Industries We Serve
Millin Associates offers over three decades of proven knowledge in all the billing procedures, requirements, regulations, and unique conditions involved in billing and processing for Health Homes, Intellectual/Developmental Disability (OPWDD), Mental Health (OMH), Substance Abuse (OASAS), Primary Care (DOH), and Foster Care settings.
Health Homes (DOH)
With the influx of patients being approved for outreach and care coordination, it is critical to have the right revenue cycle management systems and services in place to handle the increase in claims volume and data communication between the Health Home Leaders and Care Management Agencies (CMA’s).
There are a number of items that have significantly complicated the Health Home billing process:
- The process to submit claims to Managed Care Organizations is unique to Health Homes and does not go through the standard 837 file format.
- The posting of payments from MCO’s is unique to Health Homes as the Health Home receives spreadsheets from the MCO’s instead of the electronic 835 file format.
- As of September 1, 2016 Health Home Leaders will be responsible to process all claims for services provided by CMA’s. This creates a real challenge for Health Home Leaders and CMA’s.
Millin Associates provides revenue cycle management expertise and software solutions to tackle this unique billing process. In addition to the countless standard features in the MillinPro system, it has the ability to :
- Submit the unique claims file format for MCO payments and 837/835 format for Medicaid claims.
- Auto-post the spreadsheets of payments sent by the various MCO’s.
- Integrate with your care coordination system thus eliminating double data entry work.
- Integrate with your accounting system.
- Communicate claims data between the Health Home and the CMA through its web-based portal. The Health Homes are able to provide full transparency to CMA’s through live access to payment/pending/denial status and resolve any outstanding claims issues through the MillinPro proprietary issue tracker – all in 1 centralized system. The Health Homes has the ability to ensure each CMA only has access to claims pertaining specifically to the patients they provided services for.
- Our development team is currently in the process of integrating features from the MAPP into MillinPro.
As of January 1, 2016 NYC agencies that are approved by OMH/OASAS to provide HCBS services are able to start servicing eligible individuals.
Some agencies may have experience billing for behavioral health services while others have never billed a payer prior to offering these services. Either way, billing managed care plans for Home & Community Based Services (HCBS) is new to all providers and comes with a number of complexities.
Thanks to Millin’s expertise in billing HCBS for OPWDD providers combined with its Managed Care expertise, partnering with Millin is a natural fit.
Our MillinPro billing system integrates with the EMR of your choice!
- Community Psychiatric Support & Treatment
- Psychosocial Rehabilitation (PSR)
- Habilitation/Residential Support Services
- Family Support & Training
- Short-Term Crisis Respite
- Intensive Crisis Respite
- Pre-Vocational Services
- Transitional Employment
- Intensive Supported Employment (ISE)
- Ongoing Supported Employment
- Education Support Services
- Empowerment Services – Peer Support
- Non-Medical Transportation
- Staff Transportation
Intellectual/Developmental Disability (OPWDD)
The billing process for OPWDD providers has gotten increasingly more complicated and overall reimbursement continues to shrink. Now that MCOs and DISCOs are being added to the mix, it is more vital than ever to ensure that proper solutions are in place. After all, with today’s tight budgets, most agencies do not have the luxury of writing off claims and learning from mistakes over time.
Millin Associates offers invaluable expertise and system solutions to confidently navigate this revenue cycle maze.
- Community Habilitation
- Day Habilitation
- Pre Vocational
- Therapy Services – Article 16
- Self-directed Services
- … and many more
Mental Health (OMH)
With the introduction of APG based billing requirements, new HCBS services and the multitude of managed care organization, it’s a whole new ballgame for OMH providers. The billing process has transformed dramatically…and the changes keep coming.
Agencies providing residential services will be facing their own obstacles in the near future as BHOs are introduced. The rules and regulations frequently vary from one payer to the next, with subtleties that can be challenging to track.
MillinPro’s proprietary rules engine and APG calculator are increasingly essential in keeping on top of the vast number of changes so that providers do not inadvertently leave any revenue on the table. In addition, APG and managed care experts are there to provide knowledgeable support for the entire revenue cycle management process.
- Outpatient Mental Health – Article 31
- Apartment Treatment Program
- Community Residence
- Case Management
Substance Abuse (OASAS)
OASAS providers have not yet been exposed to Managed Care Organizations as fully as OMH and DOHs. But significant change is on its way. It is anticipated that as of 2015, the majority of substance abuse treatment services will need to be billed to the various Managed Care plans.
Each of the dozen Managed Care plans maintain its own rules and regulations, which promises to be even more complicated than the transition to APGs. Providers who take a proactive approach to these impending changes will be at an advantage.
Rest assured with Millin Associates software and service solutions, it is possible to confidently navigate this cumbersome maze.
- Outpatient Substance Abuse – Article 32
- Methadone Treatment
- Residential Treatment
Primary Care (DOH)
Articles 28s have contracted with Managed Care Organizations for quite some time and are also the first providers that had to comply with Medicaid’s APG rules. Unfortunately with low reimbursement and continuous regulatory changes, the billing process remains a complicated one to handle.
Many FQHCs provide thousands of services annually and continue to grow exponentially. While they had the ability to opt out of the APG rules and are still entitled to “wrap around” funds, challenges that focus on the volume of claims are still ever-present.
Millin Associates provides the vital resources and systems to support small and large agencies in ensuring maximum efficiencies and reimbursement.
- Primary Care – Article 28
- Primary Care – FQHC
Foster care agencies currently bill Medicaid a monthly fee for no more than a few hundred children, yet the dollar value associated with those claims are substantial. As a result, eligibility issues frequently arise.
Even a couple of claims falling through the cracks can be very costly. In addition, as foster agencies transition to Managed Care and Health Homes in the near future, the entire billing process will shift to a different reimbursement model.
With Millin Associates solutions, foster care agencies can help ensure they receive the reimbursement they’re entitled to, by relying on an organization that boasts a proven track record within the managed care and Health Home environment.Millin Associates solutions are specifically designed for the following type of providers: OPWDD, OMH, OASAS, DOH, OCFS