FINAL FFS training Oct 2014 Auth & billing for new

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New Provider Fee for Service (FFS)
Initiative Technical Assistance
Training Session
DEPARTMENT OF HUMAN SERVICES (DHS)
DIVISION OF MENTAL HEALTH & ADDICTION SERVICES
(DMHAS)
AUTHORIZATION AND BILLING TRAINING
SEPTEMBER 2014
How to Request a FFS Authorization
for Treatment and Bill for Services
DASIE
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Required for all publicly funded clients
Determines client income and program eligibility
Go to AUTHORIZATION LINK
Request ASSESSMENT VOUCHER
(Not applicable for Drug Court referrals, skip to admission)
ASSESSMENT/EVALUATION
Clinician completes LOCI to determine Clinical need required to continue admission. ASI
required for FFS clients
ADMISSION - Level of Care is populated in admission based on LOC recommended
by the agency in the LOCI. Be sure to select correct site license.
Choose payer source in admission based on DASIE eligibility
Click AUTHORIZATION LINK to Request TREATMENT authorization-review
info for accuracy prior to requesting a Treatment authorization
If client is eligible and funds are available, an authorization is created. Enhancements,
if needed, should be added
2
How to Request a FFS Prior Authorization for
Treatment and Bill for Services
B
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Provider claims (bills) for services rendered in www.nj-das.net
Click on “Provider Services” then choose “Enter a new claim”. You will need
Clients Date of Birth
Level of Care and Enhancement Services must be recorded
For a 30 day authorization, agency must provide services and submit claims in
first 15 days to keep authorization active or it will cancel back to the start date.
Agency must provide services and submit claims in second 15 days or the
authorization will cancel mid-point
Agency receives electronic reimbursement from CSC for authorized services every
two weeks
3
Login to NJSAMS Real Time Data
4
 Login to NJSAMS Real Time Data
 NJSAMS system requirement is Microsoft Internet
Explorer Version 8 or higher as internet browser. Please do
not use any other browsers like Google Chrome or Fire Fox
etc. and please do not search NJSAMS in Google, MSN or
any other internet search tools. Please use URL/Link
https://njsams.rutgers.edu/NJSAMS
If your agency’s current browser is not Internet Explorer,
please download Internet Explorer version 8 or higher
 Enter your User ID and password. NEVER share your user
ID & password with another staff member. Everyone needs
their own user ID & password
Summary DMHAS Fee-for-Service
Request and Approval Process
5
 Prior-authorization for any service is requested through
NJSAMS after completing the DASIE, LOCI, and ASI
 Authorizations for treatment are requested after completing
above and Admission screens (Drug Court does not fund Assessments)
 Vouchers are requested through NJSAMS to CSC, the DMHAS
Fiscal Agent
 CSC approves the request based on:

Availability of funds; Client eligibility; Provider Eligibility
 If the request meets the criteria for authorization:



Services are authorized through an interface of NJSAMS and CSC
Provider can view service request status on NJSAMS immediately
New authorizations must be secured every 30 days (or more often if
authorization is of a shorter duration)
NJSAMS DASIE
(DMHAS Addictions Income Eligibility)
6
 DASIE is an income and program eligibility tool in
New Jersey Substance Abuse Monitoring System
(NJSAMS)

https://njsams.rutgers.edu/NJSAMS
If your agency staff needs to know how to enter client
in NJSAMS, please click on “Help” on the horizontal
menu. Also Data Entry Forms are available under
“Document”
NJSAMS
How to start
7
 Open Internet Explorer or click on the link
https://njsams.rutgers.edu/njsams
 Enter User ID and Password
 Search your client by Client ID, SSN or last Name
NJSAMS Home Screen
8
NJSAMS Screens You Will Use
9
 DASIE: Client Identifiers- calculation of income and program
eligibility; required for all publicly funded treatment
 Assessment Screens: Clinical information, ASI, LOCI
 Admission Screens: LOC, Payer, Choose license #
 Prior Authorization Link
 Funding Source Screen (on the 5th tab/accordion/page)
 Discharge (If the client is discharged, voucher is cancelled by system)
DASIE: Client Identifiers
10




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Name – First, Last
Birth date and Gender
Social Security Number
Client ID is generated
Initiative specific number



