This Frequently Asked Questions (FAQs) page provides answers to questions BabyNet providers have asked related to recent BabyNet and the BabyNet Reporting & Intervention Data Gathering Electronic System (BRIDGES) updates. Providers will be notified of all new or updated information on this page via SCDHHS communications (Alerts, Bulletins, Listserv messages, etc.). Providers can subscribe to receive these communications here. BabyNet should be selected as a topic of interest. Additional questions should be sent to BRIDGES@scdhhs.gov. Underlined statements (not links) indicate information that may be different than what was explained in previous trainings/webinars.
Click the topic link below to go directly to that section of the FAQ:
Where can I accurately find a beneficiary’s Medicaid (FFS and MCO) eligibility?
The SCDHHS web tool reflects the most up-to-date and reliable Medicaid (FFS and MCO) eligibility information.
The SCDHHS web tool will depict “Eligible,” “Ineligible” or “Unknown,” for a beneficiary’s Medicaid eligibility status. If a beneficiary is not eligible for Medicaid and only is eligible for BabyNet, the web tool will portray this as an “Error.”
Medicaid eligibility is documented on the Financial Support Screen in BRIDGES, but during integration, the SCDHHS web tool is the most accurate source for this informaiton.
How do I enter a service log for a visit that lasts longer than what is recorded in Planned Services?
If your visit lasts longer than planned due to a make-up visit or other appropriate reason, you may enter more than one log for that visit. For example, a 90-minute home visit that includes 30 minutes of make-up time from a missed visit should be recorded with two service logs. The first service log is for 60 minutes (2:00-3:00) and the second is for 30 minutes (3:00-3:30). Make sure the times do not overlap or you will get an error message.
If you entered the frequency for Family Training/Special Instruction as 4/month, you can enter additional logs if you have to make up a visit that happens to be a fifth visit for that month.
What does the error message “Not BTW” mean?
It means your date of service does not fall between the start and end dates for that particular IFSP. You will need to choose a different plan in the top right corner of the service log. After selecting the plan and the service, the date range will automatically display. This will help you determine the correct plan.
How do I create a service log before an initial IFSP is finalized?
All early intervention services provided prior to the initial IFSP should be recorded as service coordination (Primary Service Coordination/FT in BRIDGES). If you do not see this as an option in the service log drop-down, you need to add yourself to Planned Services.
Are CPT codes and ICD-10 codes required for service coordination and special instruction/family training?
New T codes for service coordinators/special instuctors are:
- T1016 - Service Coordination
- T1018 - Assessment
- T1027 - Family Training
The ICD-9 code for these services was 315.9. The ICD-10 code conversion recommendation is F81.9 or F89.
What activities should be documented in the service log as services delivered?
The services delivered status should be selected for all billable/covered activities.
Covered and non-covered activities are listed in the Early Intervention Medicaid manual.
Service Coordinators and Special Instructors should continue to bill for services as they did under SCDDSN.
Providers will always be expected to follow the most current EI manual posted. Updated manuals will be announced on the SCDHHS website. We encourage providers to subscribe to Medicaid communications via email.
Do we submit service logs for non-billable activities?
- Non-billable activities that other team members need to be aware of, including service coordination activities, should be documented.
- No-shows should be documented as such.
- Visits canceled by family should be documented as “absence due to family.”
- Visits canceled by a provider (including SC/SI) should be documented as “absence due to provider.”
Do I use actual start and end times on the service log for family training and service coordination?
Yes, actual time should be used. If a phone call takes place from 10:05-10:16, that exact time should be recorded in the service log. Remember, if the activity spans across the 12:00 p.m.-1:00 p.m. hour, you must use military time. All other time can be entered as standard time. For example, 12:45-13:45 would be entered for 12:45 p.m.-1:45 p.m.
Since BRIDGES records time in minutes and DHHS pays per unit, how will time be computed?
Actual time will be converted to units for payment.
