LA Professional Billing Input

LA Professional Input Billing is a program that allows the user to claim records that can be filed with Medicaid for reimbursement.

• Before starting LA Professional Input Billing for the first time: Be sure to obtain the ability to download monthly Medicaid eligibility files from the DHH VPN. Click the following link for directions on this procedure: DHH VPN Access Directions.

Menu Location

On the left navigation panel select Required Reporting > Entry > LA Professional Input Billing.

Setup Options

Year - Defaults to the current year. A prior year may be accessed by clicking in the field and making the appropriate selection from the drop down list.

District - Default value is based on your security settings. This will be limited to the district only.

School - Default value is based on security settings. If assigned to a school, the school default value will be the school site code. This is a default setting and can not be changed. If the staff member is a supervisor or other district office employee with access to the Student Information System, they will be able to run programs for one school, a small group of schools, or all schools in the district.

Billing Group - Select the billing group. Click in the field to change the Billing Group number. NOTE: After creating a "Transmit" file, the program automatically creates the next billing group. Transmit is located under the Action tab, located in the top right corner of the page.

Billing Perm - This field allows for the custom medicaid billable permission to be set so that the program logic will know which permission code to look for to determine if a student can be billed for. If no permission(s) is chosen only a list of students without permissions will populate. NOTE - To have access for Medicaid billing, permissions must be set up by going to System -> User Management -> select staff member -> Category of Medicaid -> Program of Professional Input Billing.

Import RN Consultations Only - This option allows the user to limit the import of consultation records to only those that are given by RN nurses and will exclude consultation records created by nursing aids and assistant nurses.

OK - Click to continue.

Top

Initial Items to Complete/Review Before Beginning to Create Claim Records

Click on the Action button located in the upper right corner of the screen. The information is loaded on each student but can be changed if necessary for an individual.

Default Submit/Receive

• Submitter Information (top) - Enter Organization Name, Submitter ID#, Contact Name, Contact Phone, Contact Email, and Contact Fax.

• Submitter Information (middle) - Enter Organization Name as LOUISIANA MEDICAID and Receiver Code as LA-DHH-MEDICAID

• Submitter Information (bottom) - Enter Provider ID# (7-digit #), NPI# (10-digit #), Employer ID# (Tax #), Address Line 1, Address Line 2, City, State, Zip Code, V/H Site Code (3-digit #)

Save - Select to save the input information that has been entered.

Clear - Select to clear out all information that has been entered.

Cancel - Select to cancel.

Default Claim Info

• Claim Information - Enter Facility Code, Provider Signature on File, Provider Accept Assignment Code, Assignment of Benefits Indicator, Release of Information, Parent Signature Source Code, Special Program Code, Was an EPSDT referral given to the patient, and EPSDT Condition Indicator.

• Service Information - Product/Service ID Qualifier, Unit of Basis for Measurement Code, EPSDT involvement.

Save - Select to save the input information that has been entered.

Clear - Select to clear out all information that has been entered.

Cancel - Select to cancel.

Edit Default Referral Doctors

These are specific to each User and School, so if a new user to the program tries to use the program for the first time in Professional Input Billing, it is recommended that they set up their Default Referral Doctors.

• Column Headers - School, Vision First (first name of the doctor), Vision Last (last name of the doctor), Vision AC (area code of the doctor's phone number), Vision Prefix (prefix of the doctor's phone number), Vision Phone (phone number of the doctor), Hearing First (first name of the doctor), Hearing Last (last name of the doctor), Hearing AC (area code of the doctor's phone number), Hearing Prefix (prefix of the doctor's phone number), Hearing Phone (phone number of the doctor).

Print - To find the regular print instructions, follow this link: Standard Print Options

To edit the doctor's information, click on the doctor's name and a popup box will appear. Change/correct the information, select the Save button.

Mass Update Default Referral Doctors

To add a Vision/Hearing doctor to the list, fill in the area that pertains to the doctor. Once that has been some, select the Save button.

