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Medicaid Behavioral Health Redesign: Rejected Claims

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Tuesday, February 27, 2018

As many of you are aware, the Medicaid Behavioral Health Redesign was implemented in Ohio at the beginning of the year.  A few of the insurance companies are reporting systems issues that need to be worked out.  United Health Community Plan reports many claims are being rejected with the code A-17—NPI not Billed.  UHCCP requests that everyone be aware of the following:

Behavioral Health Redesign is now in effect as of 1/1/2018 and Optum has identified a growing trend of inappropriate billing according to the Ohio Department of Medicaid’s coding specifications. A significant number of claims are being submitted and denied “A17 | NPI not Billed” because the NPI is not being reported on each detail line. Behavioral Health Redesign coding specifications indicate this is a requirement. 

For specific reference to this requirement, providers should visit: http://bh.medicaid.ohio.gov 
Provider > Manuals, Rates & Resources > IT Resources (Final) > EDI/IT Q&A Document

UHCCP reports that providers are not able to submit claims with rendering NPI at the line level through the UHC claims portal. This portal does not have the capacity to submit claims in this format.  Claims in this format will have to be sent paper claim or through a clearinghouse.

If you bill United Health Care Community Plan and you have questions about this, please feel free to email me.

Jim Broyles, Ph.D.,  OPA Director of Professional Affairs

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