Provider Update Newsletter
November 2006, Volume 169
All Providers
Do You Have Your NPI?
RIte Smiles
Medicare Part B (Professional) Crossover Processing
Electronic Billing
Claims Processing Tips
Rhode Island Medical Assistance Identification Card
Hospitals, Dialysis Centers & Ambulatory Surgical Centers
Medicare Part A (Institutional)
Crossover Processing
Do You Have Your NPI?
Only 215 more days until the National Provider
Identifier (NPI) compliance date!
Countdown has begun; do you have your NPI?
Don’t risk disruption to your cash flow –
Get your NPI now! National Provider Identifiers (NPIs) will be required
on claims sent
on or after May 23, 2007. Every healthcare provider needs to get an NPI!
Learn more
about NPI and how to apply by visiting the CMS website by clicking
here. This
page also
contains a section for Medicare Fee-For-Service (FFS) providers with
helpful information
on the Medicare NPI implementation. A Countdown Clock is now available
on this page
to remind health care providers of the number of days left before the
compliance date;
bookmark this page as new information and re-sources will continue to be
posted.
All HIPAA covered healthcare providers, whether they are individuals or
organizations,
must obtain an NPI for use to identify themselves in HIPAA standard
transactions. Once
enumerated, a provider's NPI will not change. The NPI remains with the
provider regard-
less of job or location changes.
HIPAA covered entities such as providers completing electronic
transactions, healthcare
clearinghouses, and large health plans, must use only the NPI to
identify covered healthcare
providers in standard transactions
Health care providers may obtain their NPI in one of three ways:
-
Apply on-line by clicking
here
-
Call the NPI Enumerator (1-800-465-3203) and
request a paper NPI application
form, complete it, and mail it back to the address on the form; or
-
Apply for a bulk enumeration, which allows an
Electronic File Interchange Organiza-
tion (EFIO) approved by CMS to obtain a number of providers’ NPI
NPI Tip
When applying for your NPI, CMS urges you to include your legacy
identifiers, not only
for Medicare but for all payers. If reporting a Medicaid number, include
the associated
State name. This information is critical for payers in the development
of crosswalks to
aid in the transition to the NPI.
RIte Smiles
We are happy to report that the RIte Smiles Program
began on September 1, 2006 – approxi-
mately 8,300 children were enrolled in UnitedHealthcare Dental-RIte
Smiles. An add-
itional 3,656 children that live in the northern cities and towns in
Rhode Island were enrolled
on October 1, 2006. The relevant cities/towns are listed below:
| Burriville |
North Providence |
| Cumberland |
North Smithfield |
| Foster |
Scituate |
| Glocester |
Smithfield |
| Johnston |
Woonsocket |
| Lincoln |
|
We will continue to update you on the enrollment schedule for the
remaining areas of the
state over the next several months.
IMPORTANT RITE SMILES PHONE NUMBERS
UnitedHealthcare Dental’s recruitment line: 1-888-679-8923.
UnitedHealthcare Dental’s Provider Service number: 1-800-822-5353.
EDS’ Provider Customer Service Help Desk: (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!
Medicare Part B (Professional) Crossover
Processing
RI Medical Assistance has begun the processing of
Part B Medicare claims electroni-
cally through the new COBA contractor, Group Health Incorporated (GHI).
These files
included claims from July 1 through to present dates.
During our testing process we have found numerous claims denying due to
EDS having
outdated Medicare numbers on file. In order to facilitate timely
processing of your elec-
tronic crossover claims and eliminate the need for you to submit these
claims on paper,
we are requesting that you update your Medicare number with EDS.
Please provide your Medicare number via e-mail by clicking
here.
If you submit as a group, EDS will need your group
Medicare number and the Medicare
number for the individuals that are a member of that group via e-mail by
clicking here.
If you do not have access to e-mail please fax your Medicare number(s)
to Dianne Folco
at 401-467-9581.
Electronic Billing
How to receive your dollars in your pocket NOW!
Did you know that approximately 20% of all claims received by EDS are
returned to your
office for three reasons, which are easy to avoid?
-
The Billing Provider original signature is
missing or invalid
-
The Provider Number is illegible, missing or
invalid
-
The third most common reason is actually a
combination of the first two
These are very easily avoided by billing
ELECTRONICALLY.
ELECTRONIC billing has faster turnaround time, saves on postage,
eliminates data
entry errors, has a lower suspense rate, and will improve your office
productivity.
In addition your secondary billing can also be submitted ELECTRONICALLY
which
will improve your turn around time.
For more information or for a copy of our FREE
electronic software, which includes FREE
installation, training, and reference material, please call the EDI
Coordinator at (401) 784-3813.
Claims Processing Tips
When claims are RTP’d (returned to provider) please
ensure proper corrections are made
before re-submitting the claim.
-
Please do not staple, paper clip, tape, etc.
claims together as it is not necessary.
-
Please do not mark-up the EOB’s with check marks
etc. All names and information,
other than the recipient you are billing for, should be blacked out.
-
Please ensure proper alignment of claim
information. Claims are being scanned and if
the information is not in the boxes it will not be picked up
correctly.
Please also refer to the above article to obtain
more information on billing electronically.
Rhode Island Medical Assistance
Identification Card
This card is an identification card for clients
(beneficiaries) of the Rhode Island Medical
Assistance Program. The card can be identified by the Rhode Island State
logo.
Prior to treating a holder of this
card, it is necessary for you to verify patient eligibility by
accessing The Department of Human Services (DHS) web site at
www.dhs.ri.gov or
contacting EDS Providers Services Recipient Eligibility Verification
line by calling
1-800-964-6211 for instate toll callers and bordering communities or
401-784-8100 for
long distance callers.
Please ensure you obtain the appropriate numbers listed, it has been
mentioned that other inappropriate businesses were contacted when
calling the Medical Assistance Line.
Please Note: Additional phone numbers on the back of this card
are for client use.
Medicare Part A (Institutional) Crossover
Processing
RI Medical Assistance will begin processing both in
and outpatient hospital Medicare
secondary electronic claims through the new COBA contractor Group Health
Incorp-
orated immediately. These files included claims from July 1 to current
dates.
In order to facilitate timely processing of your electronic crossover
claims and eliminate
the need for you to submit these claims on paper, we are requesting that
you provide
your Medicare number to EDS.
Please provide your Medicare number via e-mail by clicking
here.
If you do not have access to e-mail please fax your Medicare number(s)
to
Dianne Folco at 401-467-9581.
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