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Provider Update Newsletter
February 2007, Volume 172
 

All Providers

National Provider Identifier/Do You Have Your NPI?
Important Information Regarding RIte Care, RIte Share and Medical Assistance Patients
Claims Filing
 

Ambulance Providers

Policy Change

Do You Have Your NPI?

Rhode Island Medical Assistance is starting to collect NPI numbers from our providers. The following is required for Medical Assistance. If you received a hard copy letter from the enumerator you can fax a copy to 401-467-9581, Attn: Enrollment. If you received your NPI number via email you can forward that email to us by clicking here.

1. Your NPI Number

2. The Taxonomy code you were assigned or placed on your NPI application.  

3. All current Medical Assistance provider numbers. Including your attending numbers within a group

4. Your Billing Name and telephone number

For more information on NPI, click here.

Important NOTICE: If your office is billing as a group, the group or organization must obtain an NPI for the practice as well as the individuals with in the group.

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 pay you. 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 assigning 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 electronic 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.

If an NPI was received before June 1, 2006 you may have not received a taxonomy in written form. Medicaid is requesting your taxonomies associated with all NPI(s).

Important New Information Regarding RIte Care,
RIte Share and Medical Assistance Patients

Federal law now requires that U.S. Citizens who apply for or receive Medical Assistance, RIte Care or RIte Share (except those receiving SSI or Medicare) to show proof of their citizenship and identity. New applicants must show proof of citizenship and identity before becoming eligible. Current recipients must show proof at recertification. Applicants and recipients will only have to provide this proof once.

For persons 16 years of age or older, proof of citizenship and identity can be shown with;

• A passport or certificate of naturalization OR

• Birth certificate AND either a driver’s license or state photo ID card or school photo ID

For children under 16 years old, proof of citizenship and identity can be shown with;

• A passport or certificate of naturalization OR

• Birth certificate AND parent’s signature on affidavit form verifying identity for children under 16

(Other documents may also be acceptable. A complete list of acceptable documents can be found on the DHS website by clicking here.

New applicants and current recipients will be a provided written information and instruction on these new rules. If they have questions upon receipt of that information, they are directed to contact their RIte Care health plan (if they are currently on RIte Care), the DHS website by clicking here or the DHS Infoline at 462-5300.

Claims Filing

When a Medical Assistance recipient has other health insurance the provider must bill that health insurance resource prior to billing the Medical Assistance Program. If you do
not have the capability to bill secondary claims electronically then a copy of the Explanation of Benefits (EOB) from the other insurance carrier must be attached to the Medical Assistance Program claim for recipients with other insurance.

The Primary Insurances provide you with the ability to print an EOB (Explanation of
Benefits) from their web site. It has come to our attention, that this EOB is not providing you all the mandatory information required to submit with your claim for payment. Please note we must have the following information to process your claims requests:

The following information must be visible on the EOB’s for the claims to be processed in
a timely manner.

Name of the Primary Insurance
Date that the Primary Insurance paid or denied the claim
Patient’s name and ID#
Date of Service
Appropriate procedure Codes according to your Provider type
Total charges/ deductible and co-ins/ allowed amounts/ and paid amounts must be visible
Explanation of Primary Insurance denial codes

Due to optical scanning, please do not highlight or mark up the EOB. Also please be sure to check yes in box 11D and include the correct carrier code in box 9 D. The most current carrier code listing can be found on the DHS Website by clicking here.

Policy Change

Effective January 1, 2007, you will now be reimbursed for your mileage beginning from mile 1. You will no longer be required to bill procedure code A0888 for your mileage up to 10 miles. Now your claims billing will only require procedure code A0425 with the appropriate modifiers for billing RI Medical Assistance.

This policy will be in effect for any claims with a date of service beginning January 1, 2007.
If you have any questions please contact Kelly Leighton at 401-784-3823 or email Kelly by clicking here.