Medicaid DID billing records

Evan Anderson filed this request with the Department of Human Services of New Jersey.
Tracking #


Est. Completion None


From: Evan Anderson

To Whom It May Concern:

Pursuant to Open Public Records Act ("OPRA"), I hereby request the following records:

A spreadsheet of Medicaid claims for treatment of Dissociative Identity Disorder (DSM-5 300.14, ICD-10 F44.81).

The requested documents will be made available to the general public, and this request is not being made for commercial purposes.

In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.

Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 7 business days, as the statute requires.


Evan Anderson

From: Department of Human Services

Mr. Anderson,
The Division of Medical Assistance and Health Services (DMAHS) received the OPRA request you submitted in the below e-mail chain. That OPRA has been assigned number C127759.

Before staff can determine what we might have that is responsive to your request, we need some additional clarification. You indicate that you are seeking a “spreadsheet of Medicaid
claims for treatment of Dissociative Identity Disorder (DSM-5 300.14, ICD-10 F44.81).” What information exactly did you want to be included in the spreadsheet? Without specific details regarding the information you are seeking we cannot move forward.

Please provide the information you wish to obtain from DMAHS and we would be happy to inquire with staff as to what is available, and what the cost would be to provide data to you. We await your response. Thank you.

Kellie L.K. Pushko
Regulatory Officer/Deputy OPRA Records Custodian
NJ Division of Medical Assistance and Health Services
Office of Legal and Regulatory Affairs
P.O. Box 712
Trenton, NJ 08625

From: Evan Anderson


I'm specifically interested in provider information and number of claims (or total monetary value), broken down by year.

Hope that helps,

From: Department of Human Services

It is still not clear what you are seeking from the Division. What type of provider information do you want – the provider name? And are you looking for the aggregate number of claims? If so, do you mean submitted or paid? And what is the timeframe/dates you are look at for this data? It would be very helpful if you could provide a sample layout so staff can better understand the exact fields and data you would want provided to you. Again, without specifics it is difficult and/or impossible to respond.

We will await more information from you. Kindly keep the OPRA number assigned to this request in the reference/subject line for clarity. Thank you.
Kellie Pushko

From: Evan Anderson

I'm looking for a spreadsheet of paid Medicaid claims, with the following columns: date (or just year), provider (name or NPI), billing code (300.14 or F44.81), service provided (e.g., psychotherapy, 45 minutes), amount paid. The time frame is between 1/1/2000 and the date my request is processed. Please see attached for a sample layout.


From: Department of Human Services

I will provide staff with this information and see if they need further details or clarification. We will endeavor to respond to you within 7 business days (by January 5, 2018) but with staff vacations for the holidays we may need more time. I will let you know. Thank you.
Kellie Pushko

From: Department of Human Services

Some additional questions and comments regarding this request that need clarification before we can proceed with determining the cost estimate:

· We can only provide year, not actual date of claim because of HIPAA

· The types of claims with these diagnosis codes are ‘encounters’(HMO paid) and fee for service(Medicaid paid) . However, we only have encounter claims going back to 2007, not 2000 as requested. Our options are:

· We could omit encounters entirely

· We could include encounters back to 2007, and only fee for service claims back to 2000

· We could include both encounters and fee for service claims, but only back to 2007

· If you want to include encounter claims please be advised that we can NOT give encounter payments by provider. We may be able to include all encounter payments for all providers (as an aggregate total), but we are contractually obligated to notify the MCOs of this request and they may have additional concerns

· Claims have up to 17 diagnosis codes and we will be selecting on the basis of any one of them being either DSM-5 300.14 or ICD-10 F44.81. Do you want us to report on ALL the diagnosis codes on the claim?

· Not all claim types record a ‘service provided’. Inpatient claims indicate a DRG and long term care claims only have diagnosis codes. In the case of inpatient claims, do you want us to indicate the DRG?

After we hear from you we will see if further clarification is needed or if the cost estimate can be provided. Thank you.
Kellie Pushko

From: Evan Anderson

Hi there,

Thanks for the response. To respond to each of your points:

- Year, instead of date, is fine.
- I think the best option here is to omit encounters entirely.
- I am not interested in other diagnosis codes, so you may exclude all that aren't 300.14 or F44.81, unless it is easier for you to leave them in.
- For inpatient claims, I would like if you could indicate the DRG.

Hope this helps,

From: Department of Human Services

OPRA C127759 was closed on 8/14/2018 due to inactivity. We sent a follow up inquiry to you on 1/3/2018 and never received further response. When a subsequent OPRA request was filed by you (C135561) we inquired about the older OPRA and closed the file when we did not hear further from you. I have attached the original emails from C127759 and the follow up (including receipt) that was sent in conjunction with C135561.

Due to age, we cannot reopen this OPRA request, however, please feel free to file a new OPRA request through the state’s on-line OPRA system using the below instructions:

· Go to State of New Jersey’s OPRA page at the following link:

· Click on: State Request Form

· When asked to select the department from which you wish to receive information, choose HUMAN SERVICES

· When asked to select the agency within Human Services from which you wish to receive information, choose DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES

· Complete form and submit

If you reference the older OPRA number in the request it will help facilitate the process once filed. Thank you.

Kellie L.K. Pushko, Esq.
Regulatory Officer/OPRA Records Custodian
NJ Division of Medical Assistance and Health Services
Office of Legal and Regulatory Affairs
P.O. Box 712
Trenton, NJ 08625