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MN 1115 SUD Demonstration Providers

ASAM is providing a standardized version of the ASAM criteria to the public in the hopes of increasing the quality and consistency of patient assessments and individualized, patient centered care.

ASAM CRITERIA ASSESSMENT INTERVIEW GUIDE

Please see the July 26, 2022 e-memo from DHS for additional details:

7/26/22 Behavioral Health e-Memo.

-Posted 8/9/22


 DBT PROVIDERS: Updated DBT IOP Authorization Form (DHS – 6322)

An updated DBT IOP Authorization Form, DHS 6322 has been released for immediate use.

This form can be found on the MN DHS website by following this link:

DHS-6322-ENG (Initial Dialectical Behavior Therapy (DBT) Intensive Outpatient Program (IOP) Authorization) (state.mn.us)

Please update your records and begin to submit all appropriate cases with this documentation.

Posted 6/24/22


Providers: Please Prevent PHI Incidents

All Providers submitting cases via the Atrezzo Portal, please ensure the documentation uploaded is for the recipient the case is being created for to prevent any PHI incidents.

If Kepro receives a case with PHI for a member other than the case was created for, Kepro will reject and void the case. 

Kepro will enter a message in Atrezzo Portal:

Provider, the documentation submitted contains PHI for a member other than who the case was created for. This request cannot be processed and has been voided. Please ensure when uploading/attaching documentation via the Atrezzo portal that it is for the correct recipient. Please submit a new request through the portal at mhcp.kepro.com. Documentation and Authorization requirements are listed in the MHCP Provider Manual.”

Additionally, a letter will be sent via the MN-ITS mailbox.

Posted 3/1/2022


 

Hot Topics

Providers, Please Prevent PHI Incidents

 

All Providers submitting cases via the Atrezzo Portal, please ensure the documentation uploaded is for the recipient the case is being created for to prevent any PHI incidents.

If Kepro receives a case with PHI for a member other than the case was created for, Kepro will reject and void the case. 

Kepro will enter a message in Atrezzo Portal:

Provider, the documentation submitted contains PHI for a member other than who the case was created for. This request cannot be processed and has been voided. Please ensure when uploading/attaching documentation via the Atrezzo portal that it is for the correct recipient. Please submit a new request through the portal at mhcp.kepro.com. Documentation and Authorization requirements are listed in the MHCP Provider Manual.”

Additionally, a letter will be sent via the MN-ITS mailbox.

Posted 3/1/2022


 

Announcements

Reminders for Case Submissions:

1. Review the below request type definitions to determine the most appropriate selection:

  • Prior Authorization - the service(s) or item(s) have not been provided yet. This request is to seek prior approval.
  • Retrospective - the service(s) or item(s) have already been rendered prior to requesting for authorization.
  • Reconsideration – this form of request is submitted following a medical necessity/Medical director denial. The denial letter received via MN-ITs has details on how to submit reconsideration requests to Kepro (please note, Kepro does not handle appeals). This request should be received within 20 working days of the date of the denial.  

2. Review Timeframe

  • Kepro has up to 10 business days to take initial action (approve, deny, or pend for additional information) on a prospective authorization request.
  • Kepro has up to 20 business days to take initial action (approve, deny, or pend for additional information) on retrospective and reconsideration requests.
    • change requests will be processed within 20 business days
  • If a request is pended for additional information needed, providers have up to 15 calendar days to return all requested information. Failure to respond may result in denial and require a new Authorization to restart the process with all documentation necessary to make a determination.
  1. Verify eligibility and Authorization Requests and Medicare or Third-Party Liability (TPL) Coverage prior to submitting requests.

** For additional information on authorization requirements refer to the below MHCP Provider Manual link**

https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_008925

Posted March 8, 2022


ASAM Criteria Assessment Interview Guide

ASAM is providing a standardized version of the ASAM criteria to the public in the hopes of increasing the quality and consistency of patient assessments and individualized, patient centered care.

ASAM CRITERIA ASSESSMENT INTERVIEW GUIDE

Please see the July 26, 2022 e-memo from DHS for additional details:

7/26/22 Behavioral Health e-Memo.


DME Reminder

Providers, when creating a PA for DME and supplies, please use S=Supply as indicated below.

DME Hot Topic Image


EIDBI Providers, Kepro has two announcements:

Kepro has added two new documents under the CMDE/EIDBI provider training tab.

These checklists have been created to assist providers with submitting EIDBI ITP and CMDE authorizations. Each case will be reviewed to ensure all necessary documentation has been provided and services requested meet medical necessity criteria outlined in EIDBI policy.

Effective Feb. 1, 2022, EIDBI providers are only required to complete a CMDE once every three years for people with autism spectrum disorder (ASD) or related conditions.

Families still may request a CMDE once per year, if they choose. Providers may complete CMDEs once per year without prior authorizations when clinically appropriate and within service limits listed on the EIDBI billing grid. For more information, visit the full announcement:

Change to EIDBI comprehensive multi-disciplinary evaluation (CMDE) policy.


DME Equipment & Supplies

Nutritional Products and Related Supplies:

Under Covered Services, we added In-line cartridge containing digestive enzymes (HCPCS code B4105) as a covered MHCP benefit beginning Oct. 1, 2021.

Click here for more detailed information in the DHS Manual.


EIDBI/CMDE PROVIDERS: 

Effective DATE 10/8/2021 - Please be advised  Service Agreements will no longer be created for EIDBI requests for administrative reasons such as:

  • All required documents not included;
  • Provider NPI not valid;
  • Request represents a duplicate authorization;
  • Or when Recipients have active PPHP.  If you require a medical necessity review only for a client that has active PPHP, please indicate that in the case note before submission. 