SBI # - Criminal Justice Initiatives; Court Referred client
DUII- Driver’s License number
Household size and household income input used to
calculate Federal Poverty Level (FPL) to determine
eligibility for public funding
11
NJSAMS DASIE
12
NJSAMS DASIE
13
NJSAMS DASIE (Program Eligibility for FFS)
14
NJSAMS DASIE
15
NJSAMS DASIE Final Report
16
The Client FFS eligibility in DASIE
17
NJSAMS – Click on Treatment Authorization
18
 When the client name displays click on “Select”
 Click on “Treatment Authorization” to request
voucher
Assessment Authorization in DASIE
19
 For FFS funding, other than Drug Court, you will need an
Assessment authorization
 Once assessed, the client will need to be admitted prior to
securing an authorization for Addictions Treatment,
including any enhancements
Steps in NJSAMS Prior Admission
20
 Intake Assessment before admission
 DASIE
(Income for FPL and Program Eligibility)
 Addiction Severity Index (ASI)
 Level of Care Index (LOCI)
Must be completed to continue Admission
Admission in NJSAMS
21
Note: Level of Care (LOC) is populated from the Initial
Level of Care the Clinician recommends in the LOCI
evaluation – after admitted, LOC in admission cannot be
changed
Treatment Authorization in NJSAMS
22
 Detail from Admission module populates fields in
Treatment Authorization Section
 Select correct funding source based on FFS Initiative
eligibility in Program Eligibility in DASIE
 If requirements are not met, the following message
will pop-up when clicking on treatment
authorization:
Treatment Authorization Cont’d
23
 Authorization request date
 Current date will auto fill in the system
 Service Request start date
 can be 7 days in advance, or due to weekends and holidays,
can be backdated 5 days
 If you wait to backdate, funds MAY not be available for new
clients for those funding initiatives with new clients limits
 Enhanced Services can be added or removed by
checking and unchecking
Note: Once an authorization is generated, current information should
be accessed through www.nj-das.net
Adding and Removing Enhanced Services
24
Services for
Vivitrol no
longer
available
are
highlighted
in yellow
Discharge Module
 Full Discharge

25
Reasons for Discharge

 If the client is continuing care

Continuing Care Type
NJSAMS Prior-authorization Parameters
(See Chart 2 reference)
26
 Assessment
 Initial Treatment Authorization at LOC
 Continuing Stay Treatment Authorization at same agency - no
extension required
 Continuing Stay Treatment Authorization at same agency - extension
required as per LOC parameter
 Change Level of Care (LOC) within agency
 Transfer to new Level of Care (LOC) at new provider
 Transfer to new provider same (LOC) Level of Care
 Parallel Care
To recap –
NJSAMS Data Elements Required for Treatment Prior Authorization
27
DMHAS DASIE Completed
Assessment
Clinical Information
LOCI completed - LOCI date reference
Addiction Severity Index (ASI) completed
Admission
Level of Care (populated from initial LOCI)
Admission Date
Funding And Service Request Information
Funding Source (need to select)
Authorization request date
Service date range depends on LOC Packages
Discharge
Continuing Care Discharge
Full Discharge
Fee for Service (FFS) Network Initiatives
28
 Driving Under the Influence (DUII)
 Drug Court Initiative (DCI)
 MAP – State Parole Board (SPB)
 MAP – Department of Corrections (DOC)
 Medication Assisted Treatment Initiative (MATI)
 Screening, Brief Intervention & Referral to Treatment
(SBIRT) – Mercer County only
 South Jersey Initiative (SJI)
 Recovery and Rebuilding Initiative (RRI)
[Annex A 2]
Drug Court Initiative (DCI)
29
 It is a good idea for Providers to market their
program to local or statewide Drug Courts
 Referrals will come directly from the Drug Court
Coordinator; not from DMHAS
 For all admission denials and administrative
discharges, contact Steve Fishbein with specific
reason for each via e-mail
[email protected]
 Drug Court extensions have a separate process than
other initiatives (will be addressed later in this
presentation)
Drug Court Initiative (DCI)
30
 Physical and mental health medications are billed
through a paper billing process

DC reimburses providers at cost for 2 months per level of
care (this is meant to be used as a bridge while providers
assist clients to access other means for paying for their
medications)
 To request an electronic version of medication billing
forms