Add Eligibility

NOTE - To save additional months of eligibility, keep the screen open after clicking Save Eligibility. Change the Eligibility Month, then click the Save Eligibility button again. Repeat for each month needed. Click the "X" in the upper right when done adding eligibility month(s) to the student.

Student Name - The student's name will appear once it is selected from the Student Id field.

Student ID - Click in the box to select the student to add eligibility.

Eligibility Year - Year of Medicaid eligibility.

Eligibility Month - Month of Medicaid eligibility.

Medicaid Number - Student's Medicaid number.

Save Eligibility - Select to save input information to submit for eligibility.

Cancel - Select to cancel.

Import Eligibility

Each month, a Medicaid Eligibility file will need to be downloaded from DHH, via VPN. If not done, a set of directions for obtaining access to the DHH VPN may be accessed by clicking here: DHH VPN Access Directions.

After the import process is completed, there will be a list of those that are not found in Student Master database. Medicaid Eligibility Import Errors will be displayed with errors – most of these will be where SSN is not in the database. These can be research by printing and investigating on LAMedicaid.com, if necessary.

Eligibility Year - Year of Medicaid eligibility.

Eligibility Month - Month of Medicaid eligibility.

Upload File - Select Choose File to attach the eligibility file. Click the "JDrive" icon in the upper right of the page (little cloud icon next to your username). Eligibility file will be in this location. Right click to download.

NOTE: Remember, this is VERY confidential information. Do not move or share the file to an unsecured location.

OK - Click to continue.

Cancel - Click to cancel.

Import Consultation

In order to bill for Consultations the consultation record must have a nurse of record be an RN Nurse in the Human Resource Master with an Object Function code of 118 2134 and is not fully federally funded. The consultation records must also have a CPT Code and a DX Code. No consultation records will be imported by the LA Professional Input Billing program unless they have an RN Nurse of record that is not fully federally funded, a CPT Code, and a DX Code.

In order to bill for consultation records with the CPT Codes T1018, T1502, and T1002 the student needs to have an IHP that is/was active on the date of the service/consultation and be Medicaid eligible for the year and month that the service/consultation took place in. The IHP`s that the LA Professional Input Billing program`s logic looks at are found almost entirely in the Health System`s IHP tab. The only other place that the LA Professional Input Billing program logic will look for an IHP is the Health Care Plan Date field in the Special Ed Master`s IEP tab.

Even if a student does not have an active IHP on the date of the consultation the LA Professional Input Billing program will still import consultation records with the CPT Codes T1018, T1502, and T1002. The program will give you a warning in the Medicaid Consultation Claim Import Errors dialog letting you know that the user needs to double check that the student has an IHP on file somewhere so that Medicaid does not take back the money received after an audit.

In order to bill for consultation records with the CPT Code T1001 the student only needs to be Medicaid eligible for the year and month that the service/consultation took place in. An IHP is not required. It is important to note the purpose of this code. This does NOT include the assessment that the nurse conducts every time he/she sees a student. This would include any evaluation by the school nurse for which the parent would otherwise take their child to a clinic, etc. For example, a child coming to a school nurse for a possible broken bone. As result of the nurse’s findings, the parent would take the child to seek additional medical attention. This would be an allowable claim, according to Medicaid. A parent is probably not going to take a child with a skinned knee to a clinic/MD. Therefore, the LEA would not claim for this assessment. As such the Import Consultations Action logic will no longer default the CPT Code T1001 on any consultation record that it imports.

Column Headers - District, School, SASID, SIDNO, Last (name), First (name), Middle (name), Type, Claim Data and Error.

Print - To find the regular print instructions, follow this link: Standard Print Options

Import Vision/Hearing

Claims for vision/hearing records must have a nurse of record be a RN Nurse in Human Resource Master with an Object Function code of 118 2134 and is not fully federally funded.

Choose which to import - Select from Both, Vision Only or Hearing Only.