*Please note, this is not an all-inclusive list.

Reminder:  All messages will be communicated through the Atrezzo Portal Message system.  Please login to Atrezzo to check messages/notifications frequently. Please be advised when responding to requests for additional information, clinical rationale/medical necessity information must be captured within the physical record (written documentation) and not solely entered as a case note. Additionally, before submitting requests for EIDBI services, please check recipient eligibility to prevent delay in services. Kepro is the medical review agent for MN MA only.


EIDBI 0373T Code Has Been Added

The 0373T code with UB modifier for higher intensity intervention services has been added to the ITP form and effective as of Thursday 10/14/2021.   This code and modifier are now available when creating Cases in the Kepro Atrezzo Portal.


Verbal consent of individual treatment plans (ITPs) through telehealth

A temporary peacetime emergency waiver allowing the recipient's verbal or electronic written approval of the ITP or change in the ITP for mental health services or assessments delivered through telehealth remains in effect beginning Sept. 1 2021, based on new legislation. You may document the recipient's verbal approval or electronic written approval of the treatment plan or change in the treatment plan instead of obtaining the recipient's signature. 

This is effective Sept. 1, 2021 for providers of the following services:

  • Intensive Rehabilitative Mental Health Services
  • Children's Therapeutic Support Services
  • Intensive Treatment Foster Care
  • Adult Rehabilitative Mental Health Services
  • Adult Mental Health Mobile Crisis Services
  • Children's Mental Health Mobile Crisis Services
  • Outpatient Mental Health

Call the Minnesota Health Care Programs Provider Call Center at 651-431-2700 or 800-366-5411 if you have questions about this message.


Home Health/Home Care Nursing Providers:

Please be advised, effective Monday, August 2nd 2021, a new case will need to be created for recertification requests. Additionally, as a reminder, please complete the questionnaire.


CMDE Providers Effective 6/16/2021:

For case submission - the only procedure code that can be submitted is 97151 with Modifier U8. 

 NOTE: You must attach the Comprehensive Multi-Disciplinary Evaluation (CMDE) Form with the Signature Page. This Form is available in the drop down selection when you are attaching your document(s).  

EIDBI Providers Effective 6/16/2021:

The only procedure codes that can be submitted are: 97153, 97154, 97155, 97156, 97157, H0032, AND H0046 with modifier UB. 

 NOTE: You must attach the Individual Treatment Plan (ITP) Form with the Signature Page. This Form selection is available in the drop down when you are attaching your document(s).  

GENTLE REMINDER – PLEASE CHECK RECIPIENT ELIGIBILITY PRIOR TO SUBMISSION TO PREVENT DELAY IN SERVICES. KEPRO IS THE MEDICAL REVIEW AGENT FOR MN MA ONLY

Respiratory Equipment

  •  Under Covered Services, we provided two examples of when both a portable and stationary ventilator may be covered.

  • Under Noncovered Services, we added a reminder that manual resuscitation bags are covered.

  •  Under Authorization, we explained authorization requests for a second ventilator must include a letter of medical necessity and we added the criteria that must be addressed and documentation required in the letter of medical necessity.


Update - Faster Approval of Prophylaxis D1110 Request within 2 Business Days

Effective 08/10/2021 -  The number of additional prophies approved for the current calendar year will be calculated based on the date of the first Prophy and MRC submitted on the questionnaire. The approved dates will be backdated to January 1st of the current year to allow for the authorization to be used for retrospective D1110 for the CURRENT calendar year.

Example:

1st Prophy date 08/02/2021, 3 MRC, 2 calendar year(s).

1 additional D1110 approved for the period 01/01/2021 to 12/31/2021. 3 additional D1110 approved for the period 01/01/2022 to 12/31/2022.

Reminder: Submit D1110 requests independent of other Dental Requests. D1110 requests submitted for auto-approval will receive authorization within 2 business days and for up to 2 calendar years.

PLEASE NOTE: Retrospective requests for the PRIOR calendar year must be submitted on a separate case.


Faster Approval of Prophylaxis D1110 Request Within 2 Business Days

Kepro is very excited to offer this training to assist you with submitting and obtaining approvals within 2 business days for qualified PROPHYLAXIS D1110 Prior Authorization Requests - for up to two calendar years!

Note: All Retrospective Requests will be routed for manual review. The benefit to Providers include:

  • Secure submittal of Service Authorization Request (SAR) and additional clinical documentation.
  • Receipt of a Kepro Case ID# as confirmation that all submission requirements have been met and Kepro has successfully received your request.
  • Tracking case status. Search and review submissions by submittal date, Recipient ID.

Kepro Questionnaire to help reduce “pends” for additional clinical Information. Please share this invitation with the appropriate staff in your organization who submits prior authorization D1110 prophylaxis requests and who will be available for the training session.

You must be registered for Kepro’s Atrezzo Portal in order to participate in the WebEx and to submit requests via the portal. If you cannot access the Web-Ex presentation online, you may join the audio portion of the presentation by calling the number and entering the code above. Instructions for Atrezzo Provider Portal registration are below. Are you registered for Kepro's Atrezzo Provider Portal? If you have not registered for online submission, please do so prior to the training. Visit MHCP.kepro.com, click the Atrezzo Login button and you will be prompted to enter your NPI number and Registration Code. To obtain your Registration code contact Kepro Customer Service at 866.433.3658 for assistance.

*The Atrezzo Provider Portal is a secure web based system for the submittal of Prior Authorization requests and uploading of ALL supportive documentation to substantiate Medical Necessity. 


 

Kepro is URAC accredited in Health Utilization Management and Case Management. We are also licensed to perform medical reviews in 29 states.