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Provider Update Newsletter
July 2008, Volume 189
ALL Providers
DME Providers
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 at
www.dhs.ri.gov and click on the link in 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 these changes.
RIPTA Bus Pass Program features Rhody Ten
Providers
Please post this notice for your patients' knowledge
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 due to
employment will continue to be 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.
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.
Rhody Health Partners Health Plans:
- UnitedHealthcare of NE,
Member Services (800) 587-5187
- Neighborhood Health Plan of RI, Customer Service (800) 459-6019
Elimination of Medical Assistance Coverage for Undocumented Children
and Legal Permanent Resident Children in the US for Less Than Five Years
Effective June 1, 2008, under Budget Article 10 of the State Fiscal Year 2008
Supplemental Budget, undocumented children and children who are Legal Permanent Residents
residing in the United States for less than five years will no longer be eligible for Medical
Assistance (RIte Care or RIte Share) coverage. Legal Permanent Residents are eligible to reapply
for Medical Assistance after they have resided in the United States for five years.
If you have patients whose coverage was terminated and they are unable to continue to see you,
please refer them to the Rhode Island Community Health Centers where health care is provided
on a sliding fee scale based on family income. For a list of the health centers, log on to
www.rihca.org or call the Rhode Island Health Center Association
at 274-1771 x 201. All impacted clients have received two separate notices from DHS about
this change in eligibility.
Elimination of Medical Assistance Coverage for DHS Child Care Providers
Effective July 1, 2008, under Article 14 of the 2008 Supplemental Budget of the
State of Rhode Island, Sections 40-6.2-4 and 40-6.2-5 of the General Laws entitled “Child Care-State
Subsidies,” DHS Child Care Assistance Program (CCAP) approved certified home child care providers
(as well as center-based providers) will no longer be eligible for.
Medical Assistance (RIte Care) coverage. If you have patients whose coverage was terminated and
they are unable to continue to see you, please refer them to the Rhode Island Community Health
Centers where health care is provided on a sliding fee scale based on family income. All
impacted clients have received two separate notices from DHS about this change in eligibility.
2007 Provider Satisfaction Survey
The 2007 provider satisfaction survey was distributed to 945 providers,
representing a 27% sample of the total billing provider population. The population included
billing providers for all Rhode Island hospitals and nursing homes and a 20% sampling of other
providers. 140 providers responded representing 15% of the total number of surveys distributed.
This is a 4% decrease from 2006. The providers answered 83% of the questions.
2007 was a very challenging year for providers in regards to claims processing. Many changes
affected claims submission and processing:
- New Claim Forms: CMS 1500, Dental, and UB 04 forms
- Program Implementations: Initiated necessary system changes which directly affected the
way providers conduct business with RI Medicaid
- Required use of a National Provider Identification (NPI)
The required use of a Taxonomy code in addition to an NPI for RI Medicaid required many
providers, billing companies, and clearinghouses to make additional modifications to their
billing systems, usually at an additional cost to them since other insurance payers and Medicare
did not have the same requirement(s). Many claims remained in suspense because the MMIS could
not properly identify who submitted the claim because either the NPI or Taxonomy was missing or
incorrect (004 edit). Claims in suspense therefore could not be reported on a provider’s
Remittance Advice, which caused great inconvenience and in many instances significantly reduced
payments.
The providers rated EDS’ performance as a Fiscal Agent for the Rhode Island Medical Assistance
Program at 91%. The areas that affected the decrease were:
- Timeliness of response to claims research requests by Customer Service Representative (90%)
- Timeliness and accuracy of paper claims processing (79%)
- Timeliness and accuracy of electronic claims processing (91%)
- Clarity and value of EOB messages on the RA as related to patient ARs (85%)
- Timeliness of resolution to suspended claims (75%)
- Claims processing performance compares favorably to other insurers (83%)
- Clarity and accuracy of provider reference manuals (92%)
Satisfaction scores that increased or remained the same as prior years were in the following areas
- Accessibility of Customer Service and Provider Representatives
- Accuracy, consistency and clarity of information given by the Customer Service Representatives
- Courtesy & professionalism of the Customer Service and Provider Representatives
- Timeliness of response to claims research requests by Provider Representatives
- Provider Representative and Customer Service Representatives coordinate to provide consistent information
Actions For Improvement
In response to the processing challenges of the new claim forms, NPI / Taxonomy
requirement, and the unprecedented number of claims returned to provider (RTP), EDS focused on
driving down the backlog of paper claims and high number of claims in suspense. What we did:
- Reduced inventory by 82% by moving paper claims through open/sort, scanning and data entry by
augmenting staff locally and by utilizing additional OCR resources in California.
- Increased the frequency of reference file work and augmented staff hours.
- Employed the use of automation for specific resolution’s work to help decrease claims turn
around time. This is showing an immediate effect as well as long term benefits.
- The improvements so far have resulted in a 36% reduction in suspended claims.
For 2008 EDS has already begun to focus on claims automation. Much work has been done in claims
processing to program edits and allow for claims adjudication without manual intervention,
minimizing the claims suspense inventory. This work continues. We are committed to delivering
superior service and will work on all fronts to make continuous improvements.
Attention all DME providers
Due to increase misuse of some medical
supplies, the following services, sterile (A4930) and non-sterile (A4927) gloves, will now require prior
authorization as of July 1, 2008. Authorization will be limited to dressing/catheter changes when
documented by the prescriber that the beneficiary is at risk for contamination from caregiver
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