Provider Update Newsletter Vol 136

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Provider Update Newsletter

February 2004, Volume 136

All Providers

HIPAA Compliance Update
PES Users
Payment Processing Schedule
Important Notice
Submitting Paper Claims

Home Health Providers

CNA Reimbursement

Dental Providers

Medical Assistance Dental Policy

HIPAA Compliance Update

As of the last 2003 payment cycle, approximately 75% of our total electronic claims were
submitted through HIPAA compliant transactions. Also, through thousands of transactions,
Providers are using the DHS website to quickly check eligibility, claim and Prior Authorization
(PA) status at a time and pace that is convenient for them!

Are you taking advantage of the DHS website for readily available and printable eligibility
and claim information? Are you sending HIPAA compliant electronic claims? If you are
still in transition we are here to help you. Our EDI team is ready to test your HIPAA compliant
transactions or to discuss our free HIPAA compliant Provider Electronic Solutions (PES) billing
software. You do not want to revert to paper, which could slow your payment.

Currently we are accepting both HIPAA and non-HIPAA compliant claims (exception: Nursing
Home claims and Medicare Crossover claims). A final determination on an end date for this
dual-processing contingency plan has not been made. The end date will likely coincide with
Medicare’s end date for dual processing. We are also monitoring the successful HIPAA transition
for all RIMA providers. With 75% of our claims HIPAA compliant, the transition is underway.
EDS wants to help you achieve HIPAA compliant billing and save valuable staff time through use
of the DHS website for eligibility, claim, and PA information. Please call your provider representative
to talk with us about your plans for HIPAA readiness or use of the DHS website. You may also call
the EDI Help Desk at 401-784-3884.

PES Users

How do you know if your HIPAA compliant claims have made it to EDS successfully?

There are 2 steps you should follow.

Select communication from the drop down menu to

Select Submission

Highlight the claim form (or forms) you would like to submit

Submit

Once you receive a successful transmission:

Stay on the submission menu

Deselect you claim form

Select Claim Accept/Reject report from the files to receive column

Submit

Once you receive a successful transmission

Select from the drop down menu

Communication

View Submit Report

What should you be looking for on this report?

Date and Time submission

Claims received, rejected and accepted

If the received and accepted are the same, then all your claims made it to EDS successfully
for processing. If the received and accepted are different, then there will be some claims that
have been rejected. If you have any claims that are rejected they will be listed on this report,
you can then correct them and resubmit them.

Please remember to perform the second step of this process, this will ensure that your
claims will be processed.

Payment Processing Schedule

Month

LTC Claims Due by Noon

EMC Claims Due by 5pm

Financial Cycle

Medicaid Payment Date

January
1/8/2004 1/9/2004 1/10/2004 1/16/2004

1/23/2004 1/24/2004 1/30/2004

February
2/12/2004 2/13/2004 2/14/2004 2/20/2004

2/27/2004 2/28/2004 3/5/2004

March
3/11/2004 3/12/2004 3/13/2004 3/19/2004

3/26/2004 3/27/2004 4/2/2004

April
4/8/2004 4/9/2004 4/10/2004 4/16/2004

4/23/2004 4/24/2004 4/30/2004

May
5/6/2004 5/7/2004 5/8/2004 5/14/2004

5/21/2004 5/22/2004 5/28/2004

June
6/10/2004 6/11/2004 6/12/2004 6/18/2004

6/25/2004 6/26/2004 6/30/2004

July 7/8/2004 7/9/2004 7/10/2004 7/16/2004

7/23/2004 7/24/2004 7/30/2004

Important Notice

Your Trading Partner Password will soon expire

For security reasons your Trading Partner password will expire every 90 days.
You will be notified of this in one of two ways.

During the submission process you will receive notification that your web password has expired.

Access the MMIS Web Transactions by clicking here
Enter your Trading Partner ID and your current password.
The next screen that comes up will ask you for a password, enter it twice.

Please choose a new password.

While checking MMIS Web Transactions; eligibility, claim status, PA’s etc you will receive notification
that your web password has expired .

After you enter your Trading Partner ID and current password, the next screen that comes up will ask
you for a password, you will have to enter it twice.

Please choose a new password.

If you are using PES you will also need to go to Tools, Options, and on the Batch tab update your
Web Password on this screen as well.

If you are using your own software, you will need to change it in the appropriate field in your software.

If you do not have access to the Internet, please call 784-3884.

Submitting Paper Claims

EDS has begun scanning claims through an Optical Character Recognition (OCR) solution. This
process eliminates the physical keying of documents/claims. This scanning solution will pick up
all information listed on your paper claims. Therefore it is necessary for your information to be
accurate. Your billing numbers/billing name along with your group provider, individual provider
and performing provider numbers must be listed in the appropriate areas, or claim will be subject
for denial.

Currently all HCFA and professional crossovers are being scanned and the remainder claims types
will be completed through first quarter 2004.

Dental claims will not be affected at this time by this change and will continue to be keyed manually.

CNA Reimbursement

When a Certified Nursing Assistant services are provided and reimbursed through EPSDT (procedure
code X0087) there is an 8 unit (hour) per day limit. Any claims with units greater than 8 per day will
deny. To verify the number of hours approved, please contact Gail Davis at EDS at 401- 784-3873.

Medical Assistance Policy

Over the past year, the Department of Human Services (DHS) made changes to Rhode Island Medical
Assistance Dental Policy to expedite services and simplify the processes for Dental Providers serving
Medical Assistance (MA) clients. Transportation services were also enhanced to help clients get to
appointments.

The policy changes were summarized in a December 29, 2003 mailing to all MA Dental providers.
The mailing also included information on transportation and successful claim submission as well as
reference materials on Dental Billing Procedure Codes and Limitations and the Dental Benefit Package
for both children and adults.

You can print a copy of the updated Dental Policy from the DHS website. If you have any questions
or comments on the updated policy or materials provided to you, please call your Provider Representative,
Dawn Durocher, at 401-784-3813 or the Customer Service Help Desk at 401-784-8100
(1-800-964-6211 for instate toll calls and border communities).