If I make a mistake on a service log, how do I correct it? Will supervisors be able to review service logs prior to submission for payment?
Service Coordinators and supervisors can download service log reports from each child’s service log screen.
What is the payment schedule for service logs entered after Nov. 1, 2019?
An example of the claims submission, processing and payment cycle after Nov. 1, 2019 can be found here.
How should concurrent service coordination be documented?
The SCSDB service coordinator is the service coordinator of record. This person should be on planned services and assigned as the PSC on the Demographic screen.
When a BabyNet eligible child is determined to be SCDDSN eligible prior to the child’s 3rd birthday, where is the FSP meeting documented?
For FSP meetings held 30 days prior to the child’s third birthday to the day before the third birthday, documentation and billing should be completed in BRIDGES. For FSP meetings on or after the child’s third birthday, documentation and billing should be completed in Therap.
How will we know if a child has private insurance, Medicaid (Fee for Service), or Medicaid (Managed Care)?
Private insurance information can be found on the Financial Supports screen. This information will automatically be updated from the Medicaid data system. If a child is Medicaid eligible, the "yes" radio button will be selected at the bottom of the Financial Supports screen and the eligible period will be listed. If a child is in an MCO, the "yes" radio button will be selected at the bottom of the Financial Supports screen and the eligible period will be listed. You will also see the MCO Number (Plan ID) to the right of the radio buttons. This number indicates the child's MCO. To add or correct private insurance information, service coordinators should follow instructions provided here.
MCO Plan IDs:
HM1000-First Choice by Select Health of SC
HM2200-Absolute Total Care
HM3200-Healthy Blue by Blue Choice of SC
HM3600-Molina Healthcare of SC
HM3800-Wellcare
In the future, how will service coordinators know if a child's payor sources change?
SCDHHS will provide payor source change reports to BabyNet for children with Medicaid. For Part C only children, service coordinators are responsible for getting this information from families (specifically, when a child gains or loses private insurance).
How will we know if a parent gave permission to bill private insurance?
This information should be documented on the Consent to Use Insurance Resources form and should match what it recorded in BRIDGES in the planned services section.
If the child does not have Medicaid, why do they have an SCDHHS number that looks like a Medicaid number?
Because all new referrals are added to Curam, the Medicaid eligibility system, and transferred to BRIDGES, all children will have this number generated. If a child only has BabyNet (Part C), then that number is just referred to as the SCDHHS number. If the child has Medicaid (FFS or MCO), the SCDHHS number is also their Medicaid ID number.
If a BabyNet child has private insurance and Medicaid/Part C, what information do I enter into the Accounts Payable Screen in BRIDGES?
If the provider accepted the third-party payment amount as payment in full, Medicaid cannot contribute to the claims payment.
Below is a scenario where a BabyNet beneficiary has private insurance. When this is the case, TPL is applicable to the claim.
Providers MUST wait to receive their EOBs from the third-party payors before submitting claims into BRIDGES.
After providers receive their EOBs from third-party payors, they can enter information into the accounts payable screen.
In this scenario, for Payor 1, the provider billed $150.00. The private insurance allowed amount (on the EOB) is $150.00 and the private insurance actually paid $67.56. In Payor 2, the provider should enter in the billed amount for this claim – not what providers are “billing” Medicaid/Part-C; the Billed Amount for Payor 1 and Payor 2 is the same - $150.00. Then the provider can save and submit this claim.
In this example, this claim would be submitted through BRIDGES and then transmitted to MMIS where TPL logic would be applied. The Medicaid Allowed Amount for 97110 is $21.84/unit, and in this case, there were 4 units of 15 minutes, or an hour. The total Medicaid Allowed Amount for this scenario is $87.36.
The provider billed for $150.00 for the hour, and private insurance paid $67.56. The provider then entered the billed amount ($150.00) for the hour and saved and submitted the claim.
The Patient Responsibility in this scenario is $82.44 ($150.00 - $67.56). Medicaid will pay the lesser of the Patient Responsibility and Medicaid allowed amount minus other insurance payment.
