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Provider Update Newsletter
October 2006, Volume 168
All Providers
Do You Have Your NPI?
New Dental Program for Young Children
Influenza and Pneumonia Vaccines
Direct Deposit Reimbursement
Medicare Crossover Processing
EDS Provider Representatives
Do You Have Your NPI?
Only 259 more days until the National Provider
Identifier (NPI) compliance date!
The NPI is one of the steps that CMS is taking to
improve electronic transactions for
health care. National standards for electronic health care transactions
encourage elec-
tronic commerce in the health care industry and simplify the process
involved to reduce
the administrative burdens on health care providers. With national
standards and ident-
ifiers in place for electronic claims and other transactions, health
care providers will be
able to submit transactions to any health plan in the united states.
Health plans will be able to send standard transactions such as
remittance advices and
referral authorizations to health care providers. These national
standards will make elec-
tronic data interchange a viable and preferable alternative to paper
processing for health
care providers and health plans alike.
Health care providers include individuals, such as physicians, dentists,
and pharmacies
and organizations, such as hospitals, nursing homes, pharmacies and
group practices.
Health care providers who transmit health information electronically in
connection with
any standard transaction are required by the NPI Final Rule to obtain
NPIs, even if they
use business associates, such as billing agencies, to prepare the
transactions.
You are able to apply for your NPI in one of three ways:
-
You may apply through an easy web-based
application process, which began
May 23, 2005 by clicking
here.
-
You may prepare a paper application and send it
to the entity that will be assign-
ing the NPI (the Enumerator) on behalf of the Secretary, which began
July 1, 2005.
A copy of the application, including the Enumerator’s mailing
address, is available
by clicking
here. You may also call the Enumerator for a copy. The phone
number is:
1-800-465-3203 or TTY 1-800-692-2326.
-
With your permission, an organization may submit
your application in an elec-
tronic file. This could mean that a professional association or
perhaps a health
care provider who is your employer could submit an electronic file
containing
your information and the information of other health care providers.
This process
has been available since the fall of 2005.
Remember, you may apply for an NPI using only one of
the ways described above.
When gathering information for your application, be sure that all of
your information,
such as your social security number and Federal employer identification
number, are
correct. Once you receive your NPI, you must safeguard its use.
The application form contains a Privacy Act Statement, which explains
how we may
disseminate the information collected in the application. You may
receive notices
about the NPI from many of the health plans with which you do business.
Remember
that you need apply only once for an NPI. The same NPI is used for every
health plan.
The transition from existing health care provider identifiers to NPIs in
standard transac-
tions will occur over the next year. CMS urges health care providers to
apply for an
NPI immediately. While the NPI must be used on standard transactions
with health
plans, other than small health plans, no later than May 23, 2007, health
care providers
should not begin using the NPI in standard transactions on or before the
compliance
dates until health plans have issued specific instructions on accepting
the NPI.
Health plans will notify you when you can begin using NPIs in standard
transactions.
You should be aware that health plans might request that you begin using
your NPI
prior to the compliance dates. Applying for an NPI does not replace any
enrollment
or credentialing processes with any health plan, including Medicare.
You may obtain information about the NPI by clicking
here. This site
contains Fre-
quently Asked Questions and other information related to the NPI and
other HIPAA
standards.
New Dental Program for Young Children
We are happy to report that the RIte Smiles Program
will begin on September 1,
2006. The new RIte Smiles dental plan is called UnitedHealthcare
Dental. United
Healthcare and its dental subsidiary, Dental Benefit Providers, will
administer the
new dental plan for Rhode Island. Dental Benefit Providers has
considerable expertise
in administering dental benefits and currently administers dental
benefits for 1.3
million members in 8 states. DHS is working closely with
UnitedHealthcare Dental
to assure a smooth transition for families as their children switch from
Medical
Assistance Fee-For-Service Dental to UnitedHealthcare Dental.
Approximately 30,000 children who have Medical Assistance coverage are
eligible
for RIte Smiles and will be enrolled in UnitedHealthcare Dental
beginning on Sep-
tember 1, 2006. Enrollment will continue through the end of the calendar
year. Chil-
dren will be enrolled on a regional basis and the first group will be
from northern
Rhode Island. We will continue to update you on the enrollment schedule
over the
next several months.
IMPORTANT BILLING INFORMATION
beginning September 1, 2006
Be sure to have your office staff check
patients' dental insurance ID Cards
When to bill UHC Dental
-
RIte Smiles members will have a
UnitedHealthcare Dental card. This dental plan
should be billed even if you haven’t signed up yet as a contracted
provider in the
UHC Dental Plan. If you bill Medical Assistance for services
rendered on or after
September 1 for a patient enrolled in RIte Smiles, the claim will
not be paid
because the child technically no longer has Medical Assistance
Fee-For-Service
Dental coverage. Providers not in the UHC Dental Plan network will
be reim-
bursed for dental services at the Medical Assistance rates.
