Provider Update: March 11, 2020

To:Case Management and Home Care Providers

Subject:SPA Process Notification

The Medicaid Services Unit – ADvantage Administration (MSU-AA) has received feedback from the home care provider network regarding payment issues when a skilled nursing visit is not made by the nurse type (RN versus LPN) coded on a Member's individualized service plan for visits that can be fulfilled by either level of nurse.  The MSU-AA has been accepting duplicate codes to allow for either nurse to fulfill visits of this nature, however not all providers are submitting codes in this manner. 

In an effort to prevent delays in the payment of services rendered for home care providers, the Service Plan Authorization (SPA) team will now enter any alternate G-code Skilled Nursing service lines that were not initially added by case managers to Members' service plans.  For example, if the case manager submits a Service Plan with G0299 only, SPA will add the corresponding G0300 service line and vice versa.

Appropriate utilization of codes and billing will be monitored through audit and claims review processes.

*Please submit any questions you may have through the PQ Chapter in Harmony.