Notification of Billing Requirements Update November 15, 2017

Date: 11/15/17

In the ForwardHealth Provider Information—November 2017—No. 2017-37 update titled, Clarification of Claim Submission Requirements for Outpatient Hospital Services, it states revenue codes 0905 and 0906 are NOT considered exempt under ForwardHealth’s exempt revenue code policy. Providers are required to include corresponding HCPCS or CPT procedure codes with revenue codes 0905 and 0906 on institutional claims for outpatient hospital services.

MHS Health Wisconsin’s billing requirements will be updated to require HCPCS or CPT procedure codes with the effective date of December 15, 2017.

Providers are also required to indicate the diagnosis codes appropriate for the provided service on claims. Diagnosis codes appropriate to the definition of the revenue code are required for claim submission. For example, if a service is provided and billed under revenue code 0905, intensive outpatient psychiatric services, a mental health diagnosis would be required, or if a service is provided and billed under revenue code 0906, intensive outpatient chemical dependency services, a diagnosis for substance abuse would be required.