Search

Provider Update Newsletter

January 2008, Volume 183
 

All Providers

National Provider Identifier
Covered and NON-Covered Vaccines
Coordination of Benefits

 

National Provider Identifier

To date EDS has received approximately 88% of National Provider Identifier information for providers who submit to Rhode Island Medical Assistance. If you have not yet submitted your NPI details to EDS, it is strongly recommended you do so by the dates listed below. In order to process your claims, this information is necessary.

If you have not yet forwarded your NPI information to EDS, please forward the CMS approval letter, which you may have received by e-mail, to Provider Enrollment by faxing a hard copy to 401-467-9581. Please be sure to include your taxonomy information and your current Rhode Island Medical Assistance Provider ID on the correspondence.

RI Medical Assistance will be implementing a phased-in approach for providers. Below is a schedule of providers and the compliance dates:
 

Date NPI Required	Provider Type Description		Date NPI Required	Provider Type Description
1/28/2008	Adult Day Care		2/25/2008	Psychologist
	Eleanor Slater Hospital			Hospice
	MR. Wavier – Public			Chiropractor
	CEDARRS Center			Group Behavioral Health Practice
	ICF – MR. Public Facility			Ambulance
	ICF – MR. Private Facility		3/17/2008	Licensed Therapist
	Outpatient Psych Facility			Independent Lab
	Home Meal Delivery			Optometrist
	Freestanding Psychiatric Hospital			Optician
	Independent Pharmacy			Nurse Practitioner
	Indian Health Service			LEA – Performing (Contracted) Provider
2/11/2008	Home Health Agency			Local Education Association (Special Education)
	Nursing Home			Department of Children Youth and Families
	Severely Disabled Children			Freestanding Ambulatory Surgical Center
	Personal Care Aide/Assistant			Inpatient Facility
	HBTS, Kids Connect, PASS, and Respite			Outpatient Facility
	Assisted Living Facility			Federally Qualified Health Center
	MR. Rehab			Audiologst
	Early Intervention			Nurse Practitioner - Billing
	MR. Waiver - Private			Children’s Behavior Health Services
	Freestanding Dialysis			Podiatrist
2/25/2008	Case Manager/Social Worker		3/31/2008	Physician’s Assistant
	Substance Abuse Rehab			Dentist
	CMHC/Rehab Option			DME Supplier/Prosthetics/Orthotics
	Other Therapies/PT, OT, SHL		4/14/2008	Physician

Please be aware that any claim submitted electronically to RI Medical Assistance after the required compliance date at 5:00 pm must contain an NPI and taxonomy. RI Medical Assistance will no longer accept your legacy number (Provider ID). Any claim submitted electronically, after this deadline without an NPI and Taxonomy will be denied.

If you would like more information about NPI please visit the DHS website by clicking here and click on the link for the What’s NEW section. You will find helpful information regarding these changes.

The Department of Human Services and EDS appreciates your assistance and support with this project.
 

 

Covered and NON-Covered Vaccines

NON-Covered Services

The following influenza vaccines are being supplied by the Department of Health for free, therefore the Department of Human Services will no longer reimburse for these services through the Medical Assistance Program, effective November 1, 2007:

• 90656 – Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use

• 90658 – Influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular use

 

Covered Services

The following procedure code for administering the vaccine can continue to be billed through Medical Assistance:

• G0008 – Administration of influenza virus vaccine

The following service is now a covered service to be billed through the Medical Assistance Program, for clients 60 years and older, effective November 1, 2007:

• 90736 – Zoster (Shingles) Vaccine, Live, for subcutaneous injection

The following vaccine for pneumonia can continued to be billed through the Medical Assistance Program

• 90732 – Immunization, active; pneumococcal vaccine, polyvalent

 

Coordination of Benefits

Under Rhode Island State Law and Federal Regulations (42 CFR, Public Health, Section 432, 433 and 477.20), the Rhode Island Medical Assistance Program is the payer of last resort for medical care.

The Rhode Island Medical Assistance Program requires that a provider fully utilize a recipient’s third party resources before billing the Medical Assistance Program.

When a Medical Assistance recipient has other health insurance you must bill that health insurer prior to billing the Medical Assistance Program, as Medicaid is the payer of last resort.

For a Faster Turn Around Rate for Claims

You may submit secondary claims electronically. For instructions visit the DHS Website by clicking here.  Or contact your vendor to program your software for you.

When submitting paper CMS 1500, be sure to check yes in box 11D and include the correct carrier code in box 9D. A copy of the Explanation of Benefits (EOB) from the other insurance carrier must be included with 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.

The most current carrier code listing can be found on the DHS Website by clicking here.

The following information must be visible on the EOB’s 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
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.