The below questions were asked and answered at the 08/30/2023 LA County CalAIM Ask Me Anything session. Answers provided may change based on new or updated guidance from DMH or future updates to the Exym system. Additional questions were asked live and may be viewed in the recording.
Our Batch is usually run Tuesday night but not done last night - is that normal? Should I submit a ticket every week to have them batch or did the batch date change?
- We have turned off automatic batching due to all of the updates we were making. This should be turned back on soon.
Can we manually batch EDI? Or is that also on hold? And what about FY 22/23 (non CalAIM), can we batch those?
- No, all batching from the user level is currently on hold. If you need certain activity IDs batched, please open a ticket so we can batch them for you.
We have several Non Medi-Cal claims on hold for the travel time claiming, can we batch those and claim as they are or would we need to make changes to accommodate the claim creation.
- You can batch the non-medical claims and then create a new activity for the travel time.
Billing & Claims
I would like further clarification about whether Exym is billing the LACDMH in units or minutes.
- We're billing in units, except for COS and couple of non-medical codes, which are in minutes per LADMH Guide to Procedure Codes.
Can you release our ECM billing as it has no impact from CalAIM?
- We'll look into this and get back to you.
Just to clarify, 277 rejections can be processed/resubmitted, but 835 denials aren't available yet?
- That's correct.
Can you explain the difference between getting denied at the 277 level and the 835s?
- Denials from 835s come from the state. Denials at the 277 level do not. When a claim is denied at the 277 level, it means the claim NEVER reached DMH and was denied before ever getting to DMH. For claims denied at the 277 level, you will not receive an 835 for it until fixed, resubmitted.
Where can we view the CalAIM denials?
- Any claims that were denied at the 277 level will appear on the denials screen now. If there are none, then they weren't denied at the 277 level and are awaiting processing of the 835s.
For the CalAIM 277 denials now showing up, do we create a heat ticket or should they just be resubmitted?
- If you know how to correct the denial, you can resubmit. If not, please create a ticket with the activity IDs.
How should we handle our Group denials? Should we open a ticket for this?
- Yes. Create a ticket with activity IDs so we can look into it.
For the duplicate, select one, and no modifier - can these be added as an Administrator update/override option?
- We are looking into this down the road. Please note that duplicate services are ONLY allowed for inpatient services now.
What is the status of modifiers HX?
- This has been resolved from the 8/29 release.
I understand you solved the HX modifier to the NO MC funding, but still in the activities report it's no showing, is this something we will assume is there although we cannot see it?
- It should show once the claims have been invoiced. If it hasn't been invoiced, the modifier won't show in the report. If it's been invoiced and still not showing, please create a ticket with the activity ID.
Will clinical students have the HL Modifier?
- Only the users that require the HL modifier based on DMH's guide to procedure code need it.
To clarify, we don't need to write a progress note, but still need to create another activity using the non-MC funding program to include travel time under session duration and the date needs to match the date we provided the service we are claiming travel time for?
- Yes, that is correct.
How does Exym know when to not batch a client whose billing should be on hold?
- If you put the claims on hold, they won't be batched.
What is the status of all students claims held? Have you got a response from DMH regarding student billing? This also includes Claims for Peer Support Services (H0025 and H0038).
- We're looking to put these on CWPPI.
So, are all student claims, 39020000X still to be placed on hold?
- We're working to put the student taxonomy 39020000X. we'll post system update once completed.
We are getting a lot of the $0 taxonomy rate on some templates, but the amounts are in there. Please advise.
- Please create a support ticket with a range of 5-10 activity IDs for us to look into. Please make sure that if the function on the user was changed, that the signature is updated and the signature for the user has an effective date of 7/1/2023.
With the Exym CalAIM report corrections, newer activities pull a correct rate as of 8/29/23. How is Exym working to address activities pulling incorrect rate prior to this update?
- We are rolling back batch files that were calculated incorrectly. If they were already uploaded to LA County, then we will help facilitate replacement claims.
It seems in comparing EFT to the CalAIM reports that some claims were sent with the wrong amount. Is Exym going to assist agencies in re-billing these services once the calculations have been corrected on the Exym end?
- Yes, if you create support ticket and let us know which activities ID are affected, we'll correct the rate amount.
What do we do with those claims that we already implemented travel time as activity? Can we delete?
- We don't consider travel time entered for an activity, so you can keep the old activities and just add the travel time activities.
If our support staff creates the travel time activity and enters enters the scheduled date, date of service, duration, and selects the person's name as the provider, will the claim generate on behalf of the provider? We're trying to see how we can reduce the administrative burden for our providers needing to go back and capture travel time for services provided.
- Yes, that should work.
Does the FSP travel time activity needs to have (travel) time entered as Face to Face?
- Yes, please enter it in session duration.
Are we responsible to do uploads now? Is it the same process as before CalAIM?
- Yes, you go to your Upload 837 screen and click "Approve For Upload".