Send an e-mail to Chad Williams at
[email protected] , (609) 292-7808 or Steve
Fishbein at [email protected], 609-777-0655
Driving Under the Influence (DUII)
31
DUII Agency eligibility
 Providers must have a current IDRC/IDP Affiliation
Agreement in place for all sites and LOCs

Residential Providers Affiliate with IDP directly; Ambulatory
Providers MUST Affiliate locally (County IDRC)
 Providers MUST share monthly report/information
with IDRCs for all clients receiving DUII funding
Driving Under the Influence (DUII)
32
DUII Client Eligibility
 NJ resident with a DUII conviction after October 17, 2005
 Client income 350% FPL (Federal Poverty Level)
 Client does not have to be referred by IDRC, but connection
with IDRC must be established in the NJSAMS
 When Drivers License is entered into the DASIE module,
conviction eligibility is shown/determined
 Any difficulties regarding convictions should be directed to:
[email protected] for assistance

If you do not receive a response in 24 hours, contact Andrea Connor
at [email protected] or Tom Czeizinger at
[email protected]
MAP – State Parole Board (SPB)
33
 State Parole Board funds assessments and treatment




for those referred from the Mutual Agreement
Program (MAP)
MAP Abscond Procedure revised April 2013*
All referrals should be preceded by a SPB MAP
referral form that includes the SBI number
Division of Parole Phone List April 2013*
DMHAS SPB contacts

Chad Williams; 609-292-7808;
[email protected]
* Documents located on www.NJ-DAS.net (under References)
MAP–Department of Corrections (DOC)
34
 Funds Assessments and Long Term Residential (Level
lll.5) treatment only
 Recently added urine reimbursement (add clinical
review enhancement in order to claim urines)
 DMHAS DOC contact

Chad Williams; 609-292-7808;
[email protected]
Steve Fishbein; 609-777-0655
[email protected]
Medication Assisted Treatment Initiative (MATI)
35
 MATI funds medication-assisted and other treatment services
for indigent New Jersey adult residents who have an opiate
addiction and a history of injectable drug use
 Individual must test positive for opiates or have a documented
one year history of opioid dependence
 Particular emphasis is placed on providing access to treatment
for individuals referred by Syringe Access Programs (SAP)
 If the client meets criteria for MATI-FFS, the client must refer
to MATI-MMU (Mobile Medication Unit)

With the exception of Turning Point and Straight and Narrow, who
can admit clients directly into Medically Enhanced Detox
Medication Assisted Treatment Initiative (MATI)
36
 MATI FFS referrals must come directly from one of six (6)
MATI-contract providers, unless a referral for Medically
Enhanced Detoxification (this referral would come directly
from one of two approved statewide MATI FFS Medically
Enhanced Detox Providers)
 When a MATI contract provider identifies a client who
requires a Level of Care (LOC) not provided by the standard
MATI contract, the MATI contract agency submits a MATI
referral request for authorization to DMHAS
 DMHAS MATI Contact, Adam Bucon,
(609) 984-3316, [email protected]
Medication Assisted Treatment Initiative (MATI)
37
 Approval for authorization provided to MATI contract provider
via DMHAS MATI FFS staff
 MATI contract provider notifies MATI FFS agency of approval
and refers client for appropriate LOC
 MATI FFS agency admits client and obtains authorization for
appropriate LOC
 MATI FFS agency has seven (7) days to secure an authorization
from the date that DMHAS notifies the MATI contract agency
Recovery & Rebuilding Initiative (RRI)
38
Client Eligibility: to be eligible for services available through RRI,
consumers must:
 Be 18 years of age or older; United States citizen or legal resident

Have been living in one of the storm affected counties between
Oct. 28-30, 2012 (Atlantic, Bergen, Cape May, Cumberland, Essex,
Hudson, Middlesex, Monmouth, Ocean, Union)
 Meet American Society of Addiction Medicine Patient Placement
Criteria (ASAM PPC-2) for Level 111.7, 111.7D or 111.7DE
treatment
Federal funding for treatment services provided to RRI consumers
must be accessed as the payer of last resort. Agencies are required
to review all available resources before requesting the use of RRI
funds
Recovery & Rebuilding Initiative (RRI)
39

Provider Eligibility: Participating providers must be
licensed by the NJ Department of Human Services,
Office of Licensure under the Standards of Licensure of
Residential Substance Use Disorder Treatment Facilities
(N.J.A.C 10: 161 A) and be able to provide co-located
detoxification and short term residential services

