Behavioral Health Bureau
County of Monterey
May & June 2013

• Electronic Invoice Submission Procedure
• naming convention
• supporting document
• Introducing MyAvatar Widgets and Reports:
• homeview widgets
• monthly reports
• Medi-Cal claims related reports
• County Contacts

MCBHD is accepting invoices electronically. This is to centralize the receiving point of contractors’ invoices and in result to expedite the payment processing (MCBHB Info Notice: 2012-01)
• Email invoices to : MCHDBHFinance@co.monterey.ca.us
• Within 30 days of the following the month of service
• exception - within 10 days for drug Medi-Cal program
 Naming convention
• Subject line
• MH_ContractAgency_201207_ProgramName_R
• ADP_ADPAgency_201207_DrugProgram_S
• Supporting document
• Invoice_ContractAgency_201207_ProgramName
• ResLog_ContractAgency_201207_ProgramName_R

( following the naming convention allows both the billing staff and Finance Staff to identify and locate files)

MCBHD is currently accepting the service data via the following methods . The units of services billed of each invoice should be able to reconcile using the supporting documents :
* Unsure which method your program is using? see your Program manager
1. Direct Data Entry to Avatar
• submit UOS Summary report as a supporting document
2. File Import
• submit a text data file in an acceptable data layout
• Submit the text file as a supporting document
• MCBHD staff will inform of test result with any error
3. Service Logs
• submit service logs in an acceptable format to MCBHD
• Submit service log (residential /day treatment log or outpatient logs) as a supporting documents

Following information you need to have in order to complete in entering services or generating service log/file for your invoice:
• Correct Client Number
Check referral documents for client’s name, client number, dob, SSN
• Episode Number ensure the episode number is accurate service program is matching with episode admission program
(605 Program Active Cases Report)
 Staff Number
Rendering practitioner should have a staff number issued by
MCBHD
 Contract term - Date of Service, Service type and Program

Medi-Cal system will consider a service as duplicate when it contains the following. If the service is duplicate more than once and billed without a duplicate modifier, Medi-Cal will deny the second and subsequent claims :
*
If your Program has access to Avatar you can locate the Duplicate Report via “search forms”, otherwise contact a
(PAR) Patient Account Representative at the number below.
• Same client
• Same program (sharing same NPI)
• Same date of service
• Same billing procedure code
• Service Code 311/2, 331/2, 341/2, 351/2, and 391/2 service codes are translated into a same Medi-Cal billing procedure code
• Same unit of service
The report is to identify the possible duplicate services and provide you a chance to prevent the service from being denied by Medi-Cal.
FAX it to :Attn PAR Duplicate @ 831 424-9808
Phone: PAR: 831-755-4563

*To be run after services have been entered but Before services have been billed to catch any possible duplicate errors.

ADP 7700
* (ADP 7700 should be attached with invoice and services log on a monthly basis.
See deadline for ADP billing on slide 3. ADP 7700 form applies to ADP Programs only)

Receipt confirmation
Account Payable
Invoice Reconciliation and Uploading services
Patient Account Rep 831 755-4563
Invoice/Payment Status
Account Payable
Avatar questions
EMR Help Line
831 755-4558
831 755-8996
831 755-4597
831 755-4545

- Billing Questions: contact a PAR
- Errors: contact QA

Current Home View of Provider Billing staff
– important to know what your “User Role” in Avatar

Client Financial Eligibility
Client Summary
Yellow, Green and Pink highlights reflect information for Ep
5, 4 and 3.
- Date episode was open
- Date episode was closed
- Program name
- Last SD: last service date
- Order: order in which guarantors are currently arranged
- Guar: Guarantor name (medi-cal, Medicare, umdap)
- Policy No.: Insurance ID for commercial insurance. CIN# for Medi-cal clients, Medi-care no. for Medi-care, client # for UMDAP.

