Provider Update Newsletter

November 2000, Volume 97

All Providers

HIPAA Happenings
DHS Website
UB-92 Enhancements
Revised Provider Agreement Forms
Claim Adjustments

Pharmacy Providers

Compound Drugs
POS Claims Reversal Enhancement
Accuracy Counts; Use Care When Indicating DEA Numbers

DEA Providers

DEA Homecare

 

HIPAA Happenings

The National MMIS Conference was held September 25 - 28, in Salt Lake City, at which time State Medicaid Program staffs were updated on existing HIPAA Transaction Set Rules and outstanding Notices of Proposed Rule Making (NPRM's).  The Transaction Set standards Published August 17, 2000, will require compliance by October 16, 2000.  The national healthcare data standards-setting group, WEDI, has formed collaboration with public and private healthcare entities, called SNIP - the Strategic National Implementation Process.  The goal of SNIP is to provide a forum for HIPAA problem resolution as well as develop a workable implementation plan for all affected parties. We suggest you visit their site at www.wedi.org - SNIP page, to keep up-to-date on healthcare industry efforts concerning HIPAA implementation.         There will also be a HIPAA Day at the annual ITEC Conference being held at the Convention Center in Providence November 15th.  Public and Private healthcare speakers are expected to participate in discussions concerning HIPAA implementation and upcoming NPRM's.  You may pre-register for the ITEC Conference at www.goitec.com.

WEBSITES: 

www.hcfa.gov-HCFA's home site; 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

www.wpc-edi.org - 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:SNIP page

DHS Website

We have recently added the DHS Policy Manual to this site and hope you'll find this new functionality helpful.  We encourage you to forward any suggestions to the Webmaster.

UB-92 Enhancements

EDS has made enhancements to accommodate 92 details and a total line on a UB-92 claim form and 93 details on an electronically submitted UB-92.  This change to the Medicaid Management Information System takes effect immediately.

When submitting these claims on paper, you are only required to list recipient/claim specific information of the first page, such as other insurance, diagnosis codes, occurrence dates, provider signature etc.  Please note that only one total charge, to be listed on the last page, for all paper claims submitted will be accepted for the 92 detail UB's.

Revised Provider Agreement Forms

In conjunction with the Rhode Island Auditor General and Attorney General requests, the Rhode Island Medical Assistance Program (RIMAP) is requiring revised Provider Agreement Forms (PAF) to be completed by December 31, 2000.  The revised PAF forms will be mailed to providers in November 2000.

The PAF changes are intended to further safeguard public funds, both State and Federal, in the reimbursement of RIMAP expenditures.  The revised PAF also increases the ability of oversight agencies to investigate reimbursed services rendered to our Program recipients.  If there have been no substantial changes in the organization or operation of your business, completion of the PAF will only require acknowledgment, via signature on the revised PAF, of the revised PAF Requirements.  If there have been changes in your organization's organization or operation, or if you have questions regarding the new PAF, we ask that you contact the EDS Customer Service Help Desk (401-784-8100 for local and long distance calls, or 800-964-6211 for instate toll calls and border communities) for further documentation requirements.

Claims Adjustments

In order to process claim adjustments in a timely manner, it is important that the guidelines noted in the Provider Reference Manual be followed.   This information can also be found on this site at the Paid Claim Adjustment and Refund Page where the processed is outlined.  Be sure that the adjustment form is complete.

Compound Drugs

Effective immediately, when billing an injectable compound drug, the drug should be split out into its component National Drug Classification and billed on separate/individual line items.  Each NDC should be given its own prescription number and billed via Point of Sale.

When billing liquids, gels and creams, if the prescription is a compound under $15.00, use NDC 99999 9999 99 and bill via POS.  If the prescription is a compound over $14.99, use NDC 99999 9999 99 and bill on a RI Pharmacy paper claim form.  The break down of the compound, including the NDC, Description and Metric Quantity

POS Claims Reversal Enhancement

In order to accommodate your needs, effective immediately, the window of time in which a POS claim can be reversed has been increased.  Claims submitted and adjudicated from Saturdays at 12:00 AM through Fridays at 11:59 PM can be reversed up until Friday Night at 11:59 PM.

Accuracy Counts; Use Care When Indicating DEA Numbers

As stated in policy, the Prescribing Provider's Drug Enforcement Agency number (DEA#) must be indicated in the Prescribing Physician ID field when billing to RI Medical Assistance.  Prescribing Physician information is utilized during the Retro-Drug Utilization Review process and it is imperative that correct and valid information be entered to insure accurate continued patient care and follow-up.  Your care in providing accurate information is both required and appreciated.  

DEA Homecare

Effective September 8, 2000, the MMIS started to accept and pay claims for DEA Core S clients.  Please bill the MMIS for services provided to Core S Clients after July 1, 2000.

Billing codes for Core S Clients are the same codes used for Core M and Co-pay clients:

Description	Code	Time
Homemaker	W5101	1/2 hour
Personal Care Only	*W5201	1/2 hour
Combined Homemaker/Personal Care	*W5301	1/2 hour

Please note:  Authorized service for Core S clients falls under Homemaker Only (W5101).  *Personal Care Only or Combined Home/Personal Care for Core S clients are approved on a case by case exception basis by DEA.  Also note that consistent with billing for other DEA services, the unit of service is 1/2 hour.

You may bill the MMIS in the same manner as you are currently billing for DEA clients.   Your DEA contact person for billing adjustments will continue to be Michelle Szylin at (401) 222-2858 extension 216.  Your customer service representative at EDS is Dana Ciampanelli at (401) 784-3889.