Provider Update Newsletter
April 2007, Volume 174
All Providers
National Provider Identifier/Do You Have Your NPI?
Provider Electronic Solutions
Program of All-Inclusive Care for the Elderly (PACE)
Do You Have Your NPI?
Do you have your NPI?
Have you shared it with us?
In the last couple of updates EDS has requested to receive your NPI
number, taxonomy and your current Medical Assistance number. The
Department of Human Services (DHS) requested that all RIMA providers
forward their NPI, taxonomy and current provider number to us by
March 14, 2007. This was to allow enough time for processing of your
NPI which includes testing of the new system changes.
To date we have received less than 20% of NPI information for providers
who submit to RIMA. DHS strongly encourages you to send your NPI in
today. If you have not yet applied for an NPI please click
here or call 1-800-465-3203 to
request a paper copy of the application. Please allow 30 days for
your application to be processed.
The Deadline for having a new National Provider Identifier (NPI) is May
23, 2007. As Rhode Island Medical Assistance (RIMA) prepares for this
national change within our system, it is necessary to convert current
provider numbers to the new NPI’s.
Having all the this information by the above date will decrease the
chance of any delay in appropriate claims adjudication. If you would
like further information on NPI please visit the DHS website under the
What’s NEW section, by clicking here,
you will find lots of helpful information.
Once you have obtained your NPI you can either forward the CMS approval
email to the RIXIXI helpdesk by clicking
here or faxing a hard copy to
401-467-9581.
Provider Electronic Solutions
Do you use EDS’s Provider Electronics Solutions (PES) Software? If so,
are you running on the most current version of the software? We are
currently running version 2.02.
If you are running version 2.00, you must do two upgrades. You must
first upgrade to version 2.01 and then upgrade to version 2.02.
Performing the upgrades out of order will create issues for your
database and may result in loss of data.
If you are running version 2.01, you will only have to do one upgrade to
version 2.02. The upgrades can be found on the DHS website by clicking
here.
If you are unsure of the version you are running, please follow the
steps below to determine the version. Log on to the PES software. Once
you have accessed the software:
A window will open displaying the version. If you
are not currently running version 2.02 you should upgrade your software
as soon as possible. Please print the directions down prior to starting
the upgrades, if you need assistance please contact the EDI Coordinator,
Dawn Durocher at 401-784-3813.
Once you upgrade to the 2.02 version, an
additional upgrade will be necessary in order to accommodate the new
National Provider Identifier and Taxonomy. This version is being tested
and will soon be available. More information will follow in future
Provider Updates.
Program of All-Inclusive Care for the
Elderly (PACE)
PACE began providing care to RI recipients in late
2005. If a recipient is eligible for PACE, they have elected to receive
all of their care from a PACE provider. PACE arranges for all of the
recipients’ care and reimburses their providers directly.
If a recipient is on PACE, the recipient is no longer eligible to
receive services under Medical Assistance Fee For Service (Medicaid).
If you are checking eligibility, and you hear under other insurance
“Program for All-Inclusive Care for the Elderly,” this means that if you
provide care to the recipient you will not be reimbursed by Medical
Assistance. The recipient should be referred to PACE, and they will
arrange for any treatment that is required.
If you do provide service to a PACE recipient and you bill RI Medical
Assistance your claim will be denied.
If you have any questions regarding eligibility, please contact the
Customer Service Help Desk at 401-784-8100 or 1-800-964-6211 for
in-state toll calls.
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