Provider Update Newsletter
July 2000,
Volume 93
All
Providers
HIPAA
Happenings
DHS Website
Provider Refunds
All Providers
Receiving GPA Claims Payment
GPA Covered
Procedure Codes
Federally Qualified Health Centers (FQHC) Reminder
Notification to GPA
Pharmacy and Physician Providers
HIPAA
Happenings
As this issue of the Provider Update goes to press, it
appears that Final Rules for the definition and composition of the new HIPAA health care
data transaction sets will be published by June 30, 2000. The X12 Standards Development
Organization, under the auspices of the US Department of Health and Human Services/HCFA,
has developed revised Transaction Standards for the following commonly used operations:
· Claims and Encounters · Payment/Remittance Advice
· Enrollment · Referral Certification and Authorization
· Claims Status · Coordination of Benefits
· Eligibility · Premium Payment
X12 is still developing formats for Claim Attachments and
First Report of Injury forms.
Because all Health Plans, Providers, and Clearinghouses
who process claims electronically will need to comply with the new standards, we encourage
you to visit the following Web sites for more information. Questions can also be forwarded
to the MMIS Systems & Data Unit through the DHS Webmaster at www.dhs.state.ri.us.
For additional information on HIPAA, visit the following
Web sites:
www.hcfa.gov
– HCFA’s home site; HIPAA page
www.wpc-edi.com
– Washington Publishing Company – data transaction set standards and protocols;
Code messaging
www.ehnac.org
– Electronic Healthcare Network Accreditation Commission
www.ps-tag.org
– Private Sector Technical Assistance Group – white papers on HIPAA financial
considerations
www.rx2000hipaa@rx2000.org – listserv
group featuring daily discussions about HIPAA policy and implementation
www.disa.org
- Data Interchange Standards Association; HIPAA page
www.wedi.org
- Workgroup for Electronic Data Interchange; HIPAA page
http://aspe.os.dhhs.gov/admnsimp/faqtx.htm
- US Dept. of Health and Human Services Web site; frequently asked questions concerning
HIPAA standards and implementation
DHS
Web Site
DHS has redesigned its Web site and we
encourage you to visit and check out some of the new pages. There are updated policy and
program service listings as well as an up-to-date contact directory. We have also included
links to other State and Federal agencies as well as a new HIPAA informational page. You
can direct any questions you have concerning DHS activities through the site's Webmaster
as well.
Provider
Refunds
When sending in a Provider Refund, the following must be
attached to the check:
- Copy of the Remittance Advice with the Internal Control
Number (ICN) and recipient highlighted
- The correct Provider Number
If the copy of the Remittance Advice is not available the
following information is needed:
- Recipient name and Medical Assistance Identification Number
- Provider Number
- ICN (15 digit internal control number used to identify the
claim, which can be retrieved from the Customer Service Help Desk)
If this information is not included with the Provider
Refund Check, it will result in a Non-Claim Specific Refund. A Non-Claim Specific Refund
will be posted on your Remittance Advice (RA) in the financial items section. It will not
indicate ICN, recipient information, or dates of service. All refund checks should be made
payable to State of Rhode Island and mailed to:
EDS Refunds
PO Box 2010
Warwick, RI 02887-2010
Questions can be directed to the Customer
Service Help Desk
at 401-784-8100 for local and long distance callers, or
1-800-964-6211 for in state toll callers and bordering communities.
GPA Covered
Procedure Codes
| 99201 |
Office or other
outpatient visit for the evaluation and management of a new patient |
| 99202 |
Office or other
outpatient visit for the evaluation and management of a new patient |
| 99203 |
Office or other
outpatient visit for the evaluation and management of a new patient |
| 99204 |
Office or other
outpatient visit for the evaluation and management of a new patient |
| 99205 |
Office or other
outpatient visit for the evaluation and management of a new patient |
| 99211 |
Office or other
outpatient visit for the evaluation and management of an established patient, that may not
require the presence of a physician |
| 99212 |
Office or other
outpatient visit for the evaluation and management of an established patient |
| 99214 |
Office or other
outpatient visit for the evaluation and management of an established patient |
| 99215 |
Office or other
outpatient visit for the evaluation and management of an established patient |
| 99217 |
Observation care
discharge day management |
| 92002 |
Ophthalmological
services: Medical examination and evaluation with initiation of diagnostic and treatment
program; intermediate, new patient |
| 92004 |
Ophthalmological
services: Medical examination and evaluation with initiation of diagnostic and treatment
program; comprehensive, new patient, one or more visits |
| 920012 |
Ophthalmological
services: Medical examination and evaluation with initiation or continuation of diagnostic
and treatment program; intermediate, established patient |
| 920014 |
Ophthalmological
services: Medical examination and evaluation with initiation or continuation of diagnostic
and treatment program; comprehensive, new patient, one or more visits |
| A4253 |
Diabetic Supply |
| A4255 |
Diabetic Supply |
| A4258 |
Diabetic Supply |
| A4310 – A4421 |
Ostomy Supply |
| A5051 – A5149 |
Ostomy Supply |
| E0607 |
Diabetic Supply |
| E0609 |
Diabetic Supply |
| K0277 – K0281 |
Ostomy Supply |
| K0407 – K0411 |
Ostomy Supply |
| K0419 – K0439 |
Ostomy Supply |
Federally
Qualified Health Centers (FQHC) Reminder
When billing for GPA clients, you will need to continue to
bill the encounter code as well as list the detail procedure codes.
Notification
to General Public Assistance (GPA) Pharmacy and Physician Providers
Please submit any outstanding claims for services prior to
May 1, 2000, to DHS as soon as possible. Our goal is to support one claims payment system
in order to streamline the administrative processes required for the billing and
reimbursement of GPA claims.
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