Provider Update Newsletter
June 2008, Volume 188
All Providers
Attention All Medical Assistance Providers
Electronic Data Interchange Eligibility Inquiry &
Response
New Changes to Timely Filing that Effect You
Update: Rhody Health Partners and Connect Care Choice
RIPTA Buss Pass Program Features Rhody Ten
Attention All Medical Assistance Providers
EDS continues outreach efforts to obtain your
National Provider Identifier (NPI). Currently we have received NPIs from
92% of the participating Rhode Island Medical Assistance Providers. If
you have not submitted your NPI along with your Taxonomy and Provider
Legacy ID, please do so as soon as possible for claims payment.
EDS along with The Department of Human Services (DHS) urges you to
forward your CMS approved e-mail, to Provider Enrollment by faxing a
hard copy to 401-467-9581 or send by e-mail to RI-CSHelpDesk@eds.com.
Please be sure to include your taxonomy information and your current RI
Medical Assistance Provider ID on the correspondence.
In order to process your claims, this information is necessary.
Providers must begin using both the NPI and Taxonomy numbers on all
claim submissions. Please notify your billing company or vendor to
submit test claims.
Previously we were urging you to use your Legacy ID when there were
issues regarding billing with NPI and Taxonomy. However, your current
legacy number is no longer being accepted.
If you bill through a clearing house, please make every attempt to
ensure that they have your correct NPI and Taxonomy. If your claims are
submitted with the wrong NPI and Taxonomy (not matching our records), RI
Medical Assistance will not be able to identify you and the claim will
deny.
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.
Electronic Data Interchange Eligibility
Inquiry & Response
The
Department of Human Services (DHS) in conjunction with EDS has
implemented the HIPAA electronic standard transactions for the
eligibility benefit plan coverage for the Rhode Island Medical
Assistance program. These transactions will allow providers to verify
recipient eligibility as a batch transaction which are known as the
270/271 eligibility request and response. The 270/271 companion guide is
located on the DHS website by clicking
here.
The 270/271 transactions will be accessed using your current trading
partner agreement number on the DHS website under the MMIS Web
Transactions. Providers and/or their billing agents will upload the 270
(Health Care Eligibility benefit inquiry/request) in order to receive
the 271 (Health Care Eligibility benefit response) the next business
day.
For new electronic transactions users, you can obtain a Trading Partner
Agreement form on the DHS website by clicking
here. EDS will process your request and provide you with a Trading
Partner Number.
Provider Electronic Solutions (PES) will be upgraded with the 270/271
transactions in an upcoming version to be released on a later date. The
PES upgrade will be available on the DHS website by clicking
here.
New Changes
to Timely Filing that Effect You
Modification to Timely Filing Guidelines
Effective June 1, 2008
-
Claims with a date of service over one year with
an involved third party payer (insurance), must be submitted within
ninety days (90) from the process date of the other payer
(insurance)
-
Claims with a date of service over one year that
had denied previously by EDS must be submitted within ninety (90)
days from the process date on the remittance advice
-
Any claim with a service date over one year and
a process date from another payer or a remittance advice from EDS
over (90) days will be denied for timely filing
The Rhode Island Department of Human Services
Program has a claim submission restriction of twelve (12) months from
the date of service provided to Medical Assistance clients. EDS must
receive a claim for services for Medicaid clients, with no other health
insurance and no previous denial from EDS within 12 months in order to
process claims for adjudication. Any claim submitted with a date greater
than twelve months from date of service will deny for timely filing.
Update: Rhody Health Partners and Connect
Care Choice
The RI Medical Assistance Program has two new
programs, Rhody Health Partners and Connect Care Choice, for adults over
age 21 on Medicaid. Both programs offer eligible adults more providers
to choose from, care coordination and management, help getting
information on covered services and connections to community support
services. Both programs are voluntary.
Connect Care Choice has approximately nine participating practices with
multiple sites throughout RI. More primary care practices are
anticipated to join in the next few months.
Rhody Health Partners (RHP) has two participating health plans-
UnitedHealthcare of New England and Neighborhood Health Plan of RI. RHP
Enrollment will occur over five months beginning in April 2008.
For information on either program, please check the DHS website under
“What’s New” by clicking here or
call the Enrollment Help Line at (401) 784-8877.
RIPTA Buss Pass Program Features Rhody Ten
Effective July 1, 2008, most RIte Care and RIte
Share members who need non-emergency medical transportation will be
eligible to receive a "Rhody Ten" ride pass. This will provide each
eligible member up to 10 one-way bus rides per month to meet their
non-emergency medical transportation needs. These passes will be
available at Stop and Shop and Shaw's supermarkets throughout the state.
Families who receive cash assistance (FIP) or have recently transitioned
off of cash assistance will continue to eligible for an unlimited
monthly bus pass to be used for work, training, school or medical
appointments. Families must present each member's white Medical
Assistance card at the supermarket customer service desk in order to
receive the Rhody Ten ride pass or the unlimited monthly RIPTA bus pass.
Members will receive notification through the mail of these changes by
the end of May 2008. Changes will also be advertised at the supermarket
customer service desks and through flyers distributed with June bus
passes. For more information, please call the RIte Care Information Line
at 401-462-5300.
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