In this scenario, the Medicaid allowed amount minus the other insurance payment is $19.80.
Medicaid will pay $19.80 since it is less than the patient responsibility of $82.44. See Figure 1.
Figure 1.
Providers need to use the remittance advice available in the SCDHHS web tool to manage their accounts receivable/balance their books, and not base it on the information that is available in BRIDGES.
More information about TPL can be found here.
Medicaid fee schedules can be found here.
How to update TPL information if a patient gains or loses a third-party payor?
It is the service coordinator's responsibility to maintain current TPL information for all children and to submit that to SCDHHS as a child’s TPL information changes. To do so, service coordinators must completely fill out the Health Insurance Information Referral Form (HIRF). Instructions on how to complete and submit the HIRF can be found here.
If a provider is aware of a gain/loss of a child’s third-party payor, they must notify their service coordinators of this change.
How does a provider enroll with Medicaid/Part C?
BabyNet providers must enroll with both the Medicaid and BabyNet programs, and their two respective systems – MMIS and BRIDGES. Providers should follow both programs’ unique processes on how to enroll.
Please remember that information submitted to both programs must be consistent, i.e. enrolling the correct and same NPI and taxonomies in both systems. Inconsistent data entered into the two systems may result in mismatched information, which may lead to claims being denied.
More information on how to enroll with BabyNet can be found here.
More information on how to enroll with Medicaid can be found here.
Please remember, assistants cannot enroll with Medicaid. To meet MMIS requirements, assistants must use the NPI of their supervisor who is enrolled in BRIDGES.
How can I avoid payor source errors in BRIDGES?
During the integration of BabyNet with Healthy Connections Medicaid, the planned services screen must be set up correctly in BRIDGES to avoid payor source errors for children’s coverage.
A Billing Companion Guide for BRIDGES can be found here.
Providers: Do NOT enter a Service Log if a payor source is missing or out of order.
A Medicaid Part C Invoice Sheet can be found here. It can be submitted to BabyNet_Billing_Support@scdhhs.gov to inquire about claims status.
How can I reconcile BabyNet claims payments for claims with dates of service on and after Nov. 1, 2019?
Providers will access their remittance advice in the SCDHHS web tool for dates of service after Nov. 1.
An Example of the Claims Submission, Processing and Payment Cycle after Nov. 1, 2019 can be found here.
Providers can reference their remittance advice to respectively identify the BabyNet and Medicaid claims payment amounts that they receive from the South Carolina Treasurer’s Office for dates of service on and after Nov. 1, 2019.
Should I bill the SCDHHS web tool directly for BabyNet claims?
No. Providers must bill through BRIDGES.
Providers receiving reimbursement from fee-for-service Medicaid and BabyNet no longer need to double-enter billing information. Providers should now enter service logs and billing information through BRIDGES for dates of service that occurred on or after July 1, 2019. Entering billing information in both BRIDGES and the SCDHHS web tool may result in an overpayment payment, which will require SCDHHS to take action to recoup payment for any services that were double billed.
All providers, including those serving children enrolled in Medicaid Managed Care Organizations (MCO), must continue to enter service logs into BRIDGES to ensure complete data collection, program oversight, and federal reporting. Providers must bill respective MCOs directly when rendering services to a BabyNet member who is in an MCO.
How do I send a refund to the BabyNet State Office?
For dates of service prior to July 1, 2019, providers must mail in a refund check along with the explanation of benefits (EOB) and an attached invoice for private insurance and Healthy Connections Medicaid (FFS or MCO) to the BabyNet State Office via the address below. An adjustment will be completed in BRIDGES by BabyNet staff and the next billing cycle will reflect the adjustment.
