Is there a set timeframe for submitting a CFTSS claim? Are there timeframes for resolving denials or other claims issues (not billed, pending, etc.)?
The state requires providers be given a minimum of 90 days to submit a claim.
It is recommended that providers have a process in place to make sure that every service has been billed in a timely fashion. In addition, the process should include review of remittances (response from MMCP). The goal is to account for every service and its billing status.
Where can claims testing contact information be found for each Medicaid Managed Care Plan?
Providers should contact each MMCP to get instructions on claims testing. The MCTAC Matrix below includes a tab for contacts at each MMCP related to billing: https://matrix.ctacny.org/
If the plan(s) has a subcontract with Beacon, or another plan for behavioral health, do we, the provider, bill Beacon or the MMCP for Article 29-I Core Services? Other Limited Health Related Services?
Core Limited Health Related Services are always billed directly to the Medicaid Managed Care Plan that you, the provider, are contracted with and not the delegate. For Other Limited Health Related Services, providers need to review their contract and talk with MMCP as this is different across plans.
Will there be a Mental Health indicator on ePACES to indicate SSI? In addition, will eMedNY know to lift the edit for these CFTSS rate codes if Mental Health in on the profile?
Yes, eMedNY will be able to determine if a child has SSI on their client file.