Waiver Services

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What are Waiver Services?

Although Medicaid is a federal program, it allows states to provide certain types of services, such as case management, home health aide services, personal care services, adult day health, rehabilitation, and respite care. States can provide other services with the CMS approval, such as home improvement, social transportation, or a monthly monitoring system. These special state-provided services are called waiver services.

New York Medicaid has established a pay-by-unit system to reimburse your agency for these services. Each unit has a fixed pay rate. When providing a waiver service, your agency bills according to the number of units provided.

Setting Up Billing for Waiver Services

To set up billing rates for waiver services:

1.	Go to Administration>Financial>Billing Rates.

2.	Select the billing rate you want to set up for waiver services or add a new billing rate if necessary.

3.	On the Rates tab, select V in the Gross Basis and Net Basis fields.

4.	Repeat steps 2 and 3 for each billing rate you want to use for waiver services.

5.	Click Save.

To set up contractor service code:

1.	Go to Administration>General>Service Codes/Contractor.

2.	Select the service code you want to set up as a waiver service or add a new service code if necessary.

3.	From the Service Type drop-down list, select T.

4.	Verify that the result billing rate for this service code is one of the previously set up for waiver services.

5.	Repeat steps 3-4 for each service code you want to set up as a waiver service.

6.	Click Save.

To set up resource's role:

1.	In the Resource component, select the resource who will be providing waiver services.

2.	Select General>Roles.

3.	Verify that the resource has at least one role set up as C - Contract or add a new role if necessary to designate it for providing contract services.

Entering Waiver Services

1.	Go to Transactions>General>Contract Invoices.

The Contract Invoices window opens.

2.	Select the appropriate provider in the Provider field.

3.	Click Enter & Verify Contract Services.

4.	Select the Parent Organization check box to enter and verify invoices by parent organzation.

5.	Select the Filter by Patient or Filter by Date check box to filter the information as you need.

6.	Enter the date the service was provided, the service code, the insurance company to bill, the cost of the service, the duration, number of visits, and other information about the service as appropriate.

The service must be set up as a contract service code with the T service type and must have an associated billing rate with the V gross and net basis.

7.	To verify the service, select the Verified check box.