BabyNet State Office, SCDHHS
1801 Main Street
P.O. Box 8206
Columbia, S.C. 29202
For dates of service after July 1, providers must send the EOB and a refund for private insurance and/or the EOB from a Healthy Connections Medicaid MCO (not FFS) to BabyNetClaims@scdhhs.gov. An adjustment will be completed in BRIDGES by BabyNet staff and the next billing cycle will reflect the adjustment.
If a child has private insurance and FFS Medicaid, will BabyNet pay if the private insurance and FFS Medicaid do not pay the full amount for dates of service after Oct. 1?
No. With the integration of BabyNet and Medicaid, BabyNet rates are now aligned with Medicaid’s; and, as previously announced, SCDHHS will no longer accept balance billing. Medicaid systems will now adjudicate BabyNet claims and payments.
Medicaid computes an allowable amount for a procedure. If payments received by other insurance companies are equal to or greater than the Medicaid allowed amount, Medicaid will not make a payment.
When other payments received are equal or greater than the Medicaid allowed amount, any Medicaid or BabyNet copayment must be refunded to the beneficiary. Medicaid will not make a payment greater than the amount that the provider has agreed to accept as payment in full from a third party payor.
If the other insurance payment is less than the Medicaid allowed amount, Medicaid will contribute the lesser of either the Medicaid allowed amount minus the other insurance payment, or the sum of the provider plan’s patient responsibility. The patient’s responsibility is their copay, coinsurance and deductible that is normally contributed by the patient outside the insurer’s contribution to the claim. Medicaid reimbursement is considered payment in full.
For example, if a provider did not receive a Third-Party Liability (TPL) payment amount as payment in full for a service they rendered and the Medicaid allowed amount for this service is $200, but the TPL pays $130 for the procedure and the patient’s responsibility for the procedure is $25, Medicaid will contribute the patient responsibility amount because it is less than the difference between the Medicaid allowed amount minus the TPL payment. The TPL Calculator can further depict various scenarios.
It is providers’ responsibility to check eligibility for additional insurance besides Medicaid and BabyNet. Providers can check eligibility in the SCDHHS web tool and by contacting their service coordinators. A video on how to check eligibility can be found here.
More information about TPL can be found here.
The order of payors is as follows:
- Child has private insurance and Medicaid: no Part C funds are used, private insurance is billed first and Medicaid pays last
- Child has private insurance only: private insurance is billed first and the remainder of their allowed balance may be paid by Part C
- Child has no public or private benefit: Part C pays for services
Examples:
| An Office Charges: | BCBS Allows: | BCBS Pays: | Patient Responsibility: | Medicaid Allows: | Result: |
| $100 | $50 | $40 | $10 | $35 |
Patient Responsibilit is less than Medicaid Allowed Medicaid will pay $10 |
| $100 | $50 | $50 | $0 | $60 | If the provider has agreed to accept BCBS' payment in full, then Medicaid will not make a payment. |
What is the continuity of care period for the IDEA Part C Program (BabyNet)?
The continuity of care period for the integration BabyNet and the Healthy Connections Medicaid program begins Oct. 1. Providers and service coordinators are reminded that several changes will take place during the continuity of care period (Oct. 1-Dec. 31, 2019).
Managed care organizations (MCOs) will be required to pay all Medicaid-enrolled providers listed on the Individualized Family Service Plan (IFSP) during the continuity of care period, regardless of providers’ credentialing status with a particular MCO.
In order to receive payment through an MCO for services during the continuity of care period, BabyNet providers must submit to the MCO:
- The Universal BabyNet Prior Authorization form (to be used during - and after - the continuity of care period);
- A copy of the IFSP (the print screen on planned services screen); and,
- A complete and accurate claim form to the appropriate MCO.
- Providers can find a MCO Continuity of Care Contact & Quick Reference Table here;
- If providers have questions for a specific MCO, they should contact them directly using this contact sheet.
Service coordinators must identify BabyNet beneficiaries who are enrolled in an MCO and receiving services from a non-credentialed provider.
In addition, during the continuity of care period, providers may not accept new MCO-enrolled beneficiaries unless the provider is also credentialed with the MCO in which a beneficiary is enrolled.
