Elderly Waiver Claims
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Frequently Asked Questions
FirstSolutions, a contracted vendor for Blue Plus, is processing all Blue Plus Elderly Waiver (EW) claims for Blue Advantage MSC+ and SecureBlue MSHO members. Listed below are the most frequently asked questions we have received from EW Providers and Care Coordinators regarding claims processing and service agreements. You can find this document and other information at www.first-solutions.org under ‘Services’, go to ‘Business Processing’, then ‘Elderly Waiver Claims’.
* Why is Blue Plus making such a big change of EW claims processing?
Blue Plus has a major focus to review our administrative and operating costs so that we work more efficient, without threatening client health, safety, or quality. Part of this work has been to look at reducing the cost of care we purchase on behalf of our members. This includes reviewing our current vendor contracts. By moving our EW claims processing to FirstSolutions, Blue Plus has identified:
- cost savings – lower claims processing fees
- streamlined production efficiency – more control over claims processing with a flexible claims processing vendor
- improved reporting – enhanced reporting capability to enable identification of cost trends and areas of potential savings
- enhancements – care coordinator and provider trainings and dedicated EW Service team for members, care coordinators, and EW providers
Provider FAQ
1. How do EW Providers submit claims for Blue Advantage MSC+ and/or SecureBlue MSHO members?
Providers submit Blue Plus EW claims through IGI at MNEConnect.com, a free web-based electronic billing service. They can register as a new provider for FirstSolutions by using their UMPI or NPI number and Tax ID number. IGI will forward all EW claims to FirstSolutions daily for processing. FirstSolutions will pay providers within 30 days of receipt of a clean claim based on the Service Agreement authorization sent by the Care Coordinator.
2. What Steps must be completed by Providers who wish to render services for Elderly Waiver Secure Blue and Blue Advantage Members?
- Provider must have an UMPI or NPI number in order to submit Elderly Waiver claims.
- Providers must meet the specific standards, licensing, certification and registration requirements as outlined by the Minnesota Department of Health in the Elderly Waiver (EW) and Alternative Care (AC) Program information.
- Provider must have a contract with the County for the authorized service.
- Provider must register with www.MNEconnect.com to submit claims to Payer “FirstSolutions.”
- Provider must receive authorization (Service Agreement) from member’s Care Coordinator prior to rendering services.
- Care Coordinator will submit Service Agreement to FirstSolutions by faxing to 218-740-4616 or emailing to ServiceAgreements@First-Solutions.org . A letter will be generated to the provider as well as a copy to the member, based on the approved service agreement items and will provide an authorization number. In the letter will be a listing of the approved services to be rendered with limits on the dollar amount or units to be billed. The provider must keep this letter for future reference as the information listed on the authorization will be needed when completing the claim form.
- Provider to submit claims for services to FirstSolutions via IGI Website and must include the authorization number in box 23 of the CMS1500 professional claim form.
3. How does a Provider know if they are registered with IGI?
All providers can verify if they are registered with FirstSolutions when they log into www.mneconnect.com. A list of all payers a provider is registered with will be listed under the sub menu Payer Registration View/ Update Results. If “FirstSolutions” is not listed providers will need to add this payer under “Search/Add Additional Payers”.
4. What if I (the Provider) am having problems registering as a new provider or would like to add FirstSolutions as a payer on IGI?
IGI can be contacted toll free at: 877-444-7194 or Fax: 732-909-2445 for any questions or concerns. A step by step tutorial is also available on the IGI website to help walk you through the registration process.
5. What is a Payer ID?
Some payers require a payer ID number when registering with a health plan to submit claims. A payer ID number is not required when registering with FirstSolutions. The only identification numbers required by FirstSolutions are:
- NPI ( National Provider Identifier) or
- UMPI (Unique Minnesota Provider Identifier)
- TIN (Business Federal Tax ID Number) or
- SSN (Social Security Number)
6. What are the billing guidelines for submitting an Elderly Waiver Claim?
A FirstSolutions Elderly Wavier provider manual is available on the FirstSolutions website at www.First-Solutions.org under Business Processes. A link to MNEConnect.com is also available from the FirstSolutions website where a tutorial for provider enrollment, claims submission and adjustments is available.
