Provider Letter - Administrative Letter 19-08
OKLAHOMA DEPARTMENT OF HUMAN SERVICES
Developmental Disabilities Services Division
Sequoyah Memorial Office Building
PO Box 25352
Oklahoma City, OK 73125-9907
PH: (405) 521-3571 FX: (405) 522-3037 www.okdhs.org
Administrative Letter 19-08
December 14, 2018
Developmental Disabilities Services (DDS) has received unfortunate news related to the recent change in Family Training billing codes, effective December 1, 2018. Per the Oklahoma Health Care Authority, HIPAA code limits for S5116 and S5109 only allow one unit to be billed per day per service recipient. This is an issue for DDS Family Training providers as each of you have a rate structure consisting of multiple unit increments.
As you may recall, in preparation for the change of billing codes, existing authorizations were separated into two authorizations (before and after December 1, 2018). As claims have been submitted using the new codes after 12/1/18, they have been denied payment or paid incorrectly as a result of the one session per day, per recipient, HIPAA code limit rule. We sincerely regret this information wasn't evident during planning stages and acknowledge the extra work required for providers as well as DDS to correct the issue.
Moving forward, please review your current rate structure and adjust in a manner that will allow you to bill one unit per session, per service recipient, per day, for each code. While your manual rate, as approved by the DDS Family Training Committee, should not be changed, it should be reconfigured to adhere to the one session per day rule. Upon completion, please forward your updated rate structure to Melody Peacock (email@example.com) for review and approval. Upon approval, please review your authorizations beginning
December 1, 2018, and determine how units should be adjusted. Please submit this information to Melody Peacock. DDS State Office staff will then update your authorizations as quickly as possible. The DDS Provider Support Center has been instructed to make no further authorization updates for providers billing in unit increments other than one session.
In the interim, please be aware, claims submitted for S5116 and S5109, for dates of service December 1, 2018 and forward must be submitted in a manner that reflects one session, per day, per service recipient for each procedure code and must also have a correlating authorization in order to pay and pay correctly. Any claims already submitted for dates of service December 1, 2018 that did not pay correctly, must be voided and resubmitted once you have received an updated authorization.
Also, if you haven't already updated your unit request forms, please do so. Reports indicate authorizations continue to be issued using the old Family Training codes. We are working with case management staff to correct the codes; however, it would speed up the process if unit requests received from providers reflect the new S5116 and S5109 procedure codes.
We sincerely apologize for this inconvenience and will work diligently to review your rate structures and make authorization adjustments as quickly as possible. If you have questions, please contact Melody Peacock either by email (firstname.lastname@example.org) or phone (405-521-6260).
Beth Scrutchins, Director
Developmental Disabilities Services
Department of Human Services