BabyNet providers MUST be an enrolled Medicaid provider prior to seeking enrollment and/or credentialing by an MCO.
Credentialing and contracting with an MCO is required in order to be eligible for payment by an MCO beginning with services dates on and after Jan. 1, 2020. The credentialing process requires a completed credentialing application for each MCO you intend to bill for Medicaid BabyNet services. The credentialing process can take up to 60 days after the proper submission of an accurate and complete application. SCDHHS has provided a listing of BabyNet providers that are enrolled in Medicaid to the MCOs for the purpose of reviewing the composition of their current networks with respect to BabyNet providers
If a BabyNet child loses Medicaid eligibility (FFS or MCO), do providers have a way to bill BabyNet for services rendered to that BabyNet child?
Providers need to routinely check Medicaid eligibility for members in the SCDHHS web tool. If the eligibility status in the SCDHHS web tool does not match what is in BRIDGES, providers and/or service coordinators should contact BRIDGES@scdhhs.gov to request that the eligibility information be updated. Providers should be able to bill accordingly once this information is updated in BRIDGES.
Any services on the IFSP must be provided at no cost to the family. Providers cannot stop rendering services to BabyNet children based their eligibility status in BRIDGES.
Because Medicaid and Part C are the same payor on planned services, these services should be paid with no changes made in BRIDGES. Planned services only need to be updated if third-party liability is lost or gained. These changes took effect after IFSPs were regenerated in BRIDGES in October 2019.
Will Balance Billing Be Accepted During and After the Continuity of Care Period?
No. As discussed in a July 17 webinar, beginning with the continuity of care period, SCDHHS will no longer allow providers to balance bill the BabyNet program for services provided by a managed care organization (MCO) for dates of service after and including Oct. 1. To bring BabyNet into compliance with state and federal standards, including 34 CFR 303, Subpart F, through the integration of the IDEA Part C and Medicaid programs, SCDHHS has aligned reimbursement rates and standards. This alignment includes observation of 42 CFR 447.15, whereby providers in the Medicaid program accept, as payment in full, the amount paid by the agency plus any amount for which the individual beneficiary is responsible. Accordingly, the MCO reimbursed rate will be payment in full. During the continuity of care period, reimbursement will be paid at the fee for service (FFS) rate for services provided to beneficiaries who are not enrolled in an MCO. Reimbursement for providers enrolled in an MCO will be paid at the MCO-negotiated rate. Effective Jan. 1, 2020, after the continuity of care period, the MCO-negotiated rate will be the only rate reimbursed and only providers who are credentialed with an MCO will be eligible for reimbursement.
Will all BabyNet eligible children be enrolled with an MCO?
BabyNet children that are eligible for full-benefit Medicaid coverage are generally enrolled in an MCO, including foster care children.
Children who are not eligible for full-benefit Medicaid coverage will not be enrolled in an MCO. This includes BabyNet children with PART C only or private insurance only.
Do parents have to provide consent to allow BabyNet to bill their Medicaid and/or private insurance?
Because the Part C lead agency is also the Medicaid agency, the U.S. Department of Education, Office of Special Education Programs (OSEP) has clarified that permission is not required for billing Medicaid or private insurance.
If a child has private insurance and is in an MCO, will BabyNet pay if the private insurance and the MCO do not pay the full amount for dates of service prior to Oct. 1?
Medicaid reimbursement will be made for covered services up to the lesser of the provider-billed amount or the Medicaid allowed amount. In cases where a primary insurer has made a payment, the Medicaid allowed amount shall be reduced by any primary payer reimbursement amount. Medicaid reimbursement is considered payment in full.
The order of payors is as follows:
- Child has private insurance and Medicaid: no Part C funds are used, private insurance is billed first and Medicaid pays last
- Child has private insurance only: private insurance is billed first and the remainder of their allowed balance may be paid by Part C
- Child has no public or private benefit: Part C pays for services
Will Part C pay for services if a child loses Medicaid?
