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Children and Family Treatment and Support Services / Children's Home and Community Based Services - Claims Testing Opportunity
6/20/2019 • Posted by Provider Relations

Fidelis Care encourages providers to participate and/or continue in behavioral health claims testing opportunities. Network providers who are participating in New York State’s Children and Family Treatment and Support Services and/or Children’s Home and Community Based Services program for children and youth enrolled in Medicaid Managed Care with health and behavioral health needs are encouraged to submit a request for claims testing.  

Fidelis Care continues to offer claims testing for the behavioral health services as described below.

In January 2019, providers designated to deliver Children and Family Treatment and Support Services began submitting claims to managed care organizations. These services include: 

•    Other Licensed Practitioner (OLP)
•    Community Psychiatric Supports and Treatment (CPST), and
•    Psychosocial Rehabilitation (PSR)
                  
Additionally, beginning in July 2019, providers designated to deliver Family Peer Support Services, OASAS services, and OMH services will begin submitting claims to managed care organizations. These services are listed below:

•    Family Peer Support Services
•    Office of Alcoholism and Substance Abuse Services (OASAS) Outpatient – Clinic (hospital based)
•    OASAS Outpatient – Rehabilitation Programs (hospital based) 
•    OASAS Opioid Treatment Program Services (hospital based)
•    OASAS Chemical Dependence Inpatient Rehabilitative Services
•    Injections for Behavioral Health Related Conditions 
•    Children and Family Treatment and Support Services (CFTSS), including: 
      o    Other Licensed Practitioner (OLP)
      o    Psychosocial Rehabilitation (PSR)
      o    Community Psychiatric Treatment and Supports (CPST) 
      o    Family Peer Support Services
•    Office of Mental Health (OMH) Outpatient Services 
•    OMH designated Serious Emotional Disturbance (SED) Clinic Services
•    Assertive Community Treatment (ACT)
•    Continuing Day Treatment
•    Personalized Recovery Oriented Services (PROS)
•    Partial Hospitalization
•    Psychiatric Services
•    Psychological Services
•    Comprehensive Psychiatric Emergency Program (CPEP) including Extended Observation Bed
•    Inpatient Psychiatric Services

Anticipated to begin in October 2019, providers designated to deliver Children’s Home and Community Based Services and additional Children and Family Treatment Support Services will begin submitting claims to managed care organizations.  These services include the following:

•    Caregiver Family Supports and Services
•    Pre-vocational Services
•    Community Advocacy Training and Support
•    Supported Employment
•    Palliative Care Pain & Symptom Management
•    Palliative Care Bereavement
•    Palliative Care Massage Therapy
•    Palliative Care Expressive Therapy
•    Respite - Planned
•    Respite - Crisis
•    Day Habilitation
•    Community Habilitation
•    Environmental Modifications
•    Vehicle Modifications
•    Adaptive and Assistive Equipment

To ensure a smooth transition to the new billing system, Fidelis Care wants to remind you to participate in electronic data transfer (EDI) and claims testing. 

Claims Testing Step #1:  If you would like to test claims for any of these services, please complete the enclosed survey and email it to BHClaimsTesting@fideliscare.org. Filling out the survey completely avoids processing delays. 

Claims Testing Step #2:  Once a Fidelis Care Representative has contacted you to begin the testing process, you may begin sending files for claims testing. Please do not send test files prior to being contacted.

Fidelis Care is proud to be your health care partner. If you have any questions about Claims Testing, please contact your designated Behavioral Health Provider Specialist.


Medicaid Managed Care Children and Family Treatment and Support Services (CFTSS) / Children’s Home and Community Based Services (HCBS)
                                                                       Provider Claims-Testing Instructions


In preparation for the implementation of the Children and Family Treatment and Support (CFTSS) Services that became effective in Medicaid Managed Care for enrollees under age 21 on January 1, 2019, Fidelis Care is pleased to offer claims testing to providers designated to deliver CFTSS. Below are instructions and information about the testing process.

