Search

Provider Update Newsletter
June 2006, Volume 164
 

All Providers

HIPAA Code Sets Conversion
Changes Regarding Upcoming Financial Cycle
Direct Deposit Reimbursement
New Dental Program for Young Children
Provider Enrollment Requirements
Electronic Replacements and Voids - FAST & EASY

Long Term Care Providers

Nursing Home Providers - Reminder

HIPAA Code Sets Conversion

 Have you begun to use the National Codes?

If you answered “YES” to the above question, then you are now billing RI Medical Assistance
with the “new” national procedure codes for dates of service effective May 1, 2006.

The “old” local codes that you have been billing to RI Medical Assistance will be end dated
effective April 30, 2006. If you continue to bill with the “old” local codes, your claims will be
denied.

EDS sent out provider specific mailings in March. If you have NOT received a notification with
your new procedure codes or you are not sure if your codes will be changing, please contact your
Provider Representative as soon as possible to avoid cash flow issues.

You can find your Provider Representative on the DHS web site by clicking here

 

Changes Regarding Upcoming Financial Cycle

The EDS claims submission deadline (cutoff) for payment in the financial cycle dated
May 26, 2006 will be moved back one day.

All claims must be submitted to EDS no later than 5:00 pm on Thursday, May 25, 2006, to be
included in the RA dated June 2, 2006. Any claims that are submitted after this time will not be
processed until the next financial which will pay on June 16, 2006.

Please call the Customer Service Help Desk for further assistance at 800-641-6211 for bordering communities and instate toll calling or 401-784-8100 for long distance calls.

 

Direct Deposit Reimbursement

Did you know you will receive your payment for Medical Assistance services much faster if you
enroll in Electronic Funds Transfer (EFT) payments? EFT is an electronic alternative to receiving
paper checks for Medical Assistance reimbursement.

Your reimbursement will be automatically deposited into your bank account on the day paper checks
are mailed. This method of payment also allows you immediate access to your funds on the day of
deposit, which proves to be timely and cost effective.

To enroll, simply click here to download the Direct Deposit Application.

Mail the form to:

Electronic Data Systems
PO BOX 2010
Warwick, RI 02887-2710
Attn: Carolyn Penardo
Financial Department

If you have any questions regarding enrolling for EFT, please call Carolyn Penardo at 401-784-3828
or contact by email by clicking here.

 

New Dental Program for Young Children

Dental Care for Children

Rhode Island is starting a new dental program called RIte Smiles for young children born on or after
May 1, 2000 who are eligible for Medical Assistance (RIte Care, RIte Share or Medical Assistance
fee-for-service). Eligible children from birth to five will initially be enrolled and as children reach their
sixth birthday, they will continue in the program, so each year the age of the children in the program
will increase.

RIte Smiles is designed to increase access to dental care for children on Medical Assistance and
help prevent serious oral health problems as children grow up. To do this, the State has contracted
with two new dental plans- Neighborhood Health Plan of RI—Kids First Dental and United Healthcare Dental—Let’s Smile, to provide a provider network and member services. These two newly formed
dental plans will be contacting dentists throughout the State to become a part of their provider networks.

The Department of Human Services will be enrolling approximately 30,000 children into the two
dental plans over a period of four months. The first group will be enrolled on July 1, 2006. We hope
to have many Rhode Island dentists participate in the RIte Smiles Program and improve the oral health outcomes for children on Medical Assistance. More information on RIte Smiles will be sent by mail to participating Medical Assistance dental providers this Spring.

For more information on RIte Smiles, please call: Ashley Cunningham at EDS 401-784-3832.
 

 

Provider Enrollment Requirements

Through the Provider Enrollment process, EDS along with the Department of Human Services,
requires each document of the Provider Agreement and Addendums 1 & 2 to be signed.

If you enrolled with Medical Assistance prior to 2005, please take a few minutes to obtain a copy
of these documents on the Department of Human Services web site, (links to forms listed below).
Please include your current Medical Assistance billing provider number

Click here for the Provider Agreement
Click here for Addendum I
Click here for Addendum II

These signed documents can be mailed to:

Electronic Data Systems
PO BOX 2010
Warwick, RI 02877-2710
Attn: Provider Enrollment
 

Electronic Replacements and Voids - FAST & Easy

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

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

Required information: 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.

Denied claims cannot be adjusted. Your claim will need to be corrected and resubmitted.
If you use Provider Electronic Solutions for electronic billing please click here 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.

Please call the Customer Service Help Desk for further assistance at 800-641-6211 for bordering communities and instate toll calling or 401-784-8100 for long distance calls.

 

Nursing Home Providers - Reminder

Long Term Care Eligibility is available on the DHS website. All you need to access
this web site is your Trading Partner number and password.

Once you are on the DHS website:

• Access MMIS Web Transactions

• Enter your Trading Partner ID and Password, hit Log In

• Choose Eligibility

• Enter the recipients ID number and dates of service, Hit Search

The eligibility information will appear with in seconds. Look for the section labeled Long Term Care.

If you have any questions regarding this or need help accessing the website for the first time, please
call Kelly Leighton at 784-3823 or by email Kelly by clicking here.