Part C is always the payor of last resort. If a child loses Medicaid or private insurance, Part C will pay for services.
Will BabyNet/Part C pay for services denied by an MCO?
No. MCOs are responsible for claims administration for their enrolled members.
Do therapy assistants have to be credentialed with the MCOs?
No, only therapists.
If we find that a child has two Medicaid numbers, which Medicaid number should be used for billing?
Please contact the SCDHHS Provider Service Center (PSC) for assistance 888-289-0709.
Will providers need to monitor the number of allowed units for BabyNet eligible children who are enrolled with an MCO?
It is recommended that providers monitor the number of billed units for all BabyNet children. Providers are required to submit the IFSP to the MCOs as prior authorization for payment up to the number of approved units on that document. Billing for units above the approved number on the IFSP will result in a denial of payment.
Are children able to receive (therapy) services via BabyNet and from a freestanding (non-BabyNet) provider at the same time?
BabyNet members are eligible to receive services up to the approved units on the IFSP, which will serve as the prior authorization for services. The prior authorization is specific to the service provider listed on the IFSP. Any additional services may be billed subject to an approved prior authorization specific to the billing provider.
Will MCOs require medical necessity for BabyNet eligible children?
BabyNet providers are required to submit the IFSP to the appropriate MCO in order to be eligible for payment up to the number of approved units on that document. The IFSP will serve as the medical necessity documentation.
Are providers required to enter service noted in BRIDGES for children being served by an MCO?
Yes. Providers will risk not being reimbursed if they do not enter service notes in BRIDGES.
What date will coverage begin for service providers after the IFSP (planned services) and Universal Authorization forms have been submitted to the appropriate MCO?
MCOs will begin coverage on the date the services began on the IFSP (planned services page). This will remain in effect after the continuity of care period is over.
Which MCO's have quality incentive programs and how do you qualify?
Each Healthy Connections Medicaid MCO has a quality incentive program. Providers are encouraged to contact individual MCOs to inquire about program details. Providers can also contact SCDHHS Provider Relations for additional information.
On the July 17 webinar it was stated 3 times that balance billing would be allowed until
Jan. 1, 2020. In the middle of October, it was stated it would stop Oct. 1, 2019. Why the change?
Information provided during the July 17 webinar was correct. As stated on the webinar, providers will not be reimbursed for a rate difference between Medicaid rates and rates contracted with MCOs. Providers will be paid the rate that is agreed upon in the contract with the MCO. Once a provider has credentialed and contracted with an MCO, the provider should expect to be paid the MCO contract rate. SCDHHS/BabyNet will not pay any additional amounts to providers above the MCO contract rate.
Providers not credentialed and contracted with an MCO as of Jan. 1, 2020, will not be reimbursed for services provided to BabyNet children enrolled in an MCO.
This information is consistent with the communication that was provided in an Oct. 10, 2019, alert, which stated:
“This alignment includes observation of 42 CFR 447.15, whereby providers in the Medicaid program accept, as payment in full, the amount paid by the agency plus any amount for which the individual beneficiary is responsible. Accordingly, the MCO reimbursed rate will be payment in full. During the continuity of care period, reimbursement will be paid at the fee for service (FFS) rate for services provided to beneficiaries who are not enrolled in an MCO. Reimbursement for providers enrolled in an MCO will be paid at the MCO-negotiated rate. Effective Jan. 1, 2020, after the continuity of care period, the MCO-negotiated rate will be the only rate reimbursed and only providers who are credentialed with an MCO will be eligible for reimbursement.”
Do we still bill claims in BRIDGES if patient has an MCO?
Providers must enter service logs (or service notes) into BRIDGES for every encounter with a BabyNet eligible child. A claim will automatically be created and transmitted to the Medicaid system once the service log is entered. No additional claims input is necessary in BRIDGES.