Below is a detail of the MEDS history which details the clients CIN #, County No, Month of eligibility, Aid code and current status. For a detailed explanation of aid codes refer to the Aid Code List Hyperlink Below.
Aid Code List :
(SDMC) Aid Code Master Chart
F8 – Via Care

Medi-Cal Eligibility Status
- Share of Cost 501, not eligible – 999, 000

MediCare and Other Health Coverage Eligibility Status

MediCare and Other Health Coverage Eligibility Status

Customize HomeView of your homescreen Widgets

Reports available under
Avatar PM>
Contract Agency PM Reports are:
602 Program Service Detail
603 Program UOS Summary
604 Program Financial Elig
605 Program Active Cases
606 Program Client Service Detail
625P Non MediCal Client List
663 MediCal claim status Report
664 MediCal Denial Response
664E MediCal Denial Per EOB Date
600P Program Trend
991 Program Service Code List

Trouble with Avatar:
• Can’t log to Avatar
• Can’t see certain report
• Can’t find certain forms

Program:
Service Start and End Date
Service ENTRY start and End Date
Example: Service Start (7/1/2012) and End Date (7/31/2012) + Service ENTRY start (7/1/2012) and End Date
(7/31/12) will display services rendered between 7/1/2012 and 7/31/12 AND entered between 7/1/2012 and
7/31/12. A service rendered on 7/1/12 but entered late than 7/31 will not be appearing on this selection

Displays status of MediCal claims – approved, denied and/or pending. Also provides a summary of approved, pending and denial per each service code.

Displays denied MediCal claims and the reason of the denial based on Service Dates selected.
Displays denied MediCal claims and the reason of the denial based on EOB posting dates
selected regardless service dates.
The contract agencies shall review the denial reports and inform the county whether to accept the denials or to provide the replacement information

Displays denied MediCal claims and the reason of the denial. The providers are to inform the county whether to accept the denials or to provide the replacement information

• CO 22 -> Private Insurance was not billed
Contractor - Provide insurance card front/back
Contractor - Provide a signed consent
County - Bill insurance and follow up
• CO 22 N192-> Medicare was not billed
Contractor – Provide a Medicare Consent
County - Bill Medicare and follow up
• CO 18 M80 -> Duplicate service claimed without an override code
Contractor – Indicate whether a service is true duplicate
Contractor – Credit Memo or Duplicate Override Code
County - Delete the service or replace the claim
• CO 31 or 177-> Client Not eligible for Medi-Cal
Contractor – Provide the confirmation of Eligibility (EVC#) if eligible
Contractor – Provide correct Name, DOB, CIN
County - post the denial or re-bill the claim with correct CIN

• CO 31 or 177-> if Share of Cost unmet
Contractor - none
County - applied the service cost to SOC if applicable
• CO 204 N30, N182 or N206 -> Pregnancy and/or Emergency only Medi-Cal
Contractor –Indicate Pregnancy and Emergency if applicable
County - post the denial or replace the claim
• CO A1 MA133 -> Service Overlap an inpatient stay
Contractor – provide a correct service info or Credit Memo
County - Delete the service or replace the claim
• CO B7 -> Service Program Facility Not certified
Contractor – Contact QI re: Site Certification
County - Replace the claim if applicable (when issues are resolved)

After denial 835s are posted in Avatar
1. Contract Agencies review the denials
2. Contract Agency instruct the county staff either
To post the denial (by marking X to yes) or
To submit a replacement claims
3. Complete it by initialing and dating the 664 reports and, FAX it to
831 – 424-9808 ATTN: PAR Denial
4. As directed, County will post the denials or replace the claims

If a county-paid service needs to be disallowed, follow the following
1. Submit a request to Delete Service via Error Reporting
2. Submit a Credit Memo
1. Specify Client,
2. Service Information (Date of Service, Service Code, Location, duration, staff , etc )
3. Amount
3. Offset from a future invoice or issue a check to MCBHD

 Client Update
 Error Reporting
 New User Request

Receipt confirmation
Account Payable 831 755 - 4558
Invoice Reconciliation and uploading services
Patient Account Rep 831 755-4563
Invoice/Payment Status
Account Payable
831 755-8996
831 755-4597
Avatar questions
EMR Help Line 831 755-4545 http://www.mtyhd.org/QI/