Overview. Provider Enrollment Requirements Member Eligibility Hearing Services Authorization and Billing Additional Information

Audiology Services

Overview Provider Enrollment Requirements Member Eligibility Hearing Services Authorization and Billing Additional Information 2

Provider Enrollment 3

Alaska Medicaid Provider Enrollment Providers must be enrolled in Alaska Medicaid to bill for reimbursement of covered health care services rendered to eligible Medicaid members Enrollment starts at the Enrollment portal. Go to http://medicaidalaska.com under Providers, then Enrollment Audiologist Licensing: Active license under AS 08.11 to practice audiology individually or as a group Out-of-state providers must also have active license as an audiologist and be enrolled in the Medicaid program in state where services are provided Hearing Aid Dealer Licensing Active license under AS 08.55 as a provider of hearing services and items Out-of-state providers must also have active license as a provider of hearing services and items and be enrolled in the Medicaid program in state where services are provided 4

Recordkeeping Recordkeeping requirements are documented in the Individual Provider Agreement and Tax Certification and Group Provider Agreement and Tax Certification Although most recordkeeping requirements are consistent for all providers, some requirements are provider-type specific Providers must maintain complete and accurate clinical, financial, and other relevant records to support the care and services for which they bill Alaska Medical Assistance for a minimum of 7 years from the date of service Providers are subject to audits, reviews and investigations Providers must ensure their staff, billing agents, and any other entities responsible for any aspect of records maintenance meet the same requirements. 5

Member Eligibility 6

Member Eligibility Always verify member eligibility by using one of the following options: Request to see the member's eligibility coupon or card that shows the current month of eligibility; photocopy for your records Call Automated Voice Response System (AVR): 855.329.8986 (toll-free) Verify via Alaska Medicaid Health Enterprise website http://medicaidalaska.com Fax complete Recipient Eligibility Inquiry Form - General 907.644.8126 Submit a HIPAA compliant 270/271 electronic Eligibility Inquiry transaction Call Provider Inquiry 907.644.6800, option 1 or 800.770.5650, option 1, 1 (toll-free) 7

Member Eligibility 8

Audiology Services 9

Audiologist Services Audiologist covered hearing services and hearing items: Identified in 7 AAC 115.530 Rendered within scope of the audiologist s license Include audiometric evaluation, diagnostic testing, audiometric screening, rehabilitative therapy, preventive services, corrective services, hearing items, and hearing item repairs Cochlear implantation-related services Cochlear implantation-related services include: a preliminary assessment, programming of the device, adjustments, member education, auditory rehabilitation and treatment sessions Cochlear implantation replacement parts are covered if they are prescribed by an appropriate, enrolled provider Covered parts include a microphone, speech processor, and transmitter 10

Hearing Aid Dealer Services Hearing Aid Dealer covered hearing services and hearing items: Identified in 7 AAC 115.530 Rendered within scope of the hearing aid dealer s license Includes hearing devices, accessories, supplies, repairs, and covered services when prescribed by a licensed provider within the scope of their license The department will not pay a hearing aid dealer For services rendered after the member waived the hearing evaluation For a hearing test or diagnostic procedure designed to determine the cause of hearing impairment 11

Covered Services and Items Providers must be enrolled and services or items covered Hearing services and items must be identified by the prescriber as medically necessary to alleviate a disability due to hearing impairment Services or items must be least costly service that meets member s medical need Providers must include a manufacturer s warranty of no less than one year from the original purchase date for hearing items Delivery and dispensing costs of new item or delivery of repaired item covered if item or repair capabilities are unavailable in member s municipality Trial use if supported by medical documentation and proper service authorization obtained to be covered 12

Non-covered Services and Items Administrative Expenses Included in payment for covered services and items Administrative expenses include telephone responses to questions, mileage, travel expenses, travel time, equipment setup, installation, office inventory supply, and orientation and training regarding the proper use of equipment Assistive Listening Devices Identified in HCPCS codes Assistive listening devices include telephone amplifiers, alerters, television amplifiers, television caption decoders, telecommunication devices for the deaf, and devices for use with a cochlear implant Charges submitted for adjustments, labor, repairs or replacement parts for a previously purchased hearing item when the department has purchased a newer like item 13

Labor, Repair or Replacement When a damaged hearing item is no longer under warranty, labor will be paid to assess and repair the item Labor and repair will be covered if necessary for the hearing item to function as intended Repairs will not be covered if replacement of item would be more cost effective Claims must include: Statement describing the cause for and nature of repair Description of item and its serial number if available Documentation of labor charges Labor, repair or replacement will not be covered if: Item is covered under manufacturer s warranty Item needs repair because of manufacturer s defect Item is a previously purchased hearing item and the department has since purchased a newer like item for the member 14

