Family Planning Workshop Presented by Mina Reynaga & Kristen Brice Provider Field Representatives

Call or to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL. For all contact, Claims, and Correspondence Addresses information go to the following link on the New Mexico Medicaid Web Portal: inc.com/nm/general/loadstatic.do?page=ContactUs.htm inc.com/nm/general/loadstatic.do?page=ContactUs.htm Contact Xerox

Important State Websites STATE WEBSITE: PROGRAM POLICY MANUAL BILLING INSTRUCTIONS REGISTERS AND SUPPLEMENTS:

Xerox Field Representative Provider Field Representative: Mina Reynaga (505) Ext Kristen Brice Ext Cc: 4

September Family Planning Medicaid What is Category of Eligibility (COE) 029? Medical Assistance limited to Family Planning Services, including STD screenings and treatments. Fee For Service (FFS) Medicaid pays for family planning services. – Bill claims for clients with COE 029 to ACS. Family Planning Waiver (COE 029) clients are never in any Managed Care Organizations (MCOs, i.e. SALUD!, CoLTS).

September Family Planning Medicaid What populations qualify for these services? Women transitioning from “Pregnancy Related Services Only” (COE 035) to FP (COE 029) Women of ages who are at or below the 185% poverty level as determined by the Income Support Division (ISD). Females below the age of 18 may qualify for other COE to cover these services.

September Family Planning Medicaid Which services are covered? Medical Claims and Institutional Claims: The system examines the revenue code, procedure code, and any related diagnosis codes on the line. The service is covered by the Family Planning Waiver if a combination of the following code sets are used to identify the service: Procedure Code and the diagnosis code are on the following approved code lists.

8 Approved FPW Procedure Code List

Pregnancy Prevention Diagnoses

Pregnancy Prevention Diagnoses Continued 10

September Family Planning Medicaid Which services are covered? (continued) Institutional Claims only: The revenue code and diagnosis are on the following approved code lists.

September Family Planning Medicaid Which services are NOT covered by this COE? Any service that is not listed as one of the aforementioned covered services.

September – Service not Family Planning Related Why does this denial occur when the service was actually for Family Planning? Procedure code, diagnosis code, or revenue code not recognized as family planning related. If rendered service is family planning related, resubmit claim using alternate codes from approved list available. Do not bill Medicaid client for services that can be billed using an alternate approved codes.

September Family Planning Medicaid What if my patient develops a condition that needs treatment that is directly related to a family planning procedure, such as a post-operative infection after sterilization, or an abnormal pap; is that covered?

September Family Planning Medicaid Answer: In these cases, submit the claim to ACS and if denied, appeal them to MAD with a cover letter, medical records, doctors' notes, and any conditions related to the family planning procedure. The Medical Assistance Division considers these claims on a case-by-case basis.

September Family Planning Medicaid Answer: If your client receives an abnormal pap smear: – the pap reveals an STD, STD treatments are covered under COE 029 when billed using the current approved codes lists. – the pap smear indicates cervical cancer, she may also be eligible for the Breast or Cervical Cancer Program (COE 052). Refer the patient to her ISD Case Worker to verify eligibility requirements.

September Family Planning Medicaid My client has the Family Planning COE (029) and desires a treatment that is covered by this COE however my facility doesn’t offer the necessary service. What should I tell the client? As a provider it is important to be aware of all the services that are offered under this COE, even those you don’t offer yourself. Refer the patient to a Medicaid Provider that can perform the necessary Family Planning Covered service.

September Family Planning Medicaid My client has the Family Planning COE (029) and desires a treatment that is not covered by this COE. What should I tell the client? If the client's financial situation has changed since last application, advise her to see her ISD caseworker. She may now qualify for additional benefits that cover the service. If the patient’s financial situation only permits them to qualify for COE 029 – Family Planning Waiver only, refer the patient to an FQHC facility which have all agreed to provide services on a sliding scale.

September Family Planning Medicaid My client has the Family Planning COE (029) and desires a treatment that is not covered by this COE. What should I tell the client? (continued) If the patient prefers to utilize your facility to obtain these non-covered services advise the patient she will be financially responsible for the services. – Have patient sign in writing indicating that she will be financially responsible for the specific non-Family Planning service that will be performed for your records.

September Family Planning Medicaid Always remember to: Check eligibility prior to performing services. Ensure all services are covered under this COE using the current approved code lists prior to performing services. Be aware of alternatives to offer to patients on the COE 029 – Family Planning Waiver such as FQHC facilities to establish an ongoing medical home for routine medical, dental, vision, behavioral, hearing, and all other non-family planning services. Remind COE 035 Medicaid post partum recipients that they will be automatically enrolled under COE Family Planning Waiver services approximately 2 months from their delivery.