7. I have misplaced my service agreement letter for my Secure Blue or Blue Advantage member. How do I obtain one?
If you have misplaced the FirstSolutions service agreement authorization letter or need a copy of a service agreement letter that was approved through MN-ITS, please contact us at 218-740-2336 or 1-800-584-9488 or by email to ServiceAgreements@First-Solutions.org. We will reprint your letter and mail it out to you. (Revised May, 2010)
8. How Do I Submit a Claim?
After you are registered and approved by FirstSolutions as a provider, log into www.mneconnect.com and click on the “Claims” Tab. The format for completing a claim form is the same as completing a CMS1500 professional claim. If you would like step by step instructions a tutorial as well as registration for a webinar for claims submission is available on the IGI website home page.
9. Would an EW provider be able to bill through another clearinghouse system other than IGI (i.e. clearconnect/Availity using PHDOC)?
EW providers can direct their clearinghouse to contract with IGI and then IGI will route the provider claims to FirstSolutions. To do this, EW providers should contact IGI directly to let them know that they are interested in batch claims submission – 877-444-7194. There is an implementation manual that can be referenced for specifics and instructions.
10. How do I submit an EW claim adjustment or corrected claim to FirstSolutions?
Providers can click on the “Training Materials” on the home page of the IGI website and can download the manual and view demo for more information on submitting Void and Replacement claims.
11. How can I find out if my claim was transmitted or accepted?
In order for providers to check on the status of their claims submission and payment log into the IGI website at www.MNEConnect.com and click on the menu option “claims” and then the sub menu “claims access.” Then click on Reports and then “Claims Status from Payer” option to see the status of the submitted claim. FirstSolutions will pay clean claim within 30 days of “transmitted” or “received date.” You will also notice on this screen claims that are rejected by FirstSolutions and why. Providers should not need to contact FirstSolutions directly. If you have any questions please contact the “IGI” support team at 877-444-7194.
12. How do Providers and Care Coordinators find out Blue Plus members’ ID numbers?
Providers can check member eligibility through MN-ITS or EVS. The members’ ID and group number are listed on the Blue Plus member ID card. The Blue Advantage MSC+ member’s alpha prefix of “XZG” and SecureBlue MSHO member’s alpha prefix is “XZS” (the alpha prefix goes in front of the ID#). The ID number always equals “8” + PMI# . Blue Advantage MSC+ members’ group numbers will start with “PP0” and SecureBlue MSHO members’ group numbers will start with “PP2”.
13. How will the member’s Elderly Waiver Obligation be applied?
A member may be responsible to pay a cost of services they receive under the Elderly Waiver program, which is known as the waiver obligation. The waiver obligation is deducted from the cost of the services received under the Elderly Waiver and the Provider is responsible for billing the member the amount that is applied to the claim.
14. What is the Process for billing Extended Supplies and Equipment under T2029?
All Providers who are billing for Extended Medical Supplies and Equipment must submit claim with appropriate HCPCs code to the member’s State MA plan as primary first. Member’s State Plan and eligibility information can be located on MN-ITS or EVS. State plan benefits must be accessed first for medical equipment and supplies as defined under Minnesota Rules 9505.0310. Please refer to Chapter 23 of the MHCP Provider Manual for clarification about covered and non-covered items and regulations. Durable and non-durable supplies and equipment not covered by Medicare, MA, or a third party payer must be documented by the provider on their claim. MHCP enrolled providers must follow the instruction for Medicare and Other Insurance from the Billing Policy section of the MHCP Provider Manual. A denial is not required for each claim for non-covered items, but providers must document the item’s non-coverage on the claim form for waiver. Providers will also identify the supply or equipment item on their claim form by putting the item’s description at the line item notes field on their electronic claims.
