State & National Info
From Ohio Medicaid Technology Information System:
MITS Claim Denials for Youth with “the service exceeds the benefit limit” reason
Over the past month, staff of the Ohio Department of Medicaid and the Ohio Department of Mental Health and Addiction Services has heard from behavioral health providers about Medicaid claim denials that appear to be incorrect. In particular,
providers reported claim denials for services to youth with the denial reason code reading “the service exceeds the benefit limit.”
Since there are no benefit limits for behavioral health Medicaid services to youth (except CPST), these claims were denied incorrectly by MITS. Ohio Medicaid staff recognized this as a system defect and worked with our MITS vendor, Hewlett-Packard, to develop a correction. A system correction was developed and tested. The correction was put into MITS on November 13th .If you have not already done so, providers should resubmit the claims previously denied for “the service exceeds the benefit limit” erroneously applied to youth. No other changes should be needed on these claims unless there were other reason codes on the EOB that need to be corrected.
If providers experience any further difficulties we ask that they report them to the Medicaid provider call center, 800-686-1516.
From Ohio Department of Rehabilitation and Correction:
The Ohio Department of Rehabilitation and Correction sent an e-mail to all of Ohio’s Jail Administrators encouraging them to adopt a policy that would enable family members to drop medications off to loved ones who are in jail to ensure continuity in care for inmates with chronic medical conditions, mental illness and/or addiction disorders. NAMI Ohio took the lead on developing a sample policy because we believe that it has the potential to prevent some inmates from engaging in behavior that could endanger themselves or others and result in additional criminal charges. If you think that such a policy would be useful in your respective communities, I urge you to contact your jail administrator(s) to urge them to adopt the model policy. Please contact us at firstname.lastname@example.org for policy forms and additional information.