Library: Policy

317:30-5-1203. Billing procedures for Living Choice services

Revised 7-1-13

(a) The approved individual transition plan is the medical basis for services and includes the prior authorizations, specifying:

• (1) the service;

• (2) the service provider;

• (3) the number of units authorized; and

• (4) the authorized begin and end dates of the service.

(b) Institution Transition Case Management services are billed per 15-minute unit of service using the appropriate HCPC and modifier associated with the location of residence of the member served.  A unique modifier code is used to distinguish Institution Transition Case Management services from regular Case Management services.  The services are billed effective the date of transition into Living Choice and the provider records document actual time and date of services provided.

(c) As part of Living Choice quality assurance, audits are used to evaluate whether claims are consistent with individual transition plans and services provided are documented.  Claims that are not supported by individual transition plans and/or documentation of services are referred to the Program Integrity unit.  Erroneous or invalidated claims identified through post payment reviews are recouped from the provider.

(d) Claims may not be filed until the services are rendered.