Care Coordinators must ensure and document in the community support plan prior to the purchase of the supply or equipment, that the item meets the criteria outlined in the MHCP Provider manual Chapter 26A. Care Coordinators can complete a Service Agreement for extended supplies or equipment and submit to FirstSolutions. Claims must include a narrative description of the service in the appropriate field.
15. How do I get reimbursed for the Elderly Waiver Services?
FirstSolutions will process and pay all Elderly Waiver claims within 30 days receipt of a clean claim. Payment to provider is by EFT (Electronic Funds Transfer) and remittance is available to provider electronically on the IGI website. Providers can request the Direct Deposit/ACH form by sending an email with ACH Registration in the subject line to the EWproviders@First-Solutions.org mailbox. FirstSolutions will transmit form via SECURE email where the provider can either return the completed form by faxing to 218.740.4616 or to the EWproviders@First-Solutions.org mailbox. Please allow 30 days for processing. In the interim the provider will receive a paper check from FirstSolutions .The Remittance Advice is still available on IGI website.
16. How do I bill for Waiver Services When Client is hospitalized or at an inpatient facility?
Elderly Waiver providers cannot bill for days on which the client is absent from their facility. This would be for residential services such as customized living, foster care, etc. Monthly rate must be reduced by calculating daily rate and bill accordingly. FirstSolutions will adjust claims accordingly.
17. What HCPCS service code should providers use when a client is receiving medical life line or alert? [Updated June 9, 2010]
Based on the DHS 10-25-03 Comprehensive Policy on Elderly Waiver (EW) Customized Living, pages 12-13:
“A personal emergency response device or system can be authorized and purchased through EW under extended supplies and equipment (T2029) through a qualified supplies and equipment provider if the person receives customized living services containing no or less than 24 hours of supervision.”
Care Coordinator FAQ
1. With FirstSolutions as the new vendor for processing Blue Plus EW claims, do Care Coordinators need to submit all new Service Agreements for existing EW Blue Advantage MSC+ and/or SecureBlue MSHO members?
For any open Service Agreement that has been entered into MMIS before 3/4/10, Blue Plus will be getting an electronic report from DHS that has the Service Agreement information, so Blue Plus does not need to have the counties send us this information. Any Service Agreements on 3/4/10 or after, will need to be sent (emailed or faxed) to FirstSolutions. FirstSolutions’ secure fax: 218-740-4616 or toll free at 1-877-594-4415. Secure e-mail: ServiceAgreements@First-Solutions.org . Do not submit any Service Agreements on MMIS for dates of service on or after April 1, 2010.
2. Are we supposed to close all service agreements in MMIS effective 03-31-10? (Revised April 20, 2010)
Yes, due to the transition of claims processing to FirstSolutions, all service agreements still open in MMIS must be closed. Please go into MMIS and close as of 3/31/10. Any updates or changes on service agreements on 4/1/10 and beyond must be submitted to FirstSolutions. Counties that are affected by this change as of 4/1/10 are: Aitkin, Anoka, Becker, Benton, Carver, Cass, Chisago, Clay, Crow Wing, Dakota, Isanti, Mahnomen, Mille Lacs, Morrison, Norman, Otter Tail, Pine, Polk, Ramsey, Rice, Scott, Sherburne, Stearns, Todd, Wadena, Washington, Wilkin and Wright.
For counties starting 7/1/10: Chippewa, Cottonwood, Faribault, Fillmore, Houston, Jackson, Kandiyohi, Kittson, Lac Qui Parle, Lake of the Woods, Le Sueur, Lincoln, Lyon, Martin, Marshall, Mower, Murray, Nicollet, Nobles, Olmsted, Pennington, Red Lake, Redwood, Rock, Roseau, Swift, Watonwan, Winona, and Yellow Medicine.
DHS has put in an edit that will not allow any service agreements with a date after 6/30/10 to be entered into MMIS. Therefore, a new service agreement to FirstSolutions with an effective date of 7/1/10 to the end of the LTCC screening dates.
