Provider Update Newsletter
February 2003, Volume 124
All Providers
HIPAA Happenings
Privacy Awareness Seminar
Enrollment Form and Process
Pharmacy Providers
Pharmacy Waiver Application
Home Health Providers
Modified Section of MDS Form
HIPAA Happenings
Claim Type to HIPAA Transaction Mapping
As you know DHS and EDS are working diligently to implement HIPAA mandated transactions. One of the first steps in this process was to identify which HIPAA transaction to utilize for each of the DHS claim types. The following matrix provides a crosswalk from the DHS claim type to the associated HIPAA transaction.
| Claim Description |
HIPAA Transaction |
| Medical (HCFA 1500) |
837 Professional |
| Waiver |
837 Professional |
| Professional Crossover |
837 Professional |
| Outpatient Crossover |
837 Professional |
| Inpatient Crossover |
837 Professional |
| Inpatient (UB 92) |
837 Professional |
| Outpatient |
837 Professional |
| Hospice |
837 Professional |
| Home Health |
837 Professional |
| Nursing Home |
837 Professional |
| Dental |
937 Dental |
| Pharmacy |
NCPDP 5.1 |
Privacy Awareness Seminar
In December DHS and EDS held a seminar designed to boost awareness of privacy rule provisions and encourage providers to take the necessary action to become compliant. It was standing room only with over 200 providers in attendance. The presentations from this seminar can be downloaded form the DHS HIPAA
web-site. Please contact Dot Pizzarelli at (401) 784-3849 if you have questions. DHS and EDS are also planning another seminar tentatively scheduled for early March 2003. Check the March provider update for further details.
Be sure to check the DHS HIPAA web-site
periodically for timely information regarding HIPAA implementations.
Enrollment Form and Process
Thank you for your interest in the Rhode Island Medical Assistance Program. Our can locate the forms and information necessary to enroll as a provider or to add a provider to your existing group on the
DHS website. For provider enrollment you are required to send in the following forms:
· Individual or Group Provider Agreement Form
· Current copy of your practice’s form of licensure
· W-9 tax forms
· Hospital’s (only) completed Room and Revenue code sheet
Completed enrollment forms should be mailed to:
EDS
Provider Enrollment Unit
PO Box 2010
Warwick, RI 02887-2010
If you have any questions about the enrollment form or enrollment process, please call EDS at (401) 784-8100 for instate and long distance callers or 1-800-964-6211 for instate toll callers and border communities
IMPORTANT NOTE: Please DO NOT send any claims with your application. The claims can be sent once you have received an approval t join the RI Medical Assistance Program and you have received your provider number and a billing manual. If you are an out-of-state provider, prior to sending in claims you are required to provide your provider number, manual, and Prior Authorization
Pharmacy Waiver Application
The RI Department of Human Services has recently submitted an application to CMS to implement a Pharmacy Plus Waiver Program. The waiver, when approved, will allow DHS to expand pharmacy benefits to new and existing populations. We will be working on implementing this initiative within MMIS claims processing and anticipated RX Waiver implementation is Summer 2003. If you would like to review our Pharmacy Plus waiver application, please visit
the DHS web site
or call us at (401) 462-6392 for a paper copy.
Modified Section of MDS Form
Please note the only modified section on the MDS Form is the Address.
The modified Minimum Data Set is located on the DHS
website.
MDS MOD Home Care Agency Form
Please note the fax and mail to address for the MDS.
Fax completed forms to:
Attention: EDS Prior Authorization Department at (401) 941-7712.
Or Mail to
EDS
PO Box 2006
Warwick, RI 02887-2006
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