If we are already credentialed/enrolled with a specific MCO, does the MCO Universal Prior Authorization Form for BabyNet have to be sent for a patient who is enrolled with that specific MCO, even though a provider is in network with that MCO and has a prior authorization on file with them?
As a rule, providers should follow the guidelines set by each specific MCO governing prior authorizations. During the continuity of care period, the information listed on the IFSP Planned Services page dictates what services and amounts of service are covered. Any services or amounts above what is listed on the IFSP will require prior authorization in order for the claim to be reimbursed.
Prior authorization guidelines in place with MCOs may differ after the end of the continuity of care period. Providers should inquire as to the appropriate process for prior authorizations with their contracting MCO.
About the Universal Prior Authorization Form for BabyNet, do we have to send this in for future authorizations, or can we just get an authorization from the MCO per their requirements?
As a rule, providers should follow the guidelines set by each specific MCO governing prior authorizations. During the continuity of care period, the information listed on the IFSP Planned Services page dictates what services and amounts of service are covered. Any services or amounts above what is listed on the IFSP will require prior authorization to be reimbursed.
Prior authorization guidelines in place with MCOs may differ after the continuity of care period has concluded. Providers should inquire as to the appropriate process for prior authorizations with their contracting MCO.
I noticed that one child's IFSP end dates changed and was shortened. Will that change our MCO authorization time period that was approved based on longer end date?"
This question should be posed to the relevant MCO for their input. Deviations from the IFSP may require additional authorization.
Does every BabyNet child who has an MCO have to have the Universal Prior Authorization Form for BabyNet on file with the MCO? If so, is this only during this interim time or does that actually start in Jan 2020. Blue Choice Medicaid told us this does not start until Jan 2020. Can you explain the purpose of that Universal Prior Authorization Form for BabyNet? For example, we are in network with Blue Choice Medicaid. No form of authorization is required. Do we still have to do the MCO authorization form from BabyNet?
As a rule, providers should follow the guidelines set by each specific MCO governing prior authorizations. During the continuity of care period, the information listed on the IFSP Planned Services page dictates what services and amounts of service are covered. Any services or amounts above what is listed on the IFSP will require prior authorization to be reimbursed.
Prior authorization guidelines in place with MCOs may differ after the end of the continuity of care period. Providers should inquire as to the appropriate process for prior authorizations with their contracting MCO.
Will BabyNet pay for the treatments if the MCO denies authorization or service?
During the continuity of care period, the information listed on the IFSP Planned Services page dictates what services and amounts of service are covered. MCOs should pay for services and amounts listed on the IFSP during the continuity of care period. Any services or amounts above what is listed on the IFSP will require prior authorization from the MCO to be reimbursed.
Molina requires an authorization for reevaluations. Often times, providers and EIs are unaware that children have received initial evaluations until the claim has been denied. In order to receive reimbursement, the provider would have to contact the EI and request to have the plan changed to a reevaluation & rebill the service as a re-evaluation, however Molina does not provide retro authorizations. If the resubmitted claim is denied due to lack of authorization, will BabyNet provide the reimbursement?
As a general rule, providers will need to work with individual MCOs to be reimbursed for services provided to BabyNet children enrolled in that MCO. SCDHHS/BabyNet will not pay reimbursements above and beyond what the MCO has agreed to pay a provider in their contract with that provider.
Providers should ensure that all services to be performed are listed on the IFSP correctly before the service is rendered. Claims need to reflect the services listed on the IFSP. Any necessary updates or corrections to the IFSP should be completed by the service coordinator before claims are submitted for payment. Decisions regarding reimbursements for services not listed on the prior authorization are up to each MCO and should be discussed with them.
Because therapy providers have to wait on the EI to enter the therapy onto the BRIDGES planned services page before we can fax the universal authorization request to the MCO, will the MCO be required to backdate the authorizations to match the dates on the Babynet Planned Services Page? OR do providers need to put the child's therapy on HOLD until that info has been entered into BRIDGES and FAXED?