If you try to update a date range past 6/30/10 in MMIS it will error out.
3. In the Blue Plus communication, is “care coordination” the same as case management?
Yes, our definition of care coordination is also known as case management.
4. Is there a Service Agreement form that care coordinators could use to fax or email FirstSolutions?
Please see the www.first-solutions.org website. Under ‘Services’, go to ‘Business Processing’, then ‘Elderly Waiver Claims’. On the right hand side under Tools, click on ‘Service Agreement’. This Service Agreement form can be faxed to FirstSolutions’ secure fax at 218-740-4616, toll free at 1-877-594-4415, or via secure e-mail to ServiceAgreements@First-Solutions.org.
5. What if a county has a form they have, that meets all the Service Agreement elements? Can that be sent in?
That is okay to use an equivalent Service Agreement form.
6. How do we make changes to the Service Agreement? Is there a “short form” or how do we make FirstSolutions aware the Service Agreement being sent to them is a change and not a new Service Agreement?
If Care Coordinators would like to add authorized services, FirstSolutions prefers that the Care Coordinator complete a new one with the added information. We will then add it to the client’s EW information. The DHS form 3070 is pretty short, only two lines, plus there is a field to delete a service. Care Coordinators would mark the delete box and add the new services or changes to the existing one. Or they have sent a fax or email and on the header would identify the changes to be made. FirstSolutions would then look in the claims system to see if there were service(s) that needed to be reprocessed according to update or changes.
7. How do we make changes when it is across many clients, such as when there is a change in a rate or provider that affects a large number of EW recipients? Is it a full Service Agreement on every client or will we be able to do it in a spreadsheet format of some type?
If it is a rate change such as COLA, we would change the rates in FirstSolutions claims processing system and reimbursement would be adjusted on the amount authorized based on the start date. If the rate change was for a specific provider, FirstSolutions could program that in their system and process.
8. We have a few vendor pay providers (we have 10 clients with vendors) that the county pays and then the county bills via the state system. These providers lack technical billing capabilities. These entities will need to enroll with the FirstSolutions and have FirstSolutions support to implement the requirements.
Counties can either continue with the vendor pay process currently established, except the county would bill FirstSolutions instead of the state. Or these providers would need to register with IGI and should attend one of the upcoming Webinars. Please go to the FirstSolutions website at www.First-Solutions.org for future Webinar dates and registration.
9. Does a Service Agreement need to be complete for Blue Advantage MSC+ and/or SecureBlue MSHO members who are not on EW?
A Service Agreement does not need to be completed for Blue Plus members if they are not on an EW. If the member does go on waiver, the Care Coordinator time will be put on the service agreement at that time.
10. Does an Elderly Waiver need to be opened if a community well member receives life alert and meals?
Yes, those are not Medicaid covered benefits, they are waiver benefits. The member needs to be assessed and found eligible for Elderly Waiver in order to have these services provided.
11. Do care coordinators need to include the care coordinator services as a line item on the Service Agreement?
The Care Coordinator time must be billed directly to Blue Plus, however, the Service Agreement does need to include the care coordination services as a line item because these costs are included in the member’s case mix cap.
12. How do Providers and Care Coordinators find out Blue Plus members’ ID numbers?
Providers can check member eligibility through MN-ITS or EVS. The members’ ID and group number are listed on the Blue Plus member ID card. The Blue Advantage MSC+ member’s alpha prefix of “XZG” and SecureBlue MSHO member’s alpha prefix is “XZS” (the alpha prefix goes in front of the ID#). The ID number always equals “8” + PMI# . Blue Advantage MSC+ members’ group numbers will start with “PP0” and SecureBlue MSHO members’ group numbers will start with “PP2”.
13. Does a Service Agreement need to be completed for Blue Advantage MSC+ and/or SecureBlue MSHO members who are not on EW but who are receiving Care CoordinationServices?
