Billing

Understanding Eligibility Determination Coding

By October 5, 2023January 12th, 2024No Comments

Activities That Are Coverage Exclusions/Non-Billable

Eligibility determinations for CBDD services include some activities involved with intake, such as OEDI/COEDI and the LOC when used to verify County Board eligibility or redetermination of County Board eligibility.

Some examples of activities related to intake include: scheduling, administering, and scoring eligibility determinations, etc.

Activities That Are Allowable/Billable

Assessment – Eligibility assessment tasks that are used to verify an individual’s need for HCBS waiver services through DODD.

Referral and Linkage – Assisting with Medicaid eligibility (not county board eligibility duties)

If you have questions about anything TCM-related, please contact us at TCMTeam@medicaidbillingsolutions.com.