Services available through the RRI: Assessments, Short
Term Residential, Inpatient Detoxification, Medically
Enhanced Inpatient Detoxification, Case Management,
Co-occurring Services, Vivitrol and Transportation
Screening, Brief Intervention & Referral to
Treatment (SBIRT)
40
 Funds Outpatient (Level l) & Intensive Outpatient (Level ll.l)
only
 For Mercer County residents & Mercer County providers
only (Expect to expand to Middlesex County in near future)
 Referrals will come solely from Henry J. Austin Federally
Qualified Health Center (HJA), with 5 project sites serving
the greater Trenton area
 Contact Kathleen Russo at 609-984-4053 or
[email protected]
Structure for Fee for Service Benefits Packages
41
 Structure of FFS Benefit Package

ASAM

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






[Annex A 1]
Assessment
Outpatient Service Packages
Intensive Outpatient
Partial Care
Long Term Residential Packages
Short Term Residential Packages
Detoxification
Medically Monitored Enhanced Detoxification
Enhancements











[Annex A 3]
Clinical Review
Co-Occurring Clinical Services
Co-Occurring Medication Monitoring Services
Psychiatric Evaluation
Medication Assisted Induction/Stabilization Methadone
Medication Assisted Methadone Maintenance
Medication Assisted Induction/Stabilization Suboxone
Medication Assisted Suboxone Maintenance
Recovery Support
Medical Services
Vivitrol Enhancements
(see sample ASAM and
Enhancements excel sheets)
Co-occurring Network Enhancement
42
 Co-occurring services are an enhancement to treatment
 There is a difference between Co-occurring Licensure and
being approved as a Co-occurring provider in the FFS
network

Provider must contact Office of Licensure (OOL) to add co-occurring
services to their existing Ambulatory or Residential Addictions License
per N.J.A.C. 10:161B-10.4
 DMHAS requires that once approved for the MATI, DUII,
RRI or SJI FFS networks, a provider must apply and be
accepted into the Co-occurring network

Once OOL approves co-occurring status, a provider must submit a
separate application seeking quantitative detail descriptions of how cooccurring services will be delivered, scoring a 70 or above to be FFS cooccurring approved
Co-occurring Enhancement Services
43









Psychiatric Evaluation
Comprehensive Intake Evaluation
Medication Monitoring/Consultation
Clinical Consultation
Family Therapy (with or w/out client present)
Individual Therapy- half hour or one hour session
Co-occurring Group Therapy
Crisis Intervention
Case Management
DMHAS Co-occurring contact is Chad Williams,
609-292-7808; [email protected]
Extension Request Process
44
 Who: All fee for service network providers will need to




submit an Extension Request LOCI for continued care review
What: Extensions allow the client to continue in treatment
after the initial authorization expires at the same level of care
When: Providers are prompted to submit an extension
request within NJSAMS 15 days prior to the end of the
authorization
Where: Providers request an extension in the NJSAMS
Extension Request LOCI (ERL)
Why: Providers will not get reimbursed for services if the
client continues in treatment without a new authorization
FFS Extension Review Process for
Continuing Care Authorizations
45
 All Fee for Service Network providers must submit the ERL
through NJSAMS for the DMHAS Extension Review Staff
 DMHAS Extension Review will consist of:

The completion of the ERL – all appropriate ASAM
Dimensions completed using ASAM Risk Rating
language with supporting clinical documentation.
Extension request LOCIs cannot be more than 30 days
old when submitted to Drug Court and DMHAS
otherwise they will not be accepted
 When the ERL is completed appropriately, the provider is
notified by DMHAS Extension Review staff via ERL in
NJSAMS
ERL Approval
46
 Approval Status can be found under ERL by clicking
“MODULES” on horizontal menu.
FFS Extension Review Process for Continuing
Care Authorizations
47

If corrections to the ERL are needed to be made by
the provider, then the Extension Request will be
denied by DMHAS Extension Review Staff via ERL
in NJSAMS

The request will be denied until the Extension
Request is resubmitted and appropriately
completed by the provider; the request can then be
approved by DMHAS Extension Review Staff
FFS Extension Review Process for
Continuing Care Authorizations
48
 Examples of Fee for Service Extension Request
Denials:




The DMHAS Extension Review Staff determined that the ERL
was insufficient in its information as it does not have
supportive documentation in the appropriate dimensions to
justify the need for treatment at the level of care requested
Client was already discharged from treatment; an extension
request is no longer needed
Client’s level of care was changed which does not require an
extension request
The provider requested an extension for ASAM Level 1.0
(Outpatient Treatment) which does not ever require an
extension
Drug Court Extension Review Process for Continuing
Care Authorizations
49
 Extension Request Policy for Drug Court participants requires






additional steps
Each Drug Court treatment provider must contact the referring Drug
Court and e-mail them an ERL (Extension Request LOCI) for their
review, prior to submitting to DMHAS
The LOCI MUST be able to justify the level of care
A Drug Court Extension request cannot proceed without
Drug Court notification
Once the referring Drug Court team completes their final review of the
ERL, the Drug Court Coordinator will then forward the Extension
Request to the DMHAS Extension Mailbox indicating their approval
DMHAS staff reviews the DC Coordinators’ approved extension request
per the general policy
The Drug Court Coordinators’ denied extension requests are not
forwarded to the DMHAS extension Mailbox
Drug Court Extension Requests
50
 Drug Court Clients extension requests must be
approved by Drug Court Coordinator
 You can find the Drug Court Coordinator and their
back-up’s e-mail addresses on www.nj-das.net under
Documents /References
 All Fee for Service Network providers must submit
the ERL via NJSAMS for the DMHAS Extension
Review Staff
Drug Court Extension Requests
51
 Should your program experience difficulties
contacting the referring Drug Court Coordinator
within 72 hours, please contact Steve Fishbein,
DMHAS’ Drug Court Coordinator at (609) 777-0655
or [email protected]
NJ-DAS.net –billing site
52
Click on “provider services”; then choose
“Enter a new claim”
53
DMHAS FFS Billing Procedure
54




Provider agencies will enter claim data (encounter) for each
client on the www.nj-das.net website
 Encounter data includes: date, service type, number of
units; and, if claim is for co-occurring services, counselor
credentials
Encounter data will be the basis for generating claims
Providers will receive electronic payments directly from CSC
Providers must have electronic payment capabilities
established with CSC in order to receive payment
FFS Claim Submission Requirements
55
 Service/claim submission is required regularly, at least weekly



There has to be a level of care service provided and a claim
entered within the first fifteen days to keep the authorization
active for the second fifteen days
There has to be a level of care service provided and a claim
entered within the second fifteen days to keep the authorization
active
If the authorization stays active, you will have an additional 15
days to review your billing to be sure you did not miss billing for
any services before the authorization is totally closed
Important Note: Active Auths with Claim Submission Report available on www.nj-das.net
(discussed later in presentation)
FFS Claim Submission Requirements
56
Example
Authorization 123789
Start Date 1/6
End date 2/5

Initial encounter/claim: Service must be reported by 1/21 or
authorization will be cancelled with full encumbrance and 0 value for
utilization –authorization will be cancelled as of 1/6 (the start date), If
service is reported between 1/6 and 1/21 the authorization will remain open
till 1/21

Mid-point encounter/claim Additional service must be reported by 2/5
or the authorization will be cancelled on 2/5 with a cancel date of 1/21.
LOC Authorization value will be based on date of cancel. If it is an
outpatient service the full encumbrance will have been assigned for
utilization rate calculation since all outpatient are fully encumbered by 15
days.

Final Claim Submission: Agency must complete submission of all
claims for the above authorization by 2/20. If claim submission is not
complete and agency submits claim Timely Filing error 108 will be
identified when claim is submitted
NJ-DAS.net Claim Denial Codes
Denial Code
0
4
6
18
31
61
101
102
103
104
105
106
107
108
109
110
111
112
Description
57
None
Not authorized on dates indicated
Authorization cancelled or discontinued
Provider no longer actively enrolled
Invalid provider for date of service
Procedure designation does not exist
Clinician not licensed for service
Number of units/amount per service by day exceeded
Number of units/amount per service by week exceeded
Number of units/amount per service by month exceeded
Number of units/amount per service by year exceeded
Encumbrance for service package exceeded
Clinician required
The time limit for filing has expired
Number of units/amount per service by client exceeded
Client exceeded annual limit for level of care
Client exceeded number of units for the level of care
Your contracted encounter has been recorded
Authorization search
58
Reports available on www.nj-das.net
59
Active Auths with Claims Submission Deadline
Report
60
Active Auths with Claims Submission Deadline
Report (continued)
61
Red Zone Report
62
Claim Detail Report
63
What is Utilization Rate?
64
 Utilization rates are a performance indicator that mirrors
clinical events of successful engagement and retention in
treatment
 Research has shown that high engagement and retention
rates are strongly correlated with positive treatment
outcomes
 The practice of monitoring utilization rates will maximize
provider service delivery and claims submission
 Manage FFS resources through fiscal project in order to
ensure funds will be available for existing clients as well as
new clients
Definitions for Utilization Reports
65
 Initial LOC encumbrance