No, a service agreement does not need to be completed if member is only receiving Care Coordination services. All Care Coordination claims for HCPCS T1016 will always be billed directly to Blue Plus.
14. How do care coordination providers, such as counties and clinics, submit Care Coordination claims for Blue Plus SecureBlue MSHO, Blue Advantage MSC+, and/or CareBlue SNBC, elderly, nursing home, and community well members?
All Care Coordination claims for Blue Plus members in rate cell A (community well), B (nursing home certifiable) and D (institutional) members should be submitted to Blue Plus using your legacy ID/payer provider number associated with your Blue Plus contract. IGI at MNEConnect.com, a free web-based electronic billing service is one option that may be used.
15. If the claims for Care Coordination are all being sent to Blue Plus, does the Service Agreement need to have the Care Coordination Authorization?
The Care Coordinator time must be billed directly to Blue Plus, however, the Service Agreement does need to include the care coordination services as a line item because these costs are included in the member’s case mix cap.
16. Why do Care Coordinators need to put a narrative in the Service Comments on a Service Agreement? (Revised April 28, 2010)
Effective 4/1/10, narratives are not required for S5120 or S5130 but are required for Extended Equipment/Supplies (T2029) and Modifications/Adaption (S5165).
When completing a Service Agreement Care Coordinators must put a description in the Service Comments box of DHS Form 3070. The Service Agreement is data entered in the FirstSolutions claim system, a letter is generated and mailed to client and provider confirming the approving the Service Agreement request. All Service Agreement narratives are included in the letter to clients and providers and clarifies the duration of services.
17. What is expected for the use of the extended supply and equipment code, T2029?
In the comment section of the Service Agreement, indicate what supply and equipment is being authorized, along with the dollar amounts.
18. What HCPCS service code should provider use when client is receiving medical lifeline or alert? (Revised April 28, 2010)
Please note the update below:
Based on the DHS 10-25-03 “Comprehensive Policy on Elderly Waiver (EW) Customized Living”, pages 12-13
- A personal emergency response device or system can be authorized and purchased through EW under extended supplies and equipment (T2029) through a qualified supplies and equipment provider if the person receives customized living services containing no or less than 24 hours of supervision.
Therefore, FirstSolutions will correct claim service codes and services agreements that were previously submitted to FirstSolutions using the S5165 (modifications/adaptations) to T2029- extended supplies and equipment.
19. Is there a Service Agreement form that care coordinators could use to fax or email FirstSolutions?
Please see the www.first-solutions.org website. Under ‘Services’, go to ‘Business Processing’, then ‘Elderly Waiver Claims’. On the right hand side under Tools, click on ‘Service Agreement’. This Service Agreement form can be faxed to FirstSolutions’ secure fax at 218-740-4616 or, via secure e-mail to ServiceAgreements@First-Solutions.org.
20. How can Care Coordinators, EW Providers and Members get their billing questions answered?
– EW Providers can contact FirstSolutions directly regarding claim questions at:
FirstSolutions 1-800-584-9488 or 218-740-2336
– Care Coordinator Service Agreement Questions:
FirstSolutions 1- 800-584-9488 or 218-740-2336
– Care Coordination Providers can contact Blue Plus Provider Services regarding claim questions at:
Blue Plus Provider Services 651-662-5200 or 1-800-262-0820
– Member Questions:
Blue Plus SecureBlue MSHO Member Services (651) 662-6013 or 1-888-740-6013
Blue Advantage MSC+ Member Services (651) 662-8700 or 1-888-878-0137
For Additional Information Regarding Waiver Services
– Please refer to the FirstSolutions EW Provider Manual located at www.first-solutions.org under ‘Services’, go to ‘Business Processing’, then ‘Elderly Waiver Claims’ for specific details to the answers listed below.
– If you need additional information regarding waiver services, please log on to the DHS web site under the provider manual by going to:
http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/DHS_id_000094.hcsp
Select the chapter you are interested in, such as home care services, HCBS waiver services, or billing policy, and press the GO button.