Rental Rental or rent-to-purchase will not be covered if purchase is less expensive Rental or rent-to-purchase will be paid as follows: Rental period thirty days or longer, monthly rental fee will be ten percent of allowed purchase price Rental period less than thirty days, amount paid = rental fee (as calculated above) / number of days in the month x number of days item was rented Rental periods over twelve months of continuous use will not be paid Labor, repair and maintenance will not be paid before total rental fee payments equal the allowed purchase price; these costs must be included in the rental fee When total rental payments reach allowed purchase price, labor, repair or maintenance will be paid after sixty days or when warranty expires, whichever is later 15

Hearing Aids - Covered No more than one hearing aid per ear, per member, per three calendar years One fitting fee per ear, per purchase or rental of hearing aid One dispensing fee per ear, per purchase or rental of hearing aid Any type of monaural or binaural hearing aid that is worn in or behind the ear If replacement is covered and manufacturer s warranty is in effect, only difference between deductible and maximum allowable will be paid 16

Hearing Aids Hearing aid supplies included with hearing aid: Single cord Y-cord Harness New receiver Bone-conduction receiver with headband 17

Hearing Aids Under Twenty One Unlimited ear mold impressions and ear molds Unlimited hearing aid repairs if: Hearing aid warranty is no longer in effect and Provider has not been paid a dispensing fee No more than two replacements of lost hearing aids if: Hearing aid warranty is no longer in effect Hearing aid was lost no more than three years after original purchase date Written explanation of device loss is submitted with claim No more than two replacements of broken hearing aids if: Hearing aid warranty is no longer in effect Hearing aid was broken no more than three years after original purchase date Hearing aid cannot be repaired, or cost of repairs exceeds replacement 18

Hearing Aids Over Twenty One No more than two ear mold impressions and ear molds per ear, per three calendar years No more than two hearing aid repairs if: Hearing aid warranty is no longer in effect and Provider has not been paid a dispensing fee No more than one replacement of lost hearing aid if: Hearing aid warranty is no longer in effect Hearing aid was lost no more than three years after original purchase date Written explanation of device loss is submitted with claim No more than one replacement of broken hearing aid if: Hearing aid warranty is no longer in effect Hearing aid was broken no more than three years after original purchase date Hearing aid cannot be repaired, or cost of repairs exceeds replacement 19

Hearing Aids - Batteries Twenty hearing aid batteries a month up to one hundred and sixty a year per member Thirty cochlear implant alkaline batteries per month Fifty five cochlear implant zinc air batteries per month If batteries are for hearing aid the department did not purchase, provider must record manufacturer s serial number and purchase date of the hearing aid 20

Authorization and Billing 21

Service Authorization Required for some services and items Required for payment amounts that exceed the maximum allowable Requests for replacement must show necessity of replacement and lack of warranty coverage Requested on a Certificate of Medical Necessity (CMN) form Requests are reviewed on an individual basis Factors considered include: Degree of member s hearing loss Type of hearing loss suffered Configuration of member s hearing loss Management and treatment plan prepared 22

Fee Schedules Fee schedules tell you: What services are covered Maximum allowed reimbursement Additional documentation requirements Other special considerations Fee schedules can be found on http://medicaidalaska.com in the Documents & Forms section 23

Certificate of Medical Necessity 24

Certificate of Medical Necessity 25

Certificate of Medical Necessity 26

Service Authorization Tips For relevant services, be sure to use a modifier to indicate the ear to which a service will be rendered Make sure dates are within appropriate timeframes Must attach an audiogram test report to CMN request or complete the clinical assessment section with great detail, including the assessment or audiogram results 27

Billing 837P electronic transaction Health Enterprise Payerpath CMS-1500, professional paper claim form 28

Additional Information 29

Overpayments & Repayment of Payment Errors Providers should closely review each remittance advice (RA) to ensure it reflects accurate payment for all billed services, including correct member details and services provided. In accordance with 7 AAC 105.220(e), Alaska Medical Assistance providers have 30 days from the time of payment to notify the department in writing of a payment error. Federal law (42 U.S.C. 1320(d)) requires repayment of overpayments to the department within 60 days of identifying the overpayment. Mail the written overpayment notification and a copy of the RA page detailing the overpayment to the address below: Conduent State Healthcare, LLC P.O. Box 240807 Anchorage, Alaska 99524-0807 30

Additional Resources Alaska Medicaid Health Enterprise website at http://medicaidalaska.com. Information necessary for successful billing Includes provider-specific Medicaid billing manuals and fee schedules You may also call: Provider Inquiry Eligibility only 907.644.6800, option 1,2 or 800.770.5650 (toll-free), option 1,1,2 Claim status and other inquiries 907.644.6800, option 1,1 or 800.770.5650 (toll-free), option 1,1,1 31