The Department of Vermont Health Access (DVHA) thanks providers who attended one of the Supervised Billing open forums or who reached out via email to ask questions or provide helpful feedback about HCAR 9.103. The feedback received via email and during the open forums has been incredibly helpful in shaping a path forward for Supervised Billing.
As DVHA continues to work on a new version of HCAR 9.103, Non-Licensed and Non-Certified (NLNC) providers can continue to provide clinical services under the extension until 12/31/25 in accordance with HCAR 9.103 and all other relevant manuals and rules.
If providers are taking advantage of the extension and are choosing to submit new claims for pro-bono services provided by NLNC providers under Supervised Billing with a date of service within the last 180 days, you may now submit those claims electronically to Gainwell following correct coding.
For providers who are taking advantage of the extension and are submitting new claims for pro-bono services provided by a NLNC provider, with a date of service between the last 180-365 days, PLEASE REACH OUT TO YOUR GAINWELL PROVIDER REPRESENTATIVE. Your Gainwell provider representative will look at your unique situation and help ensure that your claims are submitted properly and that all the necessary overrides are in place to ensure you are paid for these pro-bono services. DVHA is requiring that all new claims for pro-bono services provided by a NLNC provider be submitted and received by Gainwell within one year from the date of service or by May 1, 2024 – whichever comes first.
If providers run into any issues with the extension or if providers know of any situation not covered in the meeting presentation with regard to how the extension may apply, including timely filing limitations, please reach out to firstname.lastname@example.org so that DVHA can work with providers and with Gainwell to get claims submitted and paid. Each individual is operating under unique circumstances and we are committed to working with providers to work through obstacles.
DVHA will continue working on the Supervised Billing rule and will reach out to providers with any updates regarding the new iteration of Supervised Billing. DVHA thanks providers for their patience and continued service to Medicaid members.
Resources from the open forums are available below for future reference by providers. If providers have any questions about the extension, or how the extension will apply to their situation after reading the attached documents, please reach out to DVHA for further clarification.