Schools - Select the school(s) to import from.

Date Start - Select the start date of the date range.

Date To - Select the end date of the date range

OK - Click to Continue

Cancel - Click to cancel.

Import Service Provider Logs

Import Therapy Claims

Prior to importing the Therapy Claims, follow these instructions to download the Therapy Claims file.

• Click on the Reports tab to show the list of available report categories.

• Click on the RSM Admin Reports category to expand/display the list of reports.

• Click on the Sessions report found under the RSM Admin Reports category to bring up the report options.

• Fill out the Begin and End dates and the desired LEA(district). Make sure that the Provided options is set to All or Yes and that the Show Deleted option is NOT SELECTED.

• Enter a Reports Description and select the Excel format for the Export Format.

• Click the Add to My Reports button to run the report.

• Once the report has finished running download the file to your desktop or a desired folder.

Next, follow these instructions to format the file into the appropriate import format.

• Open the XLS file into an editor and delete the first couple of rows to remove unneeded data headers from the file. You need to remove enough so that the column headers for the data are the first line in the file.

• Now you need to delete 3 columns: IEP Goals Addressed, Progress Notes, and Additional Comments.

• Save the document as a CSV file under a new name.

• You want to keep the data formatting as original. (screen shot included)

• The field delimiter should be a comma while the text delimiter is a double quote. (screen shot included)

• Next save the file.

• Provider Information - Reference Identification Code

• Claim Information - Facility Code, Provider Signature of File, Provider Accept Assignment Code, Assignment of Benefits Indicator, Release of Information, Patient Signature Sources Code, Special Program Code, Was an EPSDT referral given to the patient, EPSDT Condition Indicator

• Service Information - Product/Service ID Qualifier, Unit of Basis for Measurement Code, EPSDT involvment

Choose File - Select Choose File to attach the eligibility file. Click the "JDrive" icon in the upper right of the page (little cloud icon next to your username). Eligibility file will be in this location. Right click to download.

Save - Select to save the input information that has been entered.

Clear - Select to clear out all information that has been entered.

Cancel - Select to cancel.

Transmit

Main

Initial Items to Complete/Review Before Beginning to Create Claim Records

The information is loaded on each student but can be changed if necessary for an individual. Click on the Action button in the upper right of the screen. Click on the item to edit/review each.

Entering Claims

1. On the lower left, click the Claim Information tab.
2. Set the Date of Service, then in the Student field, select the student. The student’s name is entered into the field and the student’s Medicaid number appears to the right of the name.
3. Click in the Provider SSN field and find the provider’s name from the list. If the provider is not listed, check with Human Resources. Human Resources can add the person, then the provider will appear in the list. After selection, the section is populated with the provider’s information (SSN, Last Name, First Name, Middle Name and Suffix).
4. Click on the Reference Identification Code to select the proper code for the provider.
5. The Claim Submitter’s Identifier is populated by the program along with Total Claim Charges after this claim is saved.
6. The Facility Code through the EPSDT Condition Indicator fields are populated by the default settings indicated by Default Claim Info.
7. If anything needs to be adjusted, do so now. If complete and correct, select Health Care Diagnosis Code 1 through Health Care Diagnosis Code 4 if needed.
   • One code is required but more than one can be entered.
   • To find the Diagnosis Code, click on the column heading Value and then start typing in the Search box to find the code. #* If searching based on the description column, simply click in the search box to find any word in the Description.
8. The Date of Service and Product/Service ID Qualifier are already populated.
9. Select the Product/Service ID. The Product/Service Modifier is entered here and is used in different situations.
   • Examples:
     • If the Behavioral Health Product/Service ID is H0036, then a modifier of HN – bachelor’s degree or HO – master’s degree is used.
     • If more than one service is provided on the same day a modifier is needed – Speech Therapy and Occupational Therapy
10. Select the Health Care Diagnosis Code Reference Number which refers the claim info to which of the 4 diagnosis codes in the Claim Information is addressed in this claim.
11. Enter the Quantity according to the Unit of Basis for Measurement Code given in the default claim info.
12. Click the Save Service button.
13. The claim will be added to the New Services section (not yet transmitted) and the All Services section (not yet transmitted and previously transmitted claims)
14. Continue adding claims for the same student and then complete all other student claims for this billing group.
15. On the lower left, click the View All Claims tab to review all claim information for the group, including a total of charges for the billing group.

