Billing support (also referred to as the High-Medium-Low, or HML questionnaire for adult Health Home service providers) is designed to provide a single source of truth for Health Homes, CMAs, MCOs, and NYSDOH regarding the billing status of each member-month. Throughout this manual, “billing support data” and “billing support questionnaire” are used interchangeably.
CMAs must fill out billing support questionnaires for all members on a monthly basis. For CMAs who are directly entering this data into Foothold Care Management, this data is then transmitted from FCM into MAPP on every other business day. For CMAs who are directly entering data into MAPP, the data is downloaded from MAPP and uploaded to FCM on the same schedule.
The billing support data in FCM determines which members will have claims generated for a given month and which rate codes will be utilized for those claims. Per Health Home program guidelines, claims can only be generated for members when:
- Billing support has been completed for a given month and successfully uploaded to MAPP.
- The billing support data indicates that a core service had been provided during the month.
It is the responsibility of the CMA to ensure that billing support is completed in a timely fashion, completed accurately, that the information provided in billing support is backed by supporting documentation, and conforms to NYSDOH Health Home policy guidance. More information is provided , under the “Rate Codes for Adults and Children” and “Core Services” articles.