Some ODP waiver-funded services billed through PROMISe are billed monthly, while others are billed daily or by a number of units. Units of time can also vary from one program to another. Some programs have 15-minute units, while other programs have 1-hour units.
In some cases, you can combine the minutes within a day to capture as many billable services as possible, while in other instances, you may not be able to do so. Then there are rules for when you can round the minutes up or down. This can also vary by program.
PROMISe does not house all of these intricate billing rules in its system for provider billing resources. It's tricky to locate the guidelines for provider billing, payment, and claims resolution resources specific to ODP. Without knowledge of claim criteria, how provider billing and self-resolution works, or years and years of Pennsylvania I/DD claims processing and billing expertise, these rules can be easily overlooked. The billing rules for I/DD services are just the starting point, and for a system like PROMISe that requires a lot of manual entry and tedious billing submissions, this can result in claim data received delinquent or claim errors that cause denials, so providers do not receive payment and decreased cash flow. Rules like this are built into the billing logic of MillinPro for direct service providers, whereas in other ODP billing software, these types of rules may require general knowledge to manually manipulate submissions for claim payments in a timely manner.
In addition, there are several States that are already contracted with Managed Care Organizations (MCOs) to be the payer for behavioral health and intellectual and developmental disabilities direct service providers. This also means that not only do I/DD and behavioral health providers need to keep track of the nuances of each program, but every provider understands that each payer may have their own billing rules as well.
For these and many other reasons, having a system like MillinPro that replaces a large chunk of the ODP billing process is critical, and Millin's expertise is invaluable. The MillinPro billing system for Pennsylvania IDD services has a sophisticated rules engine that is updated on an ongoing basis as Pennsylvania Medicaid rules and regulations change. Millin has business analysts on staff who continuously keep track of the latest version of ODP billing guidance to incorporate them into the MillinPro billing system. The rules engine can keep track of rules by program, payer, and individuals served. This assures that a claim successfully is submitted without error the first time around. This will not only ensure payments occur in a timely manner to increase your cash flow but ultimately increase your overall collection rate and decrease time spent managing billing processes as well.
In addition, MillinPro has a proprietary claim issues tracker that ensures you are able to keep track and follow up on all issues that occur within HCSIS and PROMISe without having claims fall through the cracks. Millin alerts for claim issues that occur pre-billing in the Home and Community Services Information System (HCSIS) or after the claim is submitted through the PROMISe interface. Many agencies have recognized the value in outsourcing claims processing to Millin so we can help identify any claim errors that come up during the ODP billing process. This allows you to focus better on the waiver-funded services rendered. We manage the ODP billing for small, medium, and large agencies. Some of our clients process less than one million dollars in claim payments annually, while others process a few hundred million dollars, and everything in between.
The HCSIS service authorization report that MillinPro has built into its ODP business solutions workflow is a huge part of staying on top of claim transactions that have the potential to be rejected or denied before they're even sent through the PROMISe system for claims processing. Rather than logging into HCSIS and manually checking available units and service authorization by hand, Millin has launched a report that pulls all the claim data residing in HCSIS into MillinPro. The software then cross-references the unit authorization and utilization with the waiver-funded services rendered. If there are any discrepancies at all, MillinPro will hold the claim back and alert you immediately via the issue tracker so you can solve the issue. Once the issue is fixed, you can put it back in the queue to be sent out, and only then will the system allow you to submit it to PROMISe.
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