Provider Update Newsletter
March 2006, Volume 161
All Providers
HIPAA Code Sets Conversion
Claim Submission and Payment Schedule for Remainder of
SFY 2006
RIte Share Providers
Premium Assistance Program
Vision Providers
Refraction Testing
Adult Day Care Providers
Reimbursement for Procedure Code
X0331
Assisted Living Providers
Reimbursement for Procedure Code
SS630
Home Health Providers
Reimbursement for Procedure Code
X0043
HIPAA Code Sets Converstion
HIPAA (Health Insurance Portability & Accountability
Act) mandates that all states eliminate
the use of their local procedure codes and local modifiers except as
specifically provided
within 42 CFR (Code of Federal Regulations).
The purpose of local procedure code mapping is to attempt to crosswalk
the RI local codes
to any existing or new National HCPCS, CPT, ADA or other National Code
Sets. There
are some local codes that will remain due to the code being non-medical
or no appropriate
national code crosswalk.
DHS and EDS have completed the crosswalk of our Local Codes/Modifiers to
National
Code Sets. We have performed financial analyses to ensure that provider
reimbursements
reflect current Medicaid policy and budget allotments.
EDS is moving toward a May 2006 implementation date and expects a smooth
transition.
To keep providers informed we will be utilizing the following forms of
communication
which include the monthly Provider Updates, the
DHS website, the Banner Page of the
Remittance Advice and mailings direct to your office.
Provider specific mailings to watch for will be the code crosswalks and
workshop information
in February/March 2006. Educational workshops will be held in April
2006.
If you have recently moved or will be moving within the next 6 months,
please notify our
Provider Enrollment Department with your current address to ensure you
receive all the
appropriate mailings. To change or update your address please print a
Change of Address
form from the DHS website by clicking
here
and mailing it to:
Electronic Data Systems
171 Service Avenue
Building 1, Suite 100
Warwick, RI 02886-2010
Claim Submission and Payment Schedule for
Remainder of SFY 2005
Please note the first EFT Payment Date for June is
6/2/06 not 6/3/06 as seen on previously
printed calendars.
|
Month |
LTC Claims due by Noon |
Electronic Claims Due
by 5:00 PM |
Cycle Date |
EFT Payment Date |
|
February |
2/9/2006 |
2/10/2006 |
2/11/2006 |
2/17/2006 |
|
|
|
2/24/2006 |
2/25/2006 |
3/3/2006 |
|
March |
3/9/2006 |
3/10/2006 |
3/11/2006 |
3/17/2006 |
|
|
|
3/24/2006 |
3/25/2006 |
3/31/2006 |
|
April |
4/6/2006 |
4/7/2006 |
4/8/2006 |
4/14/2006 |
|
|
|
4/21/2006 |
4/22/2006 |
4/28/2006 |
|
May |
5/11/2006 |
5/12/2006 |
5/13/2006 |
5/19/2006 |
|
|
|
5/26/2006 |
5/27/2006 |
6/2/2006 |
|
June |
6/8/2006 |
6/9/2006 |
6/10/2006 |
6/16/2006 |
|
|
|
6/23/2006 |
6/24/2006 |
6/30/2006 |
|
July |
7/6/2006 |
7/7/2006 |
7/8/2006 |
7/14/2006 |
|
|
|
7/21/2006 |
7/22/2006 |
7/28/2006 |
Premium Assistance Program
RIte Share, Rhode Island’s Premium Assistance
Program, allows beneficiaries to
get their health insurance coverage through their employer with the
state
subsidizing a portion of the premium cost. For qualifying families, the
state pays for the
employee’s cost for that health insurance.
RIte Share also pays for 100% of a member’s co-payments. Providers can
bill the
Medicaid Program for those co-payments, if they are either a Medical
Assistance
provider or a RIte Share, “co-pay only Provider.” For information on
billing, please
call EDS at 401-784-8100.
Cost Sharing (RIte Care and RIte Share Members)
RIte Care and RIte Share members whose income is above 150% of the
federal
poverty level are required to pay a monthly premium to obtain or
maintain their
health insurance coverage. Approximately 10% of the RIte Care and RIte
Share
members pay a monthly premium to the state.In August 2002, the state
increased
the premium amounts that families are required to pay. Families that
fail to pay two
months of premium will lose their health insurance coverage for a four
month period.
Providers should always check eligibility for Medical Assistance since
members can
lose eligibility for a number of reasons. Examples include: forgetting
to recertify for
Medical Assistance annually, failure to pay premiums, or having a change
in income
or family size that may affect their eligibility.
Refraction Testing
The Medical Assistance Program will reimburse for
Refraction testing, procedure 92015,
when Medicare reimburses for the routine eye exam (procedures 92002,
92004, 92012
and 92014).
To process these claims a paper HCFA 1500 claim form must be sent in
with the procedure
92015 with the Medicare EOMB reflecting payment for the routine eye
exam. The fee for
procedure 92015 is $20.00.
All paper claims must be sent to
P.O. Box 2009
Warwick, RI 02887
ATTN: Ashley Cunningham
If you have any questions, please call Ashley at
401-784-3832 or by email by clicking
here.
Reimbursement for Procedure Code X0331
Effective January 1, 2006 the rate of reimbursement
for procedure code X0331 is $37.93.
If you have any questions, please contact your provider representative
Kelly Leighton at
401-784-3823 or email Kelly by clicking
here.
Reimbursement for Procedure Code SS360
Effective January 1, 2006 the rate of reimbursement
for procedure code SS630 is $36.32.
If you have any questions, please contact your provider representative
Kelly Leighton at
401-784-3823 or email Kelly by clicking
here.
Reimbursement for Procedure Code X0043
Effective January 1, 2006 the rate of reimbursement
for procedure code X0043 is
$67.18 per unit.
If you have any questions, please contact your provider representative
Kelly Leighton at
401-784-3823 or email Kelly by clicking
here.
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