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Provider Update: November 7, 2018

Subject:Rate Conversion Follow-up 

Priority:HIGH

Medicaid Services Unit-ADvantage Administration (MSU-AA anticipates that future conversions completed in the new Waiver Management System, Harmony, will be more efficient. However, due to the retrospective nature of the recent rate conversion, providers may find that units on service lines with an annual allotment may require adjustment.

Such conversions require the existing service line with the old reimbursement rate to be ended, and a new service line with the new rate to begin one day later.  When one service line is ended and another is created, the system must allot units based on defined parameters.  In this situation, the system allotted units on the ending line based on units billed or dates of services and the total amount of units.  Due to lags in provider billing, this has resulted in units being distributed across the two service lines inconsistent with actual units used. 

How to Submit Requests to Adjust Lines of Service

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  • MSU-AA will make the necessary adjustments to service lines as requested by providers, however, requests must be submitted according to the following process: 
    • Each Provider will be allowed to submit one request to make a retrospective change on the annual service lines for all their Members, moving units from the active service line to the line impacted by the conversion that ended on 9/30/2018.
    • Please note:  Multiple requests will not be considered.  This is a one-time submission for all required adjustments

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  • Requests to adjust service lines must be submitted using the Excel spreadsheet attached to this bulletin in order to be processed or considered.
  • Complete the spreadsheet as follows:   
    • Example – MSU-AA needs to know how many units providers expect to see on the line ending 9/30/2018 and on the line beginning 10/1/18 for T1002 service, and G0299/G0300, if applicable.  If there are 9 units on the T1002 line ending 9/30/18, but the provider needs it to be 5, enter 5 in the spreadsheet under the column heading that states, "Number of units for line ending 9/30/18". 
    • Providers should then enter the number of units that remain for that service under the column heading that states, "Number of units Remaining on line beginning 10/1/". MSU-AA staff will only move lines from the beginning line (10/01/18) to the line ending (09/30/18).  If the total remaining units exceed total units originally authorized, MSU-AA will not adjust the line.
    • Regarding the last column, please answer yes or no if the T1019 service line beginning 10/1/18 is short units, as in some cases, it has been determined that required recalculation is needed.

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Additional need to know information for making line adjustments:

  • The Provider's billing must be current through 9/30/18, in order to capture all units used and any additional units needed.
  • Requests to add units to a service line beginning 10/1/2018 or after, must occur via the process in the next section. Requests will be worked in the order in which they are received.
  • Requests for unit adjustments are time limited, and will not be accepted after December 31, 2018.    

Requests for Additional Units

Any requests for units that exceed the amount originally authorized are not considered unit adjustments and must be submitted as a Change in Service Request, which is outlined in the job sheet entitled ADv.SPPC_CM.HCAgency_Change in Service (Former Addendum), posted on our website.   

Please send spreadsheets through the PQ Chapter in Harmony.

Please note:  If you have any questions regarding the information provided above, please send questions through the PQ chapter in Harmony. 

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