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Bulletin ID: No. 67 - Update: Billing For Medicaid/Managed Care Organization (MCO) Services

Tuesday, July 6, 2010

Please note the following guidelines when submitting claims for services provided to consumers whose insurance coverage is Medicaid/MCO:

  1. Claims for the following services provided to MCO consumers, office based and off site, shall be submitted to the MCOs:

a) Diagnostic/Assessment
b) Medication/somatic
c) Counseling
d) Crises Emergency ( Certified Crises Emergency Providers)
e) Rehabilitation Day (Office Based Service)
f) Intensive Day Treatment (Office Base Service)

      2. Claims for these services will only be paid by the MCOs if provided by staff who have been paneled by the MCO.

      3. DMH nor Medicaid will reimburse providers for claims submitted for MCO covered consumers except for the following services:

a) Community Support
b) ACT
c) CBI

If you have additional questions please contact you Provider Relations Specialist.