Fee schedule
The Medicare 10.6 percent reimbursement decrease was averted due to a congressional override of the president’s veto. Payments will continue at the same rate as January to June 2008 payments.

Any reimbursement for claims made at the 10.6 percent decreased level will be adjusted automatically. Those would be claims with dates of service of July 1, 2, 3 and 7, prior to the congressional action.

Updates
Carolyn Henson from Provider Outreach and Education stated eligibility is the number one call issue with Customer Care.  National Government Services (NGS) is aware of a PPTN problem; it is currently being resolved. 

Henson also advised of a new updated version of the Forms Assistant for 855s on the NGS Web site, www.ngsmedicare.com.

The NGS Medicare Convention 2008 was held Aug. 25 to Aug. 28. Acting CMS Administrator Kerry Weems was the keynote speaker.

Customer Care
Please note: Due to increased care volue, expect long delays with the Customer Care Call Center.

Interactive Voice Response (IVR)
Information was provided on the IVR. The phone number is 1-866-250-5665.

Menus can be navigated by voice or keypad. Touch-tone entry can be used for provider numbers, Medicare numbers, dates of service, dates of birth, procedure codes and beneficiary names.

For complete instructions go here; click on resources, contact information and IVR.
 
CMS 1500
Please note that if you used the Zip + 4 when enrolling with Medicare, that number must match with the zip code appearing on your claims. Claims will be denied if you use the five-digit zip code on claims but are enrolled with the zip + 4.

The National Provider Identifier is not required in Box 32 unless you have purchased diagnostic tests. However, the zip-code is required.

Assignment of benefits
Assignment refers to the claim while participation refers to the provider. A provider who accepts assignment is prohibited from charging the Medicare patient more than the deductible and co-insurance of the approved amount. A participