ADP Help

[AdmiralKnight]

I'm hoping someone on here has some experience with ADP (Assistive Devices Program) and can perhaps help me through PM's. Our Docs used to have someone doing low vision aids, but she retired about a year ago. Of course, she was the only one who knew how to work with ADP, what was covered, what wasn't etc etc. Well, they want to get back into it again... but ADP isn't very forthcoming with info. In general it looks pretty straight forward (or atleast, as straight forward as any of the gov'ment programs are) but there are some things, like Diagnostic codes for instance, that I'm not too clear on. Any help would be greatly appriciated!


:cheers:

[Ory]

Too late to give a meaningful reply tonight, but I'll help you out tomorrow when I'm in the office.

[AdmiralKnight]

Thanks! :D

[Ory]

OK,

Diagnostic codes would be your typical ICD-9 codes; The vast majority of low vision patients have retinal issues so a 362 would be appropriate. They do not need the specific code (anything after the decimal). The authorizer, who would have to be a doctor, would need this code to file anything with OHIP so you should be able to get a diagnostic code easily.

ADP is insane about documentation. You MUST have everything right or it will sit around for a couple months, then get bounced back to you. You must send an invoice to Kingston and the EA form to North York.

Appropriate codes for each device are really important to make sure ADP pays their share. You should have a list of ADP codes for visual devices which includes maximum allowable payments.

If you have any specific questions or are missing any of this information feel free to PM me.

[AdmiralKnight]

Thanks a ton! I'll definitely take you up on your offer if we run into any more stumbling points! :D

[Caroline1008]

When I started filling out the ADP forms (before we got de-listed and handed a card with ICD-9 codes), I wrote in the diagnosis plus their visual acuity. I still do it that way. I was told that the visual acuity must be written down even though there isn't a field for it. I put it beside the diagnosis.

ADP is supposed to be for low vision which (depending on the person) is vision less than 20/50. Some say less than 20/70. I once claimed for person with 20/40 and that was not rejected.

In other words, we can't put in a claim for person who has high Rx or high add but who has better than 20/50 (or there about) vision.

[Ory]

I was told that the visual acuity must be written down even though there isn't a field for it. I put it beside the diagnosis.

ADP is supposed to be for low vision which (depending on the person) is vision less than 20/50. Some say less than 20/70. I once claimed for person with 20/40 and that was not rejected.

The previous doc in our office doing low vision did the same. I've never put in acuity and never been rejected.

Actual documentation from ADP states 20/70 in the better eye OR visual field less than 10 degrees (I think that's the right number - I'm at home now). If they decided to audit you the could in theory retroactively deny claims if the patient doesn't meet the criteria.

[Caroline1008]

I thought they say that once the paper work goes through, that's that unless there was outright fraud which is why I put in the VAs.

I once had an Optician asking me to fill in form for someone who is high myope but who was 20/20 corrected. I had a really hard time convincing them the program was for low vision patients since all high myopes think they are legally blind :) They told me that someone at ADP said they qualified so I got on the phone with that person who actually said that's true!!! So I asked her for the authorization number (since I'm authorizing for a patient that didn't meet criteria) and she backed down, mumbled something about maybe they weren't qualified and then hung up. Okaaaaay.....

Been doing ADP forms for years and years. Have never been audited once.

[AdmiralKnight]

They won't give us authorization for anything. If you use the word "authorization" they freak out on you. What we've resorted to doing was asking if they've used the coverage before and that seems to get the right info out of them... helpful folks.

[Caroline1008]

I wonder if anyone has ever filled in the "ADP prior authorization no." field on the ESA. It's suppose to be for people who qualify but find it difficult to see an ADP authorizer. That way their own doctor (a.k.a Prescriber) can send the ADP people the relevant information and ADP can authorize them for devices.

Meanwhile, my patients get confused when I say I can only authorize low tech low vision aids, not the high tech ones.

[AdmiralKnight]

Has anyone been successful in submitting a digital magnifier to them? We're getting some pretty mixed signals from ADP. It sounds like they won't even look at it if we submit it, but from what they've told us, it seems like they MIGHT help pay if the patient submits?? Seems sketchy to me.