PASRR Billing Information
Note: The new approved rate for PASRR Evaluation (PE) completion and related activities is effective for LA claim submissions. Any new claim submissions beginning, July 23, 2013, will be paid the new rate of $12.73 per 15-minute increments, or $50.92 per hour, with a cap of 6 hours.
Any claims submitted since PASRR Release 1 deployment and before July 23, 2103, automatically will be recouped and rebilled at this new approved rate, July 27, 2013 through July 28, 2013.
- When the local authority (LA) submits a PASSR Evaluation (PE), the Texas Medicaid Healthcare Partnership (TMHP) automatically will generate a request for the Texas Department of Aging and Disability Services (DADS) to create a Service Authorization for PE Completion. If the mental illness (MI) section is completed, an MI PE Completion request will be generated. If the intellectual and developmental disability (IDD) section is completed, an IDD PE Completion request will be generated. If both sections are completed, both MI and IDD PE Completion requests will be generated.
- DADS will generate a one-day Service Authorization for MI or IDD PE Completion, using the date of MI or IDD Assessment as the begin and end dates.
- The history section of the PE Authorization tab will indicate the status of each PE Completion request (PTID) to DADS. If an error occurred in processing the request at DADS, a specific response code and description will appear in the history. That information, along with the additional information contained in the LA Workflow Messages and Instructions (PDF format) can be used to resolve the problem.
- Once the Service Authorization has been created at DADS (and appears on the individual's Medicaid Eligibility Service Authorization Verification [MESAV] report) the LA can submit one or more claims to TMHP for the total number of billable hours spent on the PE, in quarter hour increments.
- The LA will use the billing information provided in LA Broadcast Message 0825-A (PDF format), emailed to the LAs on April 8, 2013, to submit the claim.
- The Line Item Control Number (LICN) will be required for PE Completion claims. This will enable the LA to bill for multiple activities for one PE on a single claim, rather than rolling them up into a daily total number of units (hours) on the claim. The LICN is currently required for IDD Targeted Case Management (TCM) Follow Up Encounters (Service Group 14, Service Code 12C). §LAs will be required to include the time in HHMM (hour hour minute minute) format in the first four characters of the LICN field. §Valid values are 0000 to 2359, inclusive. For example: midnight is 0000, 9 a.m. is 0900 and 1:45 p.m. is 1345. Characters 5 through 30 of the LICN field, which are alpha-numeric, are for local use and will not be used by TMHP.
- Claims for IDD or MI PE Completion can be submitted using the same Electronic Data Interchange (EDI) file format as the IDD TCM claims currently submitted by the LAs, or can be entered in TexMedConnect (provided the LA has a TexMedConnect submitter identification).
- The mechanism to populate the electronic file will be different for PE Completion, because TCM is based on the number of encounters, while PE Completion is based on the number of hours spent, in quarter hour increments. For example, if it took 2 hours and 45 minutes to complete all the billable activities associated with the assessment, the LA will enter 2.75 units (hours) on the claim.
- If separate individuals (or LAs) are completing the MI and IDD portions of the PE of a dually diagnosed individual, the LA(s) will bill for the number of hours each assessment took.
- If the same individual is completing the MI and IDD portions of the PE of a dually diagnosed individual, the LA will need to split the total number of hours spent between the MI and IDD claims.
- Each claim will need to use the date of assessment, which will be different if the MI and IDD assessments of a dually diagnosed individual are conducted on different days.
- PE Completion can be billed in multiple claims, submitted on different days, as long as the total number of billable hours does not exceed six hours, and all claims for a specific PE Completion use the Date of Assessment of that PE.
- The time spent participating in the Interdisciplinary Team (IDT) meeting will be included in the total number of hours for PE Completion.
- A future enhancement will split out the IDT participation into a separate Service Authorization, which will be billed separately by the LA.
- There is no difference in submitting claims for Medicaid-eligible and non-Medicaid individuals. In both cases, DADS will locate, validate or request the creation of a unique ID for the individual (referred to on the PE as the Medicaid No. and on the claim as the Client/Medicaid No., even if the individual is not Medicaid eligible).
|Input of PL-1 screening data into LTC online portal||No*|
|Preliminary scheduling call with facility to arrange assessment||Yes|
|Meeting/coordination with nursing facility staff||Yes|
|Review of individual's medical records||Yes|
|Face-to-face communication with Individual||Yes|
|Communication/coordination with guardian and collateral contacts||Yes|
|PASRR Evaluation results letter to Individual||Yes|
|Documentation and entry of evaluation data into LTC online portal||Yes|
|Participation in nursing facility IDT for PASRR-positive Individual||Yes|
|Completion of LTC online portal input following NF IDT meeting||Yes|