UnitedHealthcare
Dental is actively recruiting dentists throughout the State to be
part of its dental
network. For more information on becoming a participating provider,
please
call UnitedHealthcare Dental’s recruitment line at:
1-888-679-8923.
-
For children with Medical
Assistance ID cards who are in the Rite Smiles but
haven’t received their UHC Dental ID card yet, call UnitedHealthcare
Dental’s
Provider Service number at 1-888-679-5353 to confirm eligibility.
When to bill EDS (for Medical
Assistance Claims)
For EDS’ Provider Customer Service Help
Desk, please call: 401-784-8100 for long
distance or 1-800-964-6211 for in-state toll calls.
If you haven’t already signed up to become a part of the RIte Smiles
dental plan network,
we hope you will do so.
Influenza and Pneumonia Vaccines
The Department of Human Services (DHS) will
reimburse for influenza and pneumonia
vaccines for “Fee for Service” Medical Assistance recipients age 18
years and older only.
(Contact The Department of Health to obtain vaccines)
Please see below for some important guidelines for billing these
services:
-
When a 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 may 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 may 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.
|
Description |
Influenza |
Pneumonia |
| Vaccine |
90658 |
90732 |
| Administration |
G0008 |
G0009 |
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 pa-
per 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 log onto the DHS Website by clicking
here. Choose Medical Assistance
Provider Services/Provider Forms/Authorization for Direct Deposit by
clicking
here.
Mail the form to:
EDS
PO BOX 2010
Warwick, RI 02887-2010
Attn: Donna Richard
Financial Department
If you
have any questions regarding enrolling for EFT, please call Donna
Richard at
401-784-3854 or email by clicking
here.
Medicare Crossover Processing
The purpose of this article is to inform providers
of a change in how EDS will receive Medi-
care crossover claims. The Centers for Medicare & Medicaid Services
(CMS) has partnered
with a Coordination of Benefits Contractor (COBC), Group Health
Incorporated (GHI) to
consolidate all Medicare Claims processing.
As a result, EDS will no longer receive crossover claims from any of the
fiscal intermediaries.
Fiscal intermediaries will pass their claims to GHI. GHI will then
forward all paid claims for
clients identified as dual eligible, to EDS for processing.
During this transition, providers are not required to take any action.
As a result of this transition, providers may experience a slight delay
for crossover claims to
process with Rhode Island Medical Assistance.
We appreciate your patience as DHS and EDS work to enhance the process
for adjudicating
Medicare crossover claims.
EDS Provider Representatives
| |
|
|
Donita Johnson
donita.johnson@eds.com
401.784.3817 |
Kelly Leighton
401.784.3823
kelly.leighton@eds.com |
Karen Murphy
401.784.3888
karen.murphy@eds.com |
Ashley Cunningham
401.784.3832
ashley.cunningham@eds.com |
Sally McCarthy
401.784.3817
sally.mccarthy@eds.com |
|
"Services to Elderly/Adults with
Disabilities" |
"Youth Services" |
"Physician Services" |
"Hospital Services" |
| Adult Day Care |
Case Management/Social Worker |
Dental |
Dialysis Center |
| Ambulance |
CEDARR's |
FQHC |
Free Standing Psych Facility |
| Assisted Living |
Children Services |
Indian Health Services |
Inpatient facility |
| Eleanor Slater |
CMHC |
Medical Clinic |
Outpatient Facility |
| EPSDT |
DCYF |
Nurse Practitioner |
Free Standing Amb Surgical Center |
| Home Health Skilled Nursing |
Early Intervention |
Physician (Anesthesia, OBGYN) |
Ingelcia Simas
401.784.3818
ingelcia.simas@eds.com |
| Hospice |
Group Practice |
Physician Assistant |
"Pharmacy Coordinator" |
| ICF-MR |
HBTS, TCYC, PASS, Respite |
Podiatry |
DME |
| Meal on Wheels |
Head Start |
Vision |
Independent Labs |
| MH Waiver |
LEA |
Pathology |
Pharmacy |
| MHRH |
Lead Center |
|
|
| MRDD - Day Program |
Licensed Therapist |
|
Dawn Durocher |
| Nursing Homes |
Other Therapies/Riding |
|
401.784.3813
dawn.durocher@eds.com |
| Personal Care/Homemaker |
Psychologist |
|
"EDI Coordinaor" |
| Waiver Group Homes |
Substance Abuse Rehab |
|
|
| PACE |
|
|
|
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