Services Eligible for Testing

New Children and Family Treatment and Support Services: Effective January 1, 2019

Claims Testing Start Date

Other Licensed Practitioner (OLP)

October 1, 2018

Community Psychiatric Support and Treatment (CPST)

October 1, 2018

Psychosocial Rehabilitation

October 1, 2018

New Children and Family Treatment and Support Services: Effective July 1, 2019

Claims Testing Start Date

Family Peer Support Services (FPSS)

January 1, 2019

New Children’s Home and Community Based Services: Effective October 1, 2019

January 1, 2019

  • Caregiver Family Supports and Services
  • Pre-vocational Services
  • Community Advocacy Training and Support
  • Supported Employment
  • Palliative Care Pain & Symptom Management
  • Palliative Care Bereavement
  • Palliative Care Massage Therapy
  • Palliative Care Expressive Therapy
  • Respite- Planned
  • Respite – Crisis
  • Day Habilitation
  • Community Habilitation
  • Environmental Modifications
  • Vehicle Modifications
  • Adaptive and Assistive Equipment

January 1, 2019

New Children and Family Treatment and Support Services: Effective January 1, 2020

Claims Testing Start Date

Youth Peer Support and Training (YPST)

June 1, 2019

Crisis Intervention

June 1, 2019


Submitting a Claims-Testing Request 

If your organization is interested in testing, please complete the Fidelis Care Claims-Testing Survey and email it to BHClaimsTesting@fideliscare.org

Please fill out the survey completely to avoid processing delays. Once your survey has been received, a Fidelis Care Representative will contact you to begin the testing process. Please do not send test files before that time to avoid claim-processing issues. 

Electronic Submission

Fidelis Care strongly recommends using the electronic data interchange (EDI) system for claims submission. Electronic claims submissions expedite the processing and reimbursement of clean claims, reduce and/or eliminate the number of claims not being received, and prove timely submission through electronic acceptance reports.

•    Existing Providers:  If your organization currently submits claims to Fidelis Care, you are considered an existing provider. Existing providers who will be submitting Children and Family Treatment and Support service claims may submit test claims through the normal EDI channels. Please prefix the file name with test_ and change ISA16 to T. Providers may use current members for testing or may request test member data from Fidelis Care.

•    New Providers:  Providers of children and family treatment and support services who have never before submitted claims to Fidelis Care should contact their clearinghouse or billing vendor to see if they have connectivity with Fidelis Care. Fidelis Care works with all major clearinghouses. If you are not working with an electronic submitter or if your clearinghouse does not have connectivity with Fidelis Care, please indicate that on the Fidelis Care Children and Family Treatment Support Services Claims-Testing Survey, and a representative will contact you. Fidelis Care will provide test member data to all new providers interested in testing. 

General Information for Claims Submission 
Receiver Name:          Fidelis Care 
Fidelis Care Receiver ID:      113153422
Fidelis Care Payer ID:      11315

Response Reports
•    277 Report: electronic claim acknowledgement in X12 format.  
•    999 Report: receipt acknowledgment of claims and whether the transaction is in compliance with HIPAA requirements. 
•    RPT Report: information from Fidelis Care, in a non-X12 format, on the status of submitted claims (837 transactions).

Note: The above response reports will not be provided as part of the claims-testing process. A Fidelis Care representative will provide direct feedback after testing.

Corrected Claims

•    The original claim number must be submitted and the claim frequency type code must be 7 (replacement of prior claim). 
•    2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to 7
•    2300 Loop, REF Original Reference Number (ICN/DCN) Segment where REF01Element equals F8, REF02 Element must contain the Fidelis Care original claim number

Claims-Testing Feedback 

A Fidelis Care representative will contact you after testing to provide feedback on the testing process.  
If you have any questions about claims testing, please email BHClaimsTesting@fideliscare.org
 

 

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Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

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