As you know each service code in the system can have multiple "billing codes", called payer type billing code. Although the billing codes might be the same now for insurance and DDD we still require that you have both a billing code for insurance (if the member has TPL) and one for DDD. This is because the output requirement for DDD is a bit different than insurance output and sometimes requires different modifiers.

The transition team at SpokeChoice has done the best to convert your 3 letter DDD billing codes to CPT codes. During the transition from FOCUS to Wellsky you will see both 3 letter and CPT codes. It is your responsibility to check over ALL your billing codes and ensure the proper CPT codes were annotated for you.

To do so go to Backoffice-homecare-service Codes.

Open each of your service codes and then open the payer type billing code of DDD.

You will see, if the annotation worked, the CPT code and the multiplier on the billing code.

You MUST ensure that both of these are correct. If they are missing please add them. During the parallel submission phase these place holders will be used to create an 837 file. When Wellsky goes live we will remove these fields and overwrite the existing billing code and unit multiplier for you but not until the go-live date, which, as you know, is always in fluctuation.

While you are ensuring the multiplier and cpt billing code you must also ensure the proper start date and CPT service rate. We used the DDD given chart to convert things BUT there is a good chance the automatically populated rates are not correct. This is because there are many different rates based on ratio, districts and special billing rates per member. You MUST look at the most current rate for which you are likely to bill a claim for and ensure the rate per the new rate book is correct. Keep in mind the rates are per unit and not per hour as you are used to. Edit each of the proper start date/rates and make sure the CPT service rate and CPT start date are correct

DO NOT add a new Billing rate for CPT, USE THE EXISTING Billing code and edit it with the proper CPT information. As above, during go-live date we will copy the CPT place holders to the service rate and service start date and remove the CPT place holders. Failure to follow these instructions could cause problems during go-live and you will have denials because the place holders were not correct or you created additional billing codes. If you are adding a new servicecode/billingcode, add one servicerate entry and fill out all four place holders. Current rates and future CPT Rates.

If you are not familiar with this term read about it here.

This is very important and this step should NOT be skipped or taken lightly.  For each member, diagnosis code and billing code you must add a billing code pointer. This is so each claim, when billed, can point to the diagnosis code of the patient.

Note: If you have billing code pointers that point to current CPT codes, for example billing insurance, assuming you have a code for which you intend to bill DDD, you will not need to add those billing code pointers because they already exist.

Each member should already have their diagnosis codes added. If not please check here to add them.

Navigate to Homecare-health plans-Billing code pointers

Here you will enter which Billing code should point to which diagnosis code.

Find your member you would like to add a code for.

Hit the + New button.

Temporarily you should see both the 3 letter code and the CPT, in parenthesis, for your billing code selection. This is temporary and when go-live the 3 digit codes will be removed and we will replace it with the CPT code for you.

You then need to select the Diag number that is used for this billing code. You may need to refer back to the clients profile to see which diagnosis code is the correct one. Most patients will only have one diagnosis code so this is an easy task. But, if they have multiple codes make sure the billing code is associated to the proper diagnosis code or all claims will deny.

The modifier field is necessary for certain modifiers that will be necessary during billing. Family, time of day and those type of modifiers will be added automatically as before. The type of modifiers that might be necessary on special rate modifiers like flagstaff rates. It isn't quite sure whether the TN modifier is necessary as we couldn't, as of time of this writing, get a firm answer. The DDD rate cheat-sheet will show necessary modifiers.

Once you are done adding the proper information hit the Add button.

Continue this for all billing/diag codes per member until all have been added.

Note: Missing pointers will be shown when you try and output your 837 file. An Excel file of errors will be presented instead of the actual 837 file.

The following information for each member MUST be present on all members for which there will be claims.

Address,zipcode,diagnosis,phone number, AHCCCS ID (Medicaid ID) on the policy and FOCUS Assist ID.  If any of this data is missing the 837 output will complain and show you a list of errors. Address, names (Everything) MUST match exactly whatever is in Wellsky. If it is not you will get denials and the error messages can be extremely confusing and cryptic.

During the parallel process you should see three letter billing  and CPT codes together when adding maximum hours to an ISP.

Choose only the ones you see with a parenthesis around it. This will ensure switch over when wellsky goes live.

During the parallel submission phase you will still output your FOCUS file as always to get paid. You can also, once we release the final 837 output release, submit test files to Wellsky. During this phase you will not be paid through Wellsky, only FOCUS uploads.

Once DDD goes live we will

• Remove any and all references to CPT codes on payer type billing codes and authorization dialogs
• Copy all CPT related data to the billing code and rate fields
• Remove the AZ state FOCUS button
• Remove the FOCUS Refresh button for Authorizations
• Copy all the proper CPT codes over the top of 3 letter DDD billing codes on ISP plans.

You might have errors during export.

There are could include

Missing Diagnosis codes. All members need at least one diagnosis code. Click here to understand how to add.

Missing Medicaid Number. On each policy the client needs a medicaid number should it be required for 837 or HCFA1500 output. Check the clients payer policy to ensure it is listed. Click here if you need to understand how to create policies

Missing Billing Code pointer. Each claim needs to point to a diagnosis when it is billed. Click here to understand how to create billing code pointers

Missing address or zipcode. Make sure that each client has full address and zipcode information.

Client is missing Authorization. Every claim needs an authorization if the billing code (payer type billing code) requires it. In the Wellsky output it MUST have a wellsky Auth id. Either it is missing on the authorization because the Wellsky authorizations haven't been updated or it is missing from Wellsky. You will need to determine which is the case. You can look at the clients authorizations to being that inspection. You can click here to understand how to upload Wellsky authorizations into SpokeChoice.