Provider Update Newsletter

September 2000, Volume 95

HIPAA Happenings
DHS Website
Customer Service Help Desk Inquiries
Revised Provider Change of Information Form

Remittance Advice (RA) Revision

24x7 POS Enhancement
HealthNow NY, Inc. Has Been Awarded the Region A DMERC  Contract

Recipients Should Not Be Directred to Call REVS

Obsolete Codes

HIPAA Happenings

Rhode Island has recently submitted for review its listing of State-only Local Codes (non-HCPCS and non-CPT) to the National HIPAA Medicaid WorkGroup. These codes will be compiled with other participating states into a master listing that will be further analyzed for commonalties. The WorkGroup hopes to determine if an additional code list, or an addendum to an existing code list, can be constructed that will allow states the ability to continue providing unique Medicaid services while also complying with HIPAA mandates. As you are aware, HIPAA will not allow states to use "home-grown" codes for billing purposes after the new Transaction Sets are implemented. We will keep you informed of the National WorkGroup efforts and what actions may need to be taken in Rhode Island to ensure HIPAA compliance. For further information on HIPAA, please visit the following Web sites:

www.hcfa.gov – HCFA’s home site; HIPAA page

www.wpc-edi.com– Washington Publishing Company; the manuals and implementation guides for new transaction sets

www.ehnac.org– Electronic Healthcare Network Accreditation Commission

www.ps-tag.org– Private Sector Technical Assistance Group; white papers on HIPAA financial considerations

www.rx2000@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 Department of Health and Human Services Web site; frequently asked questions concerning HIPAA standards and implementation

DHS Website

As you know, we’ve been working to upgrade and update the website in order to provide more responsive and comprehensive DHS program information to our provider community.  The site is maintained by our DHS Web Team and meets frequently to address Webmaster requests received. So, let us know what you think!

Customer Service Help Desk Inquiries

When contacting our Customer Service Help Desk for assistance with claim inquiries, please have the following information available. This will allow us to provide better quality service within a satisfactory amount of time.

1. 7 character alpha numeric Rhode Island Medical Assistance Provider Number
2. 9 digit numeric Rhode Island Medical Assistance Identification
   Number (SS#)
3. From and Through Date of Service

Revised Provider Change of Information Form

The revised Provider Change of Information Form may be viewed or downloaded from the Provider Forms page. Please keep this on file in case you need to notify EDS of any address changes, changes in ownership, license action, or bankruptcy filing. Questions can be directed to the Customer Service Help Desk at 1-401-784-8100 for local and long distance callers or at
1-800-964-6211 for long distance within Rhode Island and border communities. Descriptions of the address fields are listed below to assist you in completion of the form:

Service Address: Location where services are rendered.

Pay-To Address: Must be the same as on the W-9 form. If you want your check sent to an address different from the one on your W-9, write your provider name; then on the next line write "c/o" and the name and address to which you want it sent.

Mail-To Address: Indicate the address where all other program information should be sent.

Billing Service Address: If using an outside billing service, enter the address and telephone number of your billing service.

Remittance Advice (RA) Revision

Beginning with the June 30, 2000 Payment Cycle, Local Education Authorities (LEA) reviewing the Paid Claims section of their respective Remittance Advice's will notice a change in the reporting of the amount paid. The Remittance Advice, from this point forward, will only display the amount paid from Federal Funds on each claim. The allowed amount will continue to display the full amount the LEA provider is eligible to be paid, and the State Certified Match will continue to display the number of dollars which are matched through State funding. Presently, there have been no rate changes impacting your level of reimbursement for services provided, and LEA Providers will continue to receive only the Federally funded dollars through the Medicaid Claims Processing and Payment system.

24 x 7 POS Enhancement

By now you should be experiencing the enhancements that EDS has made to the POS system. Since July 1, 2000 the POS system has been in adjudication mode for 24 hours a day, 7 days a week, with the exception of scheduled database maintenance time. Scheduled maintenance time will be for 15 minutes each morning between 5:30 AM – 6:00 AM and 12 times yearly on Sunday evenings, from 10:00 PM – 1:00 AM. During these scheduled times, POS runs in Claims Capture mode which allows claims to be submitted but does not automatically pay or deny claims. For your convenience, listed below are the 12 pre-scheduled Sunday dates in which POS will be in Capture Mode:

07/23/00	01/21/01
08/20/00	02/18/01
10/01/00	04/01/01
10/22/00	04/22/01
11/19/00	05/20/01
12/31/00	07/01/01

HealthNow NY, Inc. has been awarded the Region A DMERC contract

Although HealthNow NY, Inc. has sent out notification regarding the DMERC transition of business from United Health Group, EDS is publishing the information in case you have not received the notification. If you have further questions, please visit the HealthNow NY, Inc. Upstate Medicare Division (UMD) website listed below or contact their transition hotline at
(607) 766-6254, Monday through Friday 7:00 A.M. to 5:00 P.M. EDT.

"HealthNow NY, Inc. has been awarded the Region A DMERC contract,
effective May 19, 2000. HealthNow NY, Inc. will replace United Health
Group as the Region A DMERC, with the transition expected to be
completed by September 22, 2000. To obtain information regarding the
transition plan and transition status updates, visit the HealthNow NY,
Inc. Upstate Medicare Division (UMD) Web site at www.umd.nycpic.com.
From the home page, click on ‘What's New at UMD,’ then click on
‘DMERC Transition‘."

Recipients Should Not Be Directed To Call REVS

The EDS CSHD continues to receive calls from recipients who are seeking assistance with inquiries concerning Medical Assistance eligibility coverage. When recipients reach the CSHD, they are dissatisfied with having to be referred to another number. The CSHD is available to providers only for inquiries on claim status information such as prior authorization and/or payment information on RI Medical Assistance claims. 

English-speaking recipients with questions concerning their Medical Assistance eligibility coverage should be directed to the RIteCare Hotline at
1-800-346-1004.

Spanish-speaking recipients with questions concerning their Medical Assistance eligibility coverage should be directed to the RIteCare Hotline at
1-800-299-8444.

Recipients needing TTY assistance should call 222-2506.

SSI recipients should call the Recipient Relations Unit at 401-462-2354.

Please note the DHS Information lines:

462-3361
462-5300
462-6340

Obsolete Codes

Listed below are HCPCS codes that are obsolete effective April 1, 2000. Replacement code(s):

OBSOLETE CODE	REPLACE WITH	OR REPLACE WITH	OR REPLACE WITH
E0452 INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE (I.E. BIPAPS)	K0532 RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE
E0453 THERAPEUTIC VENTILATOR; SUITABLE FOR USE 12 HOURS OR LESS PER DAY (I.E. BIPAP ST)	K0533 RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACKUP RATE FEATURE, USED WITH NON-INVASIVE INTERFACE, e.g. NASAL OR FACIAL MASK (INTERMITTENT ASSIST DEVICE WITHCONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE)	K0534 RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPACITY, WITH BACKUP RATE FEATURE
K0193 CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE, WITH HUMIDIFIER	E0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE	K0268 HUMIDIFIER, USED WITH CPAP DEVICE	K0531 HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE
K0194 INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE, WITH HUMIDIFIER	K0532 RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE	K0268 HUMIDIFIER, USED WITH CPAP DEVICE	K0531 HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE

EDS is currently updating any active prior authorizations with dates of service after 4/1/00 that have been effected by these changes. If you have received claim denials for prior authorization due to this change, please re-submit.