Electronic Replacements and Voids

Rhode Island Medical Assistance can process electronic replacements and voids. With a replacement, 
you can make changes to a paid claim, as in an adjustment. With a void, you may remit the entire 
payment on a claim, as in a recoup. 

Please follow the process specific to your claim type as listed below:

Professional, Dental and Waiver Claims:
Identify a replacement or void by the claim frequency code.

7 = Replacement
8 = Void

Institutional Claims: 
Identify a replacement or void by the third position of the bill type.

7 = Replacement
8 = Void

You will require - the original Internal Control Number (ICN) on the claim that you would like to replace 
or void. The ICN can be found on your remittance advice. It is a 15-digit number.

How will replacements be displayed on the Remittance Advice?

• The original claim will be voided and be reported under the “Financial Items” section as a void with
   reason code “147” (electronic replacement).
  

• Depending on its status, the replaced claim will appear under the “Paid” , “Denied”, or “Suspended” 
  section.
  

• The electronic replacement will not show under the “Adjusted Claims” section.

How will voids be displayed on the Remittance Advice?

• The void will display under the “Financial Items” section as a void with reason code “148” 
  (electronic void).

Important Reminder:

Timely filing guidelines still apply if the date of service is older than 365 days. If you have a claim with a date 
of service older than 365 days and an EOB that is within 365 days, you will need to send your adjustment to 
EDS on the Single Claim Adjustment Request Form. If you try to submit a replacement on a date of service 
older than 365 days, your original claim will be recouped and your replaced claim will deny for timely filing.

You cannot adjust a denied claim. Denied claims will need to be corrected and resubmitted.

If you use Provider Electronic Solutions for electronic billing please log on to the DHS Website for a complete 
set of instructions for submitting electronic replacements or voids. 

If you utilize another software for electronic billing; verify with your vendor that you can bill electronic 
replacements or voids using that software. 

If you have further questions, please call the Customer Service Help Desk at 784-8100 for long distance 
callers or 1-800-964-6211 for instate toll calls and boarding communities. 

New Patient Status Codes

Effective September 19, 2004, the following patient status codes can be used in Box 22 on a UB92 claim
form when billing EDS:

Status Code	Description
43	Discharged/Transferred to a Federal Health Care Facility
50	Hospice-Home
61	Discharged/Transferred to Hospital Based Medicare approved swing bed
62	Discharged/Transferred to an inpatient rehabilitation facility (IRF)
63	Discharged/Transferred to a Medicare certified long term care hospital (LTCH)
64	Discharged/Transferred to a nursing facility certified under Medicaid but not certified under Medicare
65	Discharged/Transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital

Provider Representative Name Change

Provider representative Karen Richard was recently married and is now known as Karen Murphy.  
Her new email address is karen.murphy@eds.com.  Her telephone number has not changed and is 
still 401-784-3888.

Change to Pharmacy Prior Authorization Program

Beginning September 18, 2004, Zelnorm will require prior authorization when billed to the Rhode 
Island Medical Assistance Pharmacy Program. A complete list of the prescription drugs that currently 
require prior authorization can be found below: 

Drugs Currently Requiring PA
·        Zelnorm	·        Botox
·        CNS Stimulants	·        Long Acting Narcotics
·        Erectile Dysfunction Drugs	·        Prescription 2nd Generation Antihistamines
·        Follicle Stimulating Hormones	·        Prescription Ophthalmic Allergy Medications
·        Growth Hormones	·        Xolair
·        Modafanil	·        Fuzeon
·        Weight Loss / Anti-Obesity Drugs	·        Remodulin
·        Cox-2 Inhibitors	·        Tracleer
·        Proton Pump Inhibitors	·        Flolan

As always, your support is critical to the success of this Medical Assistance initiative. It is our goal to 
partner with you in the provision of quality cost-effective health care to your patients. Questions 
regarding the Prior Authorization program may be referred to Ingelcia Simas at 401-784-3818

New Reimbursement Rates 

As of October 1, 2004, the reimbursement rates for selected Hospice procedure codes have been 
changed as follows:

Procedure Code	Rate
X0061	$122.14
X0064	$29.68
X0067	$132.82
X0070	$542.61

Please update your records and bill with the new reimbursement rate for dates of service beginning 
October 1, 2004