Frequently Asked Questions About Billing Issues
Please use the following form if you have 3 or more billing concerns:
See form instructions here:
Q. What billing codes should be used for PCS Services?
A. All billing for dates of service January 1, 2013 and later must be done with the Procedure Code 99509 and one of the following modifiers:
|HA||In-Home Care Agencies, Beneficiary Under 21 Years|
|HB||In-Home Care Agencies, Beneficiary 21 Years and Older|
|HC||Adult Care Homes|
|SC||Special Care Units|
|HQ||Family Care Homes|
|HH||Supervised Living Facilities for adults with MI/SA||HI||Supervised Living Facilities for adults with I/DD|
Q. What error codes might one receive when billing PCS?
A. See codes below.
|2222||no documentation on file|
|5308||authorized units are exceeded|
|5130/5112||procedure code billed does not match procedure code on record|
|5129/5111||a beneficiary was transferred within an agency from one office/provider number to another. Provider number on claim does not match provider number on file.|
|0023||service requires prior approval|
Q. What error codes need to be handled by NC Tracks?
A. For claims and recoupment please contact NC Tracks at 800-688-6696. Listed below are the most common error codes not handled by Liberty Healthcare of NC.
|11||beneficiary not eligible on service date|
|270||billing provider is not the beneficiary's Carolina Access PCP|
|286||referring NPI does not match the beneficiary's eligibility file|
Q. What information does Liberty Healthcare of NC need on a billing error issue?
A. All of the information below is required.
- Name of agency representative
- Provider number
- Error code received
- Medicaid identification number for the beneficiary
- Date of service being denied
Q. What should I do if my agency has multiple billing issues?
A. If your agency has more than three billing issues, please fax the requested information to Liberty Healthcare of NC at 1-919-307-8307 or email at NC-IASupport@Libertyhealth.com, Attention: Billing. A billing specialist will call or fax a response within 24-48 hours of the receipt of the billing request.
Maintenance of Service Questions
Q. How should I bill Maintenance of Service (MOS) for a client who has entered an appeal during the PCS transition?
A. All services provided on or after January 1, 2013 must be billed using the new PCS codes. This includes services to beneficiaries who appealed a reduction or denial in services under the PCS Program and are currently authorized for MOS under the PCS Program.
Middle of the Month Issues
Q. My client's new service level becomes effective in the middle of the month. How should I write and implement the new plan of care to avoid billing problems and denied claims?
A. The PCS Provider shall provide a qualified and experienced RN, or other professional as specified in licensure rules to supervise personal care services and write or adjust the new weekly POC so that it can be implemented as soon as the new service level is effective. The new service level goes into effect either 1 - 10 days from the date of the notice, and this will be specified in the Notice of Decision letter. When a change in authorized service level goes into effect, the old authorization will end and the new authorization will begin.
Billing & The Appeals Process
Q. Liberty Healthcare of NC sent a letter indicating reduction in or denial of services that is effective 10 days from the date on the authorization letter. The beneficiary has submitted an appeal of this decision. How should the agency handle billing for services that were delivered during the appeal process?
A. Beneficiaries who submit an appeal (a request for hearing) within 30 days of the date on the authorization letter are entitled to continue to receive services at the previous level (that was provided before the decision letter was sent, and not to exceed 80 hours per month) while the appeal is pending. In order to allow NC Tracks time to update service records, providers should wait 10 days from the date the client enters an appeal before submitting billing for services provided on and after the effective date indicated in the beneficiary's notice of service denial or reduction. Once service records are updated, providers should receive payment at the previous level of service for the duration of the appeal process.
Q. I have a question about a beneficiary's appeal. Should I contact the Liberty Healthcare?
A. If the beneficiary has a current appeal in QiReport, Liberty can answer questions regarding appeals.
If the beneficiary does not have an appeal in QiReport and the agency has not received a MOS letter, please contact the Office of Administrative Hearings (OAH) at 919-431-3000 to verify if the beneficiary filed an appeal within the 30 days of the date of the letter.