To all providers,

As a reminder, it is your responsibility to confirm a person's insurance when they are being admitted to your program. If you find an individual has Medicare or a commercial insurance, you must either bill the insurance company before entering a claim in CRCT, or you must have well documented verification that the insurance company will not pay your claims.

The insurance information available in CRCT only contains information on Medicaid Health plans. The individuals with Medicaid Health Plans are eligible for Medicaid. These are not the individuals that you are responsible to check. Individuals who are not eligible for Medicaid will not automatically have their information uploaded to CRCT. We are checking your process for gathering commercial (non-Medicaid) health insurance from individuals who are NOT Medicaid eligible.

CMHPSM will begin requesting documentation that you have requested information verifying Medicare or commercial insurance policies from the individuals you serve. Our first focus will be on the individuals who are not Medicaid eligible. We know that the method of verifying insurance eligibility varies widely based on the provider. When requested, please send what you use for verification of insurance, whether that is a scan of a paper document, or a screen shot from your EHR.

Please address any questions to finance@cmhpsm.org.

Did You Know? – Anonymous Reporting

When it comes to reporting suspected fraud, abuse or waste of Medicaid funds, you may have heard that we are required to report when we suspect this is happening, and about ways both staff and consumers are legally protected from making such reports.

Did you also know that there is the option of reporting anonymously? You can make an anonymous report in a variety of ways.

Feel free to contact CMHPSM Compliance staff if you have any questions reporting. You can reach us at:

CMHPSM Compliance Email: suspected compliance violations or questions about compliance may be sent via email to compliance@cmhpsm.org. Emails are sent directly to the Compliance Officer.

CMHPSM Website: suspected compliance violations may be reported with one’s identity or anonymously at https://www.cmhpsm.org/ and clicking on the form link at the bottom left of the website: “Report Fraud, Waste or Abuse: Form.”

A direct link to that form is also here: : CMHPSM Medicaid Fraud and Abuse Reporting Form. Completed forms are sent directly to the Compliance Officer.

CMHPSM Compliance Phone: suspected compliance violations or questions about compliance may be reported to the CMHPSM Compliance Officer at 734‍-249-0334.

Mail Delivery: Suspected compliance violations or questions may be mailed to:

Community Mental Health Partnership of Southeast Michigan

Attn: Compliance Officer

3005 Boardwalk Dr, Ste 200

Ann Arbor, MI 48108

You can also directly contact State and federal Authorities:

MDHHS OIG: www.michigan.gov/fraud

MDHHS OIG Letter:

Office of Inspector General

PO Box 30062

Lansing, MI 48909

MDHHS-OIG phone: 855-MI-FRAUD (855-643-7283) (voicemail available for after hours)

Federal OIG Office: https://oig.hhs.gov/fraud/report-fraud/

Federal OIG Office Phone: 1-800-HHS-TIPS (‍800‍-447-8477); TTY ‍800-‍377-4950

Federal OIG Office Mail:

U.S. Department of Health and Human Services

Office of Inspector General

ATTN: OIG HOTLINE OPERATIONS

P.O. Box 23489

Washington, DC 20026

Did You Know? – Clinical Practice Guidelines

Our system of care uses clinical practice guidelines in service provision that include evidence-based practices (EBPs) and promising practices (PPs) that both nationally and/or state endorsed. Such guidelines have been scientifically reviewed, analyzed, and translated into clinical practices to show successful outcomes

The goal of using EBPs and PPs is to quickly incorporate the best available research, clinical experience, and consumer preference into clinical practice so we can improve the quality of care and outcomes for people we serve.

Each year our Regional Clinical Practice team reviews these guidelines to ensure that:

• The guidelines are up-to-date
• Our region has accurate information on where and how the guidelines are being practiced and applied
• Any new EBPs or PPs are being recommended for implementation

CMHPSM then decides whether the recommended guidelines/practices:

• Will be adopted
• If adopted, will require regional implementation
• If adopted, will be a local option to implement

For information on the current EBPs and PPs in our region, the applicable policy and the list are available here:

Clinical Practice Guidelines Policy: https://www.cmhpsm.org/regional-policies

Evidence-Based Practices List (this link is also in the policy)

Feel free to contact CMHPSM Quality staff at 734-344‍-6079 if you have any questions about these guidelines.

CMS UPIC CoventBridge Audit

The CMHPSM and four other PIHPs in Michigan are participating in a federal CMS audit. We have been asked to pass along the following message from MDHHS related to the contracted auditing entity CoventBridge.

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Your organization is receiving this notification as you may be required to respond to an audit and MDHHS wanted to ensure you had the appropriate information should that occur.

The Centers for Medicare and Medicaid Services (CMS) utilizes Unified Program Integrity Contractors (UPIC) to perform Medicaid integrity functions. Section 1936 of the Social Security Act (the Act), established by the Deficit Reduction Act (DRA) of 2005, is the statutory authority under which the UPICs operate their Medicaid functions. Section 1936(a) of the Act provides that the Secretary must enter into contracts with eligible entities to conduct certain activities specified at section 1936(b) of the Act. Section 1936(b) of the Act provides that eligible entities under contract with the Centers for Medicare & Medicaid Services (CMS) can audit claims for payment for items or services furnished under a state plan as well as identify overpayments made to individuals or entities receiving federal funds under Medicaid to determine whether fraud, waste, or abuse has occurred or is likely to occur. CoventBridge (USA) Inc. (CoventBridge) is the UPIC for the Midwestern Jurisdiction.

In the coming months, you may receive a written request, from CoventBridge, for medical records to support sampled claims. The information requested will be necessary to properly evaluate these claims to determine if claims submitted met applicable Federal and State Medicaid laws, regulations, and policies

In accordance with the DRA and other applicable Federal laws, you will be required to provide CoventBridge with the medical records requested.

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Thank you in advance for your participation in this process.