Services listed on the IFSP Planned Services page should not be delayed. Providers should begin to render the services listed on the IFSP and file a claim once the prior authorization paperwork is complete. MCOs should reimburse for services and amounts listed on the IFSP.
The Continuity of Care period ends on Jan. 1, 2020. And that we will then go back to getting authorizations the old way. Is this correct? or will we continue to send in the Planned Services Page from Babynet, and that this will serve as the medical necessity?
As a rule, providers should follow the guidelines set by each specific MCO governing prior authorizations. During the continuity of care period, the information listed on the IFSP Planned Services page dictates what services and amounts of service are covered. Any services or amounts above what is listed on the IFSP will require prior authorization to be reimbursed.
Prior authorization guidelines in place with MCOs may differ after the end of the continuity of care period. Providers should inquire as to the appropriate process for prior authorizations with their contracting MCO.
I have tried repeatedly to access MCO's reimbursement rates for speech therapy. I do not find it in their manuals. Please help me understand where to find this information or provide current reimbursement rates for the individual MCO's for all therapy services.
Please contact the appropriate MCO for guidance on how to locate this information. A table of contact information has been made available on the SCDHHS BabyNet FAQ page. Providers can also contact SCDHHS Provider Relations at Babynet_billing_support@scdhhs.gov for assistance with specific inquiries if there are persistent issues.
I’m looking for clarity regarding if BabyNet providers will have to be contracted with the major insurance companies or just with the Medicaid MCOs?
SCDHHS has requested that BabyNet providers contact the MCOs serving the South Carolina Healthy Connections Medicaid program so that they can become credentialed and contracted. No guidance has been provided regarding contracts with specific insurance companies outside of the Healthy Connections MCOs. SCDHHS does not require contracts with any entity outside of the Healthy Connections Medicaid program.
With these new referrals. Are we able to pick them up if an MCO has all of our paperwork and we are waiting for them to do credentialing?
Providers must be credentialed and contracted with a BabyNet child’s MCO in order to provide services. It can take up to 60 days for MCOs to complete the credentialing process with providers.
Are we able to continue with the current kids past Jan. 1 if we are still waiting on credentialing?
Providers must be credentialed and contracted with a BabyNet child’s MCO in order to provide services. It can take up to 60 days for MCOs to complete the credentialing process with providers.
How will we know if a child has private insurance, Medicaid (Fee for Service), or Medicaid (Managed Care)?
Private insurance information can be found on the Financial Supports screen. This information will automatically be updated from the Medicaid data system. If a child is Medicaid eligible, the "yes" radio button will be selected at the bottom of the Financial Supports screen and the eligible period will be listed. If a child is in an MCO, the "yes" radio button will be selected at the bottom of the Financial Supports screen and the eligible period will be listed. You will also see the MCO Number (Plan ID) to the right of the radio buttons. This number indicates the child's MCO.
MCO Plan IDs:
HM1000-First Choice by Select Health of SC
HM2200-Absolute Total Care
HM3200-Healthy Blue by Blue Choice of SC
HM3600-Molina Healthcare of SC
HM3800-Wellcare
In the future, how will service coordinators know if a child's payor sources change?
SCDHHS will provide payor source change reports to BabyNet for children with Medicaid. For Part C only children, service coordinators are responsible for getting this information from families (specifically, when a child gains or loses private insurance).
How will we know if a parent gave permission to bill private insurance?
This information should be documented on the Consent to Use Insurance Resources form and should match what it recorded in BRIDGES in the planned services section.
If the child does not have Medicaid, why do they have an SCDHHS number that looks like a Medicaid number?
Because all new referrals are added to Curam, the Medicaid eligibility system, and transferred to BRIDGES, all children will have this number generated. If a child only has BabyNet (Part C), then that number is just referred to as the SCDHHS number. If the child has Medicaid (FFS or MCO), the SCDHHS number is also their Medicaid ID number.
