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Provider Update Newsletter

May 2005, Volume 151
 

All Providers

HIPAA News
Billing Guidelines to Ensure Correct Processing of Paper Claims
Trading Partner Password Expiration
What is Early Intervention?

Dental and Vision Providers

Enhancement to Online Limitations

High Acuity Home Care Providers

  Submission Guidelines for Minimum Data Sets

 

HIPAA News

National Provider Identifier (NPI)

The Final NPI Rule adopting the HIPAA standard unique identifier for health care providers
was published in the Federal Register on January 23, 2004. Health care providers can begin
applying for NPIs on the effective date of the Final Rule, which is May 23, 2005. All health care
providers are eligible to be assigned NPIs; health care providers who are covered entities must
obtain and use NPIs. All HIPAA covered entities must use NPIs by the compliance dates
(May 23, 2007 for all but small health plans; May 23, 2008 for small health plans) – CMS Web
site 4/1/2005

To view the Final Rule, please visit the CMS website by clicking here.

HIPAA Security

Compliance with the HIPAA Security Rule was due on April 21, 2005 – where are you in the
process? Many entities have discovered that developing policies and procedures to meet the Security
Rule requirements have proven much more complicated and difficult than at first thought. Because
there is also a systems component to this Rule, rather unlike HIPAA Privacy, there are several
levels of effort that must be undertaken.

If you need further information regarding the Rule, please visit the CMS Website by clicking here.
 

Billing Guidelines to Ensure Correct Processing of Paper Claims

General Billing

• Ensure that ALL required fields are completed. To determine which fields are required, please
  consult your Provider Manual or the Online Manual on the Department of Human Services
  (DHS) Web site by clicking here.
   

• Ensure that data is contained within the borders of each box
   

• Ensure that stamps do not obscure vital information
   

• Ensure that stamps do not obscure vital information. If there is no other insurance IN ADDITION
  TO RI Medical Assistance, Medicaid, DHS, RI Department of Human Services, RIte Care,
  RIte Share, or RIte Start, please indicate NO to other insurance in box 11D of the HCFA
  form (CMS 1500)

Billing for Coordination of Benefit Claims

• Include the explanation of benefits (EOB) from the primary insurance
   

• Provide the three digit carrier code for the primary insurance in box 9D of the HCFA form
  (CMS 1500). A list of carrier codes can be found in the Online Manual on the DHS Web site
  by clicking here
   

• Select YES in box 11D to indicate other insurance
   

• The total charge in box 28 must equal the sum of the detail lines contained in box 24F and must
  match the billed amount on the EOB
   

• Box 29 should contain the paid amount from the primary insurer as listed on the EOB
  

Trading Partner Expiration

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

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

• Go to the Department of Human Services (DHS) Web site by clicking here and
  access “MMIS Web Transactions”
   

• Enter your Trading Partner ID and current password
   

• The next screen will ask you to choose a new password and enter it twice

2. While checking MMIS Web Transactions you will receive notification that your web
     password has expired after you have entered your Trading Partner ID and current password

• The next screen will ask you to choose a new password and enter it twice

***If you are using PES, you must also go to Tools, Options, and update your web password on the
       Batch Tab. If you are using your own software, you must update your web password in the
       appropriate field.

If you do not have access to the Internet, please call Paula Giocastro at 401-784-3817.
 

What is Early Intervention?

Early Intervention (EI) is a program that provides services for infants and toddlers under 3 years of
age who have a developmental delay or disability. There are 8 Early Intervention provider sites located
throughout Rhode Island. The administration of the program has recently been transferred from the Department of Health (DOH) to the Department of Human Services (DHS). For general information
on Early Intervention, you may call the DHS Info Line at 401-462-5300. Questions from EI Provider
Agencies should be directed to Karen Murphy, EDS Provider Representative, at 401-784-3888 or email Karen by clicking here.

Enhancement to Online Limitations

The tooth number will now display with SEALANT (D1351) information.

Dental and Vision Limits are now available through the "MMIS Web Transactions" link on the
Department of Human Services (DHS) Web site. You may access the Web site by clicking here or
access the page directly by clicking here. To use this valuable tool, you will need:

• A Trading Partner ID and Password - To obtain a Trading Partner ID and Password, please 
  click here and print the Trading Partner Agreement (TPA). Once completed, mail it to the
  address listed on the last page of the form
   

• An Internet Service Provider (ISP) - There are a number of low-cost internet options
  available for your office. Please contact the Customer Service Helpdesk (CSHD) at
  1-800-964-6211 for instate toll calls and bordering communities, or 401-784-8100 for
  local and long distance calls for a list of these options.
   

• Access To This Feature - To be granted access, please email Paula Giocastro by clicking here.
   Be sure to include your provider number and Trading Partner ID

If you would like your office to receive web training please contact your new provider representative
Ashley Cunningham at 401-784-3832 or email Ashley by clicking here.
 

Submission Guidelines for Minimum Data Sets

Minimum Data Set (MDS) forms should be received approximately 2 weeks prior to the expiration date
of High Acuity. Once we receive the MDS form, we will send a confirmation fax within 4 business days.
If you do not receive a confirmation within 4 business days, please contact Mangala Gunaratne at
401-784-3509 to verify receipt of the fax.

Please remember that it is not possible to approve High Acuity for dates that precede the date that the fax
is received. Therefore, if an MDS form is submitted late, there will be a gap in eligibility for High Acuity,
and that level will not be billable for the given time period. If you have any questions regarding this process, please contact Kelly Leighton at 401-784-3823 or email Kelly by clicking here.