Provider Update Newsletter
August 2007, Volume 178
All Providers
Attention All Medical Assistance Providers
Citizenship and Identity Requirements for Medical
Assistance Recipients
Meet Your Provider Representative
Attention All Medical Assistance Providers
On May 23rd the implementation of the National
Provider Identifier (NPI) took place for covered healthcare entities.
Included within this, comes a change for all paper claims. Since the
State of Rhode Island’s Medical Assistance Program may require that NPI
and taxonomy be on all claim forms in the future, it is strongly
recommended that you take appropriate action necessary to include NPI
and Taxonomy on your claim forms submitted after May 23rd 2007. This
directive will encompass all provider numbers such as billing,
rendering, performing.
The CMS-1500 claim form was updated to accommodate the mandated National
Provider Identifiers and Taxonomy. The previous CMS-1500 (12-90) form
did not have the fields for reporting of NPIs. Further information on
the CMS-1500 form is available through the NUCC web site by
clicking here.
The National Uniform Billing Committee (NUBC) is responsible for
updating the UB-92; it has been replaced by the UB-04 paper claim form.
You may obtain copies of the CMS-1450 form, which is also known as the
UB-04, from the Standard Register Company, Forms Division. Instructions
for the UB-04 can be obtained from the National Uniform Billing
Committee web site by clicking here.
HIPAA requires submission of National Provider Identifiers and Taxonomy
on claims effective May 23, 2007. Effective September 30, 2007 RI
Medical Assistance will no longer accept the "old" CMS 1500 (12/90
Version) or the UB-92. Please submit paper claims after September 28th
utilizing the CMS-1500 (08-05 Version) and the UB-04.
The American Dental Association has updated the ADA claim form to
accommodate the mandated National Provider Identifiers and taxonomy when
needed. The form and further details of all changed fields is available
through the American Dental Associations website by clicking
here.
Specific instructions for billing Rhode Island
Department of Human Services (DHS) can be obtained from the DHS website,
by clicking
here.
Select Medical Assistance Provider Services, then Provider Manuals, your
provider type, then Claim Preparation instructions: If you do not
have access to the internet please contact the Customer Service Help
Desk at 401-784-8100 for instate toll callers or 1-800-964-6211 for long
distance calling.
Citizenship and Identity Requirements for
Medical Assistance Recipients
Federal law now requires that U.S. Citizens who
apply for or currently receive Medical Assistance, RIte Care or RIte
Share (except those receiving SSI or Medicare) must provide proof of
citizenship and identity in order to obtain or maintain their health
coverage.
Documentation of citizenship and identity is required for all new
applicants upon initial application and current recipients upon
recertification. Without this documentation, Medical Assistance
eligibility will be denied.
If your patients have questions about this requirement, they can log on
to DHS Website by clicking here, or
contact their RIte Care Health Plan, the DHS Infoline or their Medical
Assistance worker.
Meet Your Provider Representative
Kelly Leighton
401-784-3823
Kelly.Leighton@eds.com
"Long Term Care/
Hospital Services" |
Karen Murphy
401-784-3888
Karen.Murphy@eds.com
"Child and Family Services" |
Sandra Coles
401-784-3832
Sandra.Coles@eds.com
"Professional Services" |
Paul Mulamba
401-784-3879
Paul.Mulamba@eds.com
"Physician Services" |
| Adult Day Care |
Case Manager/Social Worker |
Ambulance |
Nurse Practitioner |
| Assisted Living |
CEDARR Center Services |
Dental |
Pathology |
| Eleanor Slater |
CEDARR Direct Services |
Dialysis |
Physician (Anesthesia/OBGYN) |
| EPSDT |
- HBTS & Kids Connect |
FQHC |
Physician Assistant |
| Free Standing Amb Surg Ctr |
- PASS & Respite |
Independent Labs |
Podiatry |
| Free Standing Psych Facility |
Children Services |
Indian Health Services |
|
| Home Health Skilled Nursing |
CMHC |
Vision |
Dawn Durocher
401-784-3813
Dawn.Durocher@eds.com
"EDI Coordinator" |
| Hospice |
DCYF |
|
| ICF - MR |
Early Intervention |
Ann Bennett
401-784-3818
Ann.Bennett@eds.com
"Pharmacy Coordinator" |
| Inpatient Facility |
Group Practice |
|
| Meals on Wheels |
Head Start |
|
| MH Waiver |
Hippotherapy |
DME |
|
| MHRH |
LEA - Contracted Providers |
Pharmacy |
|
| MRDD - Day Program |
Lead Center |
|
|
| Nursing Homes |
Licensed Therapist |
|
|
| Outpatient Facility |
Local Education Agency |
|
|
| PACE |
Other Therapies/PT, OT, SHL |
|
|
| Personal Care/Homemaker |
Psychologist |
|
|
| Personal Choices |
Substance Abuse Rehab |
|
|
| Waiver Group Homes |
|
|
|
|
