TCM Billing Unit Changes and Service Grid Revisions for 9/1/08

Targeted Case Management (TCM) Billing Unit Change Instructions

Consistent with DHHS contract changes for TCM providers, the billing unit for children’s mental health and MR/DD TCM services is changing 9/1/08 from a 1 month unit to a 15 minute unit.  At this time, the billing unit is changing, but the procedure codes are not.  This change affects the following procedure codes only:

1. Procedure codes are not changing
2. Billing units are changing from 1 month to 15 minute
3. The initial authorization period is changing from 180 days to 90 days
4. The typical initial number of authorized units is changing from 6 to 95.
5. For service dates in the month of September only, MECMS PA Billing authorization numbers are not required, and must not be included with claims for service dates in September 2008 for the TCM service codes.

These changes are reflected in the revised Service Grid, version 9/1/08.

Please see the MaineCare Provider List Serv on the OMS website for MaineCare requirements related to this change.

Beginning with service dates of October 1, providers will submit a new MECMS PA billing authorization number for TCM services.

Since the procedure codes have not changed, Do NOT Re-Register these services.  Submit a Continued Stay Request to start the new set of units and obtain the new MECMS PA billing authorization number.

Instructions in APS CareConnection®:

1. In “Search Request”, bring up your list of active TCM cases.
2. Choose the “EXT” link on your most recent TCM request, to start a new Continued Stay Request.
3. On the Administrative page, enter a start date up to 10/1/08.
4. On the Services Requested page, click “Modify” to request your new set of 15 minute units.
5. In the Additional Information field, put this note:  “Billing Unit Change- No New Info”
6. Choose “Submit”, and you’re done with that request.

The units and end dates of the authorization will be changed, and will be in your download the next day along with the new MECMS PA billing authorization number to use for service dates starting 10/1/08.