Purpose:
To provide non-Medicaid behavioral health (BH) claims providers with a method to address denied claims for clients with a 054 COE. The 054 COE was implemented by Medicaid from Senate Bill 42 (SB42) and is a Medicaid COE for an individual who has been incarcerated for more than 30 days and allows the individual to maintain their Medicaid eligibility but suspend their Medicaid benefits while incarcerated. SB42 also allows inmates to apply for Medicaid, become eligible while incarcerated and have their Medicaid benefits reactivated upon their release.
Issue:
The 054 COE will not allow claims to be paid by the MCO or Conduent for Fee-for- Service (FFS) members. For services that have been rendered to a client that has a 054 COE overlapping with another Medicaid eligible COE, the 54 COE must be deactivated before the claim will pay. BHSD is not an alternative funding source for Medicaid members who have a 054 COE since these members remain Medicaid eligible.
Method:
The Medical Assistance Division (MAD) has agreed to work with BH providers to deactivate the 054 COE for MCO or FFS members who have had benefits suspended for 30 days due to incarceration. Once MAD has deactivated the 054 COE; the provider will then be able to bill the appropriate MCO, or Conduent for FFS members.
The MAD contacts who will deactivate Medicaid 054 COE to facilitate reimbursements are:
