Provider Update Newsletter
November 2005, Volume 157
All Providers
Influenza and Pneumonia Vaccines
Medical Assistance as a Secondary Payor
Billing Instructions for Medicare Crossover Claims
Contacting the Customer Service Help Desk (CSHD)
Influenza and Pneumonia Vaccines
The Department of Human Services (DHS) will
reimburse for influenza and pneumonia
vaccines for “Fee for Service” Medical Assistance recipients aged 18
years and older only
(The Department of Health provides vaccines for ages birth through 18
years at no cost to
providers). Please see below for some important guidelines for billing
these services:
-
When the vaccine is administered during an
office visit, the vaccine supply can be
billed along with the office visit. The administration of the
vaccine, however, is
included in the office visit and should not be billed separately.
-
If the recipient is receiving the vaccine
without an office visit, such as at a “Flu and
Pneumonia Immunization Clinic,” both the vaccine and the
administration can be billed.
When billing for the vaccine, please remember to include the proper
place of service, as
referenced in your provider manual. If the place of service is not
listed (e.g. housing
authority), please use 99.
-
When medically necessary DHS will reimburse a
Home Health Care Provider for a
skilled nursing visit to administer the vaccine to Medical
Assistance recipients in their
homes. The vaccine supply can be billed in addition to the skilled
nursing visit, but
administration of the vaccine should not be billed separately.
-
Claims must be individualized by client. We do
not accept roster billing.
| |
Influenza |
Pneumococcal |
| Vaccine |
90658 |
90732 |
| Administration |
G0008 |
G0009 |
Medical Assistance as a Secondary Payor
When billing Rhode Island Medical Assistance (RIMA)
as a secondary coverage, please remember to
list the three character or numeric carrier code of the primary insurer
in Box 9D of the HCFA Claim
Form. A list of these codes can be found in every provider manual or at
the Department of Human
Services (DHS) Web site under “Healthcare” by clicking
here. Please note
that carrier codes are
only required when there is a primary insurer indicated in Box 11D. If
there is not a primary insurer
indicated in Box 11D, Box 9D should be left blank. Adhering to this and
other billing guidelines will
expedite the processing of your claims.
Billing Instructions for Medicare Crossover
Claims
Please be aware that Medicare will crossover
professional claims to Rhode Island Medical
Assistance (RIMA) when recipients have dual coverage. These claims will
appear in the
Professional Crossover Claims section of your Remittance Advice (RA).
Please allow 2 remittance
cycles for processing, as files are received once every two weeks.
If you have received an Explanation of Medicare Benefits (EOMB) from
Medicare stating that a
claim was forwarded to RIMA for processing, and the EOMB date is older
than 30 days, please
research utilizing your RA. If the claim does not appear on your RA, you
may submit your claim
electronically with the required Medicare payment information or on
paper with the Medicare
EOMB attached. When submitting paper claims that have been paid or
denied by Medicare to
EDS, always attach the EOMB form. The Medicare billed amount on the EOMB
must match the
billed amount on the claim. Thank you for your attention to this matter.
Contacting the Customer Service Help Desk (CSHD)
To allow us to provide better quality service in a
satisfactory amount of time, when contacting our
CSHD for assistance, please have the following information available:
-
Your 7 character alpha numeric Rhode Island
Medical Assistance (RIMA) Provider Number
-
The recipient's 9 digit numeric RIMA
Identification Number (Social Security Number)
-
The From and Through Dates of Service
The CSHD hours are Monday through Friday 8:00 AM to
5:00 PM. The phone numbers are
401-784-8100 for local and out of state long distance calls and
1-800-964-6211 for instate toll
calls. To receive a confirmation number, you must complete the inquiry
through the Recipient
Eligibility Verification System (REVS) line.
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