Therap has been working with two agencies participating in the New Jersey Fee for Service pilot since the pilot began. Assisting these agencies with the pilot process has required extensive support and some creativity, but Therap has a flexible system and a team of experienced billing specialists that are up to the task. Therap currently has direct Trading Partner agreements in 15 states and is used to calculate billing data in states that do not process electronic claims. Therap’s billing specialists have supported agencies in many possible scenarios. That is a good thing since New Jersey has thrown a few curve balls into the mix.
On the billing side, linking service codes to a person to track Prior Authorized (PA) service delivery is straight forward. The curve ball in NJ is that the PAs are weekly. One of the pilot agencies with 21 individual participating in the pilot is processing 66 PAs a week; the same number of PAs an annual system would develop for the year or a quarterly system for a quarter. Most states Therap bills in have annual PAs and some have quarterly PAs. They developed a PA copy process to facilitate billing in states with quarterly PAs. That process works well for weekly PAs with a small numbers of individuals and we are upgrading that to generate weekly PAs. Another curve ball is that NJ requires NPI Numbers for every location. Also a bit of a challenge; however, Therap developed a template process while working with Georgia and other states that require multiple NPI numbers. The template process facilitates the submission of claims.
Therap is an integrated system and services documented at the point of delivery generate billing data. One of the Fee for Service pilot participants is using Therap’s Attendance feature to track a single service in batch. The other pilot participant is using individual service tracking documentation to track multiple services and generate billing data that can switch from service to service multiple times during a single day. Both methods provide excellent audit trails. Pilot participants are using a third method of direct unit entry to bill for transportation since the number of units can change on a daily basis.
Last week Therap processed its first set of sample claims from the pilot participants. Therap’s NJ Conference on October 6th and 7th will have presentations that detail the NJ Fee For Service billing procedures including a presentation by participants.