The below questions were asked at the 09/06/2023 LA County CalAIM Ask Me Anything (AMA) session. Answers provided may change based on new or updated guidance from DMH or future updates to the Exym system.
Is it safe to upload our own 837 files or continue to hold our billing?
Yes, 837s created 09/06/2023 should be safe to upload. You can review them for more certainty and if anything looks off, just don't upload that file.
We have an 837 file not sent from 8/23, are the rates correct in that file or do we need to unbundle that file, and have the claims update overnight?
You can delete the file and we can batch again to make sure the claims has the correct rate.
Admin can't access the Add-on codes currently.
We're currently working on this and hope to have it in the next couple release.
Exym mentioned that there was some claims that have incorrect time and that they were working on this issue. Are these claims on hold by Exym? If they are, is it safe to upload our own 837 files or continue to hold our billing?
The rate calculations have been updated. Please review your claims and let us know if you see any issues.
What is the status of the third party claims? When are they be ready?
We're hoping to get claims tested early the week of 09/11/23.
How will the claims that went out to DMH with incorrect rates be processed?
We'll process and update them once we have the 835 processed.
Reviewing EDI-ready claims, MANY claims are not calculated correctly (60 min med claim for $109,000). Are you aware of this or should would submit a tix? Doesn't seem to have been recalculated.
Only look at the claims Ready for EDI-Invoicing under the NEW CalAIM Billing tab. If you have an activity ID, you can submit a support ticket. There were errors which is why not all of your claims became batched. An email was sent regarding this issue.
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 should be holding these now. Some may have slipped through before we got this fix in, but the claims should now be held or routed to CWPPI.
What codes did DMH say to hold?
H0025 and H0038
Is there a way to prevent staff from submitting a note when it doesn't meet the minimum?
Not currently, but claims will be routing to CWPPI if it's not enough minutes.
For SAPC rates, are we supposed to enter the rates in Exym as hourly instead of per unit like in the SAPC Rate Matrix? And if so, how would we enter rates for codes that have time likes 26-50 minutes?
Yes, please enter the hourly rate on the taxonomy rate matrix. All calculations are done on the backend.
When will you be including COS billing in CalAIM reports?
We're currently updating the report and are hoping it will done the end of this week or early next week.
When will a report be out that calculates billing by funding source? The billable services export that's currently available really doesn't take the place of the old report we had and it takes much more time to calculate everything from that.
We'll be updating the report by funding source some time in the next week (09/11/2023) or so and will give update.
DMH sent out an update that they are ready to accept travel claims.
Yes, you can start creating travel time activities now.
Is it possible to link to/attach the travel time note to the actual activity that required the travel time?
We're looking into this option and hope to find a solution soon but for now you'd need to create an activity for travel time and then LADMH will match in their system.
What billing rule are we to use for the travel time activity?
It needs the CalAIM 2023 - LADMH County RuleCode. If you are unable to add it yourself, please create a support ticket so the Exym team can add it for you.
Is it safe to say agencies should wait to create a non-medical travel note until it has been clear directive?
You may if you so choose. You may also keep track until you're ready to submit.
Last week we created the Travel Time activity per the guidance in the 8/30 AMA session. In the screenshot, it did not have the CalAIM billing rule selected. Is that correct?
It does need the CalAIM 2023 - LADMH County RuleCode. If you are unable to add it yourself, please create a support ticket so Exym Staff can add it for you.