD Practices in MH WIN d SDA only covers Room amp Board S9976 ZE however it allows the Provider to spread BG funding further thus use the allocation appropriately e ONLY applicable to adults Create an Admis
9. lock Grant Net 30 Medicaid Net 45 Medicare Upon receipt of EOB FY15 Year End Claims MUST be submitted no later than close of business on 11 13 2015 NO EXCEPTIONS will be made Approved claims are swept on Wednesday evening for payment on the following Friday therefore clean claims submitted by Monday should be in the Wednesday sweep plan accordingly for cash flow Understand dirty claims service lines that contain errors or zero pay services will be rejected and sent back to you This means the entire batch will be sent back Reference Change Batch to learn how to move a problem claim to a different batch so it does not hold up your submission and thus payment Then address errors and re submit DWMHA is not in control of when funds are available in your EFT therefore Providers need to contact their banks to determine when posting will occur 13 To submit claims via 837s EDI electronic format contact Nasr Doss 14 IF the Provider is manually entering claims rather than submitting an 837 this is done via the Claim Submission AP navigation button on the left pane of MH WIN a b Utilize Provider Claims Entry Quick Reference The Provider Claim Submission User Manual provides step by step details at your fingertips Note box 33 bottom right of HCFA 1500 will ALWAYS be the Parent Provider Box 32 to the left of box 33 is the Facility where individual is receiving services thus this is where
10. sion record in its entirety While some information may prefill it is your responsibility to ensure the accuracy and acknowledgement of this occurs when the form is saved a WSS funding and use of backend modifiers HD etc for State submission is determined by how the Women s Specialty questions are answered in conjunction with the demographic record VIP Very IMPORTANT i Regardless of existence of WSS contract if a consumer is eligible indicate such on the admission form ii IF contracted for WSS and consumer chooses to take part in a WSS program then indicate YES on the admit form that they are WSS Admitted iii The WSS Admitted YES is a flag used to indicate the funding stream through the waterfall of all funding streams inside the programming of MH WIN b Likewise the use of HH and other appropriate modifiers are determined by how the question of Mental Health MH Issues is answered i It is important to note that when MH is suspected it is verified and appropriately documented psych evaluation and diagnosis ii IF consumer does not present as having an MH issue at time of admission but then through the course of treatment it is discovered the Provider MUST change the Admission Record to reflect such and provide the necessary documentation This is the only exception other than non disclosure of pregnancy to the rule in making a change on an admission form that is not a correction to data entry error Remember the
11. the admission and all authorizations must be tied including the SARF Page 5 of 8 SUD Practices in MH WIN Reference Billing FAQs for errors and solutions as well as Clinical FAQs and General FAQs to address questions first Chances are your question has been asked in the past This will save you time and unnecessary anguish As noted previously clinicians must have an NPI number associated to them This is because services must be tied to a clinician and this is how it is done See Tie Specific Clinician to Various Claim Lines for a how to 15 Since funding drives SUD Programs it is imperative that Medicaid Eligibility be checked at the following stages panow Access and Screening into the Behavioral Health BH System Time of Admission Intake Time of Request for Authorization Time of Billing Monthly minimum Reference the Medicaid Eligibility Manual located in the Help section of MH WIN 16 Technical Support is available a ALL MH WIN issues will only be dealt with via E mails No phone calls will address system issues The person contacted for an issue is whom the Provider must continue correspondence with regardless of whether others are brought into the situation and are part of the discussion Only if the original contact hands off the issue should the Provider follow i Access Issues Pioneer Laloy Hawkins Kelly Quinn ii Authorization Issues UM Assigned
12. to serve in the best interest of our consumers and not our bottom line In either case the Initial Assessment H0001 ZV is billable upon the completion of an Integrated Bio Psychosocial Assessment BPS in MH WIN Reference the Integrated Bio psychosocial Assessment SUD Guidelines for requirements and expectations 10 A Request of Authorization follows Page 4 of 8 gt oOan0 oT SUD Practices in MH WIN This indicates the treatment plan Also includes request for units of services to address the plan Can include a change in diagnosis as treatment continues Requires the completion of the ASAM Worksheet that results in the ASAM Result Use caution when using the calculation button to ensure quantity is accurate Make use of the DWMHA Utilization Management Checklist for Submitting Authorizations SUD Treatment Codes and Internal Modifiers is available for a quick reference guide for codes and required internal modifiers Z 11 The Utilization Management UM staff have been assigned to various Providers find out who your contact is so when you have an issue with authorizations you know who to contact See the DWMHA Utilization Management Department Substance Use Technicians for assignments 12 DWMHA requires timely entry of treatment services regardless of type of data submission This can be determined somewhat by your business practices however the following must be adhered to Qoqoo0 9 B
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