Service Package maximum encumbrance
 Authorization Value LOC

Adjusted value if authorization end date is revised is cancelled prior
to initial end date. End date is revised and authorization value is
adjusted based on rules for prorating authorization.
 Total Claims

Provider amount billed for LOC services without enhancements
 Utilization Rate

Total of LOC claimed divided by LOC Authorization value
Rationale for Calculation of Utilization Rates
66
 DMHAS has sought to establish a fair and transparent
methodology for calculating the utilization or consumption rate
while allowing for maximum flexibility in the delivery of
services
 Residential authorizations are pro-rated based on number of
days the authorization is active
 Because the outpatient service packages include several
services with different rates, and there is not a simple 1:1
relationship between a unit of service and a day of service,
DMHAS is using a 2:1 ratio between the value of the
authorization and the number of days in the service period to
calculate the utilization rate
Utilization Rates
67
 For the purposes of calculating utilization rates, the total authorization
value is calculated as the total 30-day encumbrance amount divided
by 15 and multiplied by the number of days that the authorization was
open and active
 For example, an authorization with a 30-day value of $600 is worth
$20 a day (20 x 30 = 600)
 One or more services can be delivered and claimed on a given day, and
the actual reimbursement for those services will exceed $20 for a
given day
 Providers should exercise caution when canceling authorizations to
ensure that there is sufficient value on the authorization to submit a
claim for services rendered
Prior-authorization cancellation
parameters
68
 Authorizations cancelled prior to start date are not included
in utilization rate calculation
 Level of Care authorization value will be prorated. If agency
cancels authorization in timely manner this will positively
impact utilization rate

Note: outpatient authorizations after 15 days will be equal to
full encumbrance
 Authorizations cancelled by the system result in a
utilization rate of “0” for the cancelled authorization
Authorization Cancellation Reasons
69
Cancelled by Agency





Agency Error
Change Payer Source
Client Discharge
Client No-show
Client Service Needs Changed
Cancelled by CSC


Automated Cancellation – Zero Utilization (void voucher)
Automated Cancellation – Partial Utilization
Calculation for Authorization Value
Unbundled Outpatient Service Packages - Example
Some of our Outpatient Service Packages
Service
*Outpatient - up to 6
services a week
Outpatient - up to 3
services a week
Outpatient - up to 2
services a month
Outpatient - up to 6 services
a month
24
13
2
6
30
30
30
30
Per service combination
of Individual / Family and
Group
Per service combination
of Individual / Family and
Group
Per service combination
of Individual / Family and
Group
Daily Limits
3
3
2
2
Weekly Limits
6
3
2
2
Max.
Authorization per
request
Authorization
time frame
Bill Structure
Per service combination of
Individual / Family and
Group
Encumbered Amt
$662.00
$456.00
$98.00
$294.00
Note - each day
the auth is
active, The
following amount
will be charged
towards your
utilization rate:
$44.13
$30.40
$6.53
$19.60
70
Examples of Calculation for Authorization Value
of Unbundled Outpatient Service Packages
Package
Initial LOC
Encumbran
ce
$662.00
Authorization
Active for
X # of Days
2
LOC
Services
Provided
LOC Authorization Value
88.27
2x 44.13 =
individual - 1 @ $49
group - 1 @ $23
OP- 6 per
week
$662.00
$456.00
6
5
6 x 44.13 =
5 x 30.40 =
$294.00
10
5
10 x 30.40 =
5 x 19.60 =
264.80
10
10 x 19.60 =
71
group - 4 @ $23
190.00
individual - 2 @ $49
152.00
group - 1 @ $23
121.00
individual - 2 @ $49
304.00
group - 4 @ $23
190.00
individual - 1 @ $49
98.00
OP- 6 per
month
$294.00
72.00
individual - 2 @ $49
OP- 3 per
week
$456.00
LOC
Claim
Amount
group - [email protected] $23
72.00
individual - 2 @ $49
196.00
group - 2 @ $23
144.00
Utilization
Rate
81.57%
71.75%
79.61%
62.50%
73.47%
73.47%
FFS Prior Authorization Issues
72
 If your agency staff receives an error message when requesting a Prior
Authorization for a FFS Initiative, please enter information into the
NJSAMS Ticket Management System – see handout
 Immediately e-mail the following information to your agency’s FFS Prior
Authorization Contact (Your FFS contact needs to know the date this action took place for your
protection in the event the issue is not resolved in time for you to secure the authorization with the correct
start date)
NJSAMS ID (never e-mail client names)
 Funding Initiative
 Level of Care (LOC)
 Service request start date
 Error message received when attempting to secure priorauthorization/description of problem
 NJSAMS – TMS ticket number (if any)
NOTE: If error is related to name, social security # or date of birth error, please
access TMS in NJSAMS by attaching Request for Correction of client’s data form in
TMS (Ticket Management System) found on bottom link where you create a ticket

