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Library: Policy

317:50-1-16. Billing procedures for Medically Fragile Waiver services

Issued 8-1-10

(a) Billing procedures for long-term care medical services are contained in the OKMMIS Billing and Procedure Manual.  Questions regarding billing procedures which cannot be resolved through a study of the manual should be referred to the OHCA.

(b) The approved Medically Fragile Waiver service plan is the basis for the MMIS service prior authorization, specifying:

  • (1) service;

  • (2) service provider;

  • (3) units authorized; and

  • (4) begin and end dates of service authorization.

(c) As part of Medically Fragile Waiver quality assurance, provider audits are used to evaluate whether paid claims are consistent with service plan authorizations and documentation of service provision.  Evidence of paid claims that are not supported by service plan authorization and/or documentation of service provision will be turned over to the OHCA Provider Audit Unit for follow-up investigation.

(d) Service time of Personal Care, Case Management, Nursing, Advanced Supportive/ Restorative Assistance, In-Home Respite and Self Direction may be documented through the Interactive Voice Response Authentication (IVRA) system when provided in the home.  Providers are required to use the IVRA system after access to the system is made available by OKDHS. The IVRA system provides alternate backup solutions should the automated system be unavailable.  In the event of IVRA backup system failure, the provider will document time in accordance with their agency backup plan.  The agency's backup procedures are only permitted when the IVRA system is unavailable.

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