Provider Update Newsletter
November 2007, Volume 181
All Providers
Adjust or Recoup Your Claims Electronically
Quick Response to Obtain Recipient Eligibility & Other
Valuable WEB Features
New CMS 1500 and UB Forms
Provider Electronic Solutions (PES) Billing Software
Speed Up the Time in Which Your Paper Claims Process!!
Anesthesia Providers
Procedure Code Update
Adjust or Recoup Your Claims Electronically
Rhode Island Medical Assistance accepts electronic
replacements and voids. With replacements you can make changes to a paid
claim, as in an adjustment. With voids you may remit the entire payment
on a claim, as in a recoup. Both voids and replacements process
overnight.
Please follow the process specific to your claim type as listed below:.
Professional, Dental and Waiver Claims:
Identify a replacement or void by the claim frequency code.
7 = Replacement 8 = Void
Institutional Claims:
Identify a replacement or void by the third position of the bill type.
7 = Replacement 8 = Void
Required information: The original Internal Control Number (ICN) on the
claim that you would like to replace or void. The ICN is a 15 - digit
number that can be found on your remittance advice.
Important Reminder:
Timely filing guidelines still apply if the date of service is older
than 365 days. If you have a claim with a date of service older than 365
days and an EOB that is within 365 days, you will need to send your
adjustment to EDS on the Single Claim Adjustment Request Form. If you
try to submit a replacement on a date of service older than 365 days,
your original claim will be recouped and your replaced claim will deny
for timely filing.
Denied claims cannot be adjusted. Your claim will need to be
corrected and resubmitted.
If you use Provider Electronic Solutions for electronic billing please
click here for a
complete set of instructions for submitting electronic replacements or
voids.
If you utilize another software for electronic billing; verify with your
vendor that you can bill electronic replacements or voids using that
software.
Please call the Customer Service Help Desk for further assistance at
800-641-6211 for bordering communities and in-state toll calling or
401-784-8100 for long distance calls.
Quick Response to Obtain Recipient
Eligibility & Other Valuable WEB Features
You can obtain access to Recipient Eligibility
through the “MMIS Web Transactions” link on the Department of Human
Services (DHS) website by clicking here.
Using this site provides you information which can be printed to retain
with your office records. The information consists of the recipients
most recent records within a year span including Other Insurance (OI)
information. To use this valuable tool you will need:
A Trading Partner ID and password — To obtain a Trading Partner ID and
password, please click
here and
print the Trading Partner Agreement (TPA). Once completed, mail it to
the address listed on the last page of the form.
An internet service provider — There are a number of low-cost internet
options available for your office. Please contact the EDI coordinator at
1-401-784-3813 for a list of these options.
If you have not utilized this valuable resource before, this is the best
time to start. You will also find that the
DHS website is an avenue for quick
and easy access to critical eligibility, claims, financial information
and much more. Here is some of what you will find:
-
Eligibility Verification – Verify recipient
eligibility and print the information for file documentation
-
Prior Authorization Status – Check the status
of a prior authorization request
-
Remittance Advice Payment Amount – Confirm your
medical assistance payment history for the last 12 months
-
NDC Search – Pharmacies will be able to search
for a National Drug Code reimbursable by RI Medical Assistance
-
Claim Status – Check the status of a submitted
claim
New CMS 1500 and UB Forms
Effective September 30, 2007 RI Medical Assistance
will no longer accept the "old" versions of the 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.
Please make sure to include the appropriate taxonomy code when billing a
National Provider Identifier. Specific instructions for billing Rhode
Island Department of Human Services (DHS) can be obtained from the DHS
website by clicking here under
Provider Forms.
Provider Electronic Solutions (PES) Billing
Software
You can benefit by billing/submitting your claims
electronically. This software is FREE and will give you access to your
money faster! Other benefits with using this software are:
-
Client List Feature – available to store
your recipient base which has been recently expanded to hold more
recipients
-
Provides reports which allow for totals on
the detail and summary report – Number of claims and the total
amount billed will be displayed.
-
Simplified billing of coordination of
benefits claims – Client information will auto-populate, based
on information from the client list, eliminating double entry.
-
Waiver Claims – An “Edit All” button has
been added to allow you to change dates of service globally on all
claims in a ready status.
-
Nursing Home Claims – The dates of
service that are keyed on Header 1 will automatically populate the
dates of service fields on Service 1.
-
Nursing Home Claims – “Edit all” will now
work prior to the last day of the month. For example, if today is
June 23rd, you can copy your claims and edit all for dates June 1st
- June 30th. Please note that you still cannot submit prior to the
last date of the month you are billing.
The HIPAA compliant version of the RI Provider
Electronic Solutions software version 2.03 is available for download by
clicking here.
Double click on the first line to download the most current version 2.03
of PES. Installation instructions are also provided to assist with your
download, follow this link by clicking
here.
Before you can begin submitting electronic claims, you will need to
complete a Trading Partner Agreement (TPA). If you have not already
completed a TPA, you may obtain a copy for download by clicking
here.
If you are unable to download the software from the Department of Human
Services web site, please call 401-784-3813 and a CD plus instructions
will be mailed to you.
Speed Up the Time in Which Your Paper Claims
Process!!
To facilitate processing of your paper claims please
be sure to adhere to the following guidelines:
-
Ensure that your claims are properly aligned and
that pertinent information such as billing provider information and
insured ID number are legible
-
Typed written claims process more rapidly and
reduce the chance of errors
-
If billing with an NPI (National Provider
Identifier) ensure that you include a Taxonomy in the appropriate
area of the claim, Taxonomy is required with billing.
-
If billing with a legacy provider ID be sure to
include the qualifier 1D.
-
Do not staple, paper clip or tape claims
together.
-
Do not mark up EOB’s by highlighting, starring,
check marks, etc, this may cause your claim to be processed
incorrectly.
Procedure Code Update
Please be advised that the following procedure codes
will no longer require an “AA” modifier.
| 11900 |
36620 |
64475-64484 |
76005 |
| 20552 |
62270 |
64510 |
90784 |
| 20610 |
62273-62282 |
64520 |
90870 |
| 27096 |
62310-62319 |
64612-64614 |
|
| 31500 |
64400-64450 |
64626-64627 |
|
| 36488-36941 |
64472 |
67028 |
|
|