FFS Billing Issues
73
 If your agency staff receives an error message when submitting a FFS
claim, please e-mail the following information immediately to your
agency’s FFS Prior Authorization Contact




NJSAMS ID (never e-mail client names)
Funding Initiative
Level of Care (LOC)
For claims denials:
 authorization #
 denial code
 claim number
 dates of service
 description of problem
 Before submitting information regarding a claim that has been denied,
conduct a claim search at www.nj-das.net to be sure your agency has not
already been paid for the submitted dates of service
Problem resolution
74
 The Prior Authorization Contact (either Robin Blake or Barbara
Steele) assigned to your agency will review the prior authorization
error or billing problem and work with your agency to remediate the
problem
FFS Prior Authorization Contacts
75
Robin Blake
(609) 984-0899 [email protected]
Barbara Steele (609) 633-3819 [email protected]
A list of providers and their FFS contacts can be accessed through
www.nj-das.net under Documents – references;
or on NJSAMS under “Documents” (DMHAS contacts)
Additional Customer Service Support
76
 NJSAMS
 Ticket Management System (TMS) – see hand out
 www.nj-das.net
 1-888-257-2103
 Operates during normal business hours; closed weekends and
holidays
DMHAS FFS related contacts
77
Subject Matter
DMHAS Contact Person Staff E-Mail Address
Phone
Fee for Service Network Manager
Nancy Hopkins
[email protected]
609-984-1627
Fee For Service Contract Liaison
Cathy Vahey
[email protected]
609-292-8113
Co-Occurring
Chad Williams
Christine Scalise
[email protected]
[email protected]
609-292-7808
609-292-7293
Vivitrol
Ann Wanamaker
[email protected]
609-292-8186
Clinician Roster Info. System (CRIS)
Kathy Goat-Delgado
[email protected]
609-292-0563
Extension Requests
John White
[email protected]
609-633-8693
[email protected]
609-984-1142
Network Operations, Quality
Carmine Centanni
Assurance, Credentialing, and New Initiatives
DMHAS FFS Initiative contacts
78
Subject Matter
Department of Corrections (DOC)
DMHAS Contact Person
Chad Williams
Steve Fishbein
Staff E-Mail Address
[email protected]
[email protected]
Phone
609-292-7808
609-777-0655
Driving Under the Influence (DUII)
Andrea Connor
[email protected]
609-588-3544
Drug Court Initiative (DC)
Steve Fishbein
Sara Person
[email protected]
[email protected]
609-777-0655
609-984-7293
Medically Assisted Treatment (MATI)
Adam Bucon
[email protected]
609-984-3316
Recovery & Rebuilding Initiative (RRI)
Carmine Centanni
[email protected]
609-984-1142
Screening, Brief Intervention &
Referral to Treatment (SBIRT)
Kathleen Russo
[email protected]
609-984-4053
South Jersey Initiative (SJI)
Alicia Meyer
Chis Scalise
[email protected]
[email protected]
609-777-0069
609-292-7293
State Parole Board (SPB)
Chad Williams
Steve Fishbein
[email protected]
[email protected]
609-292-7808
609-777-0655
Questions
79
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