DARTS Manual - Illinois Department of Human Services

Service Reporting Information

S

ERVICE

R

EPORTING

S

CREEN

: R

ESIDENTIAL AND

R

ECOVERY

H

OME

S

ERVICES

The Residential and Recovery Home Services screen is where all Level III and Recovery Home services reimbursed per diem are reported. Additionally, psychiatric evaluations for patients receiving these services can also be reported on this screen and are reimbursed per event. The following fields are required for completion of this screen.

Unit/Program

The unit and program number of the service that is reported. Each service is entered into DARTS using a unit number and program code. Therefore, before initially entering any data and whenever corrected or

updated software is received, all provider unit number and program codes should be verified to reduce

the incidence of data rejection. The Unit and Program number(s) are displayed in the

AProvider

Unit/Program File.

@ If services are delivered at multiple sites using the same unit number and program code, additional screens will be displayed listing the unique addresses, procedure codes and dedicated funding categories for each individual site. It is especially important to verify all site numbers by address for the current fiscal year as these may vary from to year to year. All addresses should match those specified on

DASA facility licenses and Medicaid certifications and enrollments. Failure to verify this information or to notify DASA immediately if errors are discovered may result in data errors and possible delays or holds in disbursement or reimbursement for rendered services.

Year, Month

The year and month of the service.

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Service Reporting Information

Funding Code

The funding code is what directs DARTS to the correct payment source for the service. The following codes are used:

DC - DARTS/Contract: A Service which is supported in full or in part by DASA CONTRACT

(Non-Medicaid) funding

DM - DARTS/Medicaid: A Service, which is supported in full or in part by DASA MEDICAID funding. Services linked to a DM code are processed and forwarded on to the Department of Healthcare and Family Services (HFS) for reimbursement. HFS produces the Medicaid Remittance Report.

DS - DARTS/Split Billing: A Service, which is supported, by both CONTRACT AND MEDICAID funding. This funding code is only used to report certain LEVEL III services in which the treatment cost is paid by Medicaid and domiciliary cost is paid by Contract.

Unique Client/Patient Identifier

The 9-digit Patient Unique Client Identifier must match an opening in DARTS.

Billing Begin and End Date

The Billing Begin Date through the Billing End Date reports the time period for which the provider is seeking payment. If billing Medicaid (

>DM= or >DS=), the patient must be eligible for Medicaid during this date. If the patient is not Medicaid eligible for the continuous stay, each continuous segment must be billed separately.

(Example: A patient enters a program on the 5th of the month, and he stays through the 25th of that month; however, the patient is NOT Medicaid eligible on the 10th and 11th. Two

>DM= or >DS= billing records would be created. The first record would be for the 5th through the 9th. The second record would be the 12th through the 25th.)

Additionally, when a Level III or Recovery Home service spans two months, the service must be entered as two separate transactions. Example: There would be two entries for a patient who receives a Level III or

Recovery Home service from 07/15/2011 through 08/04/2011. The first would be 07/15/2011 - 07/31/2011, and the second would be 08/01/2011 - 08/04/2011.

Number of Days

This number is automatically computed by the dates entered into the Billing Begin and End Date fields.

Procedure Code

This field is not entered by the user. When the date/unit/program/funding code and billing type are entered,

DARTS will check the Unit/Program file to assure that the agency has been funded for the type of service entered and will complete the procedure code automatically.

DASA HELP

– E-MAIL:

[email protected]

– FAX: 217.558.4656

| July 2013

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Service Reporting Information

The following procedure codes (linked to the funding code) are used for LEVEL III service:

If the program is MEDICAID CERTIFIED and ENROLLED for DAY TREATMENT or

MEDICALLY MONITORED DETOXIFICATION and also has other CONTRACT funding:

Funding

Code

ADS@

DCY - Youth Residential Day Treatment (treatment portion of bill paid by Medicaid); AND

RBD - Residential Domiciliary (room and board portion of bill paid by Contract)

DCA - Adult Residential Day Treatment (treatment portion of bill paid by Medicaid); AND

RBD - Residential Domiciliary (room and board portion of bill paid by Contract)

DXT - Medically Monitored Detoxification Treatment (treatment portion of bill paid by

Medicaid) AND

DXB - Medically Monitored Detoxification Domiciliary (room and board portion of bill paid by Contract)

If the program is MEDICAID CERTIFIED and ENROLLED for DAY TREATMENT or

MEDICALLY MONITORED DETOXIFICATION; BUT has no other CONTRACT funding or is billed after the final submission date when contract funds for the previous fiscal year can no longer be accessed, the following procedure codes will be used for billing:

Funding

Code

ADM@

DCY - Youth Residential Day Treatment (treatment portion only will be billed)

DCA - Adult Residential Day Treatment (treatment portion only will be billed)

DXT - Medically Monitored Detoxification Treatment (treatment portion only will be billed)

If the program is JCAHO accredited and Medicaid CERTIFIED for Residential Rehabilitation Youth or enrolled for Medially Monitored Detoxification in a hospital subacute setting, the following procedure codes may be used for billing:

Funding

Code

ADM@

RHY - Residential Rehabilitation Youth

DXD - Medically Monitored Detoxification

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