Editing a Claim in a Billing Group

1. While on the Claim Information tab, enter any date in the Date of Service field. Next, click the Student field and select the student.
2. Scroll down to the New Services section of the screen. The services previously entered will be listed in rows.
3. Click on the row to be edited. This will populate the claim fields above.
4. Go to the field that needs changing, make the change and click the Save Service button.
5. A screen appears for (1) Update Existing, (2) New Service or (3) Cancel.
6. Select Update Existing to change the existing claim.

Creating a Transmit File

Upon completion of claims for this billing group, the next step is to create a transmit file.

1. Click the Action button in the upper right, then click Transmit.
2. On the Transmit screen, enter the Year, District, School (700 for all schools), and Billing Group.
3. Select New Transmit if this is the first time you are transmitting this group.
   • If you need to transmit this same group again at a later time, then select Re-Transmit.
     
4. After the transmit or re-transmit is complete a list of students with errors will be provided for you to correct and then process/transmit again.
5. The Transmit file is created and placed on the "JDrive". The "JDrive" space is accessed by clicking on the little cloud icon next to the user name in the top right. When clicked, the "JDrive" space of the user is opened.
   • Make sure to contact your Security Coordinator to give you R/W access to "JDrive".
6. The file is placed in a folder Medicaid, then Medicaid Billing.
7. Find the file and do a right click on it. Select Download. The file opens in a window.
8. Next right click anywhere on the file contents and select Save As. Select where you want to save the file on your computer.
9. In Windows, browse to the location of the download. Right click on the file and rename your file according to directions from Molina – H500XXX.phy

Printing Billing Group Summary

The Print Billing Summary is used to print the billing group summary to compare or reference when the weekly remittance advice reports are downloaded from LAMedicaid.com.

1. In the uppper right, click the Action button, then select Print Billing Summary.

Import Therapy Claims

1. Prior to importing the Therapy Claims, follow these instructions to download the Therapy Claims file.
   • Click on the Reports tab to show the list of available report categories.
   • Click on the RSM Admin Reports category to expand/display the list of reports.
   • Click on the Sessions report found under the RSM Admin Reports category to bring up the report options.
   • Fill out the Begin and End dates and the desired LEA(district). Make sure that the Provided options is set to All or Yes and that the Show Deleted option is NOT SELECTED.
   • Enter a Reports Description and select the Excel format for the Export Format.
   • Click the Add to My Reports button to run the report.
   • Once the report has finished running download the file to your desktop or a desired folder.
2. Next, follow these instructions to format the file into the appropriate import format.
   • Open the XLS file into an editor and delete the first couple of rows to remove unneeded data headers from the file. You need to remove enough so that the column headers for the data are the first line in the file.
   • Now you need to delete 3 columns: IEP Goals Addressed, Progress Notes, and Additional Comments.
   • Save the document as a CSV file under a new name.
   • You want to keep the data formatting as original. (screen shot included)
   • The field delimiter should be a comma while the text delimiter is a double quote. (screen shot included)
   • Next save the file.
3. To import the Therapy Claims file, click on the Actions menu and click Import Therapy Claims.
4. Under Provider Information, select the appropriate Reference Identification Code.
   • The information in the Claim Information and Service Information area will already be populated with the appropriate information.
5. Click on the Choose File button to select the claims file.
6. Click Save to begin importing.

Resources

LA Professional Billing Medicaid Guide: A quick guide on how to enter information for Louisiana Medicaid billing.

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JCampus / Required Reporting