Incarceration Town Hall Presentation

IMMEDIATE ACTIONS REQUIRED: 1. Billing Team - Update Claim Submission Process: - Implement 45-day hold before submitting claims for members with incarceration indicators on file. Do NOT submit immediately after discharge to avoid unnecessary denials. - When claims suspend with exception code 2957 (DBH services), route to back-and-pay process—do not appeal these automatically. - For all other incarceration-related suspensions, allow HCS/DOC/DPA manual review to complete before taking action (process typically takes 30+ days). 2. Billing Team - Appeals Process Change: - File first-level appeals ONLY if you disagree with incarceration determination (not for other claim denials). Use the Provider First-Level Appeal Request form. - Do NOT contact HCS before manual review completes—wait for the process to conclude. - File appeals within 180 days of denial date or DOC will not pay. 3. Billing Team - Verify Clean Claims: - Ensure all claims meet billing requirements: member TPL billed first, service authorization obtained, timely filing met (12 months from date of service). - Evaluate ALL edit codes before assuming incarceration caused denial—many other reasons exist for denials. - Do not assume incarcerated members' claims deny due to incarceration status alone. 4. Providers & Front Desk - Member Communication: - Support members in notifying DPA of release from incarceration by providing contact information: * Virtual Contact Center: 800-478-7778 * Email: doh.dpa.info@alaska.gov * In-person: DPA offices with release papers/documents - Educate members that eligibility updates are the member's responsibility, but providers can submit updates with documentation. - Advise members that release papers should be sent to DPA to trigger review span updates (done monthly, not real-time). 5. All Staff - Recognize Justice-Involved Youth (JIY) Coverage: - Flag members ages up to 21 (or up to 26 if former foster care) with incarceration history for coverage of: medical/dental/behavioral health screenings, diagnostic services, and targeted case management during 30-day pre-release and 30-day post-release periods. - These services are now Medicaid-covered under Section 5121 federal mandate; ensure they are billed to Alaska Medicaid, not DOC. 6. Billing Team - Claim Responsibility Tracking: - Understand: If member was incarcerated on date of service → DOC pays (file claim to Alaska Medicaid; if denied, DOC won't pay regardless). - If member was released before date of service → Alaska Medicaid pays (assuming current eligibility span in place). - Claims will NOT be paid by DOC if not filed to Alaska Medicaid within timely filing (12 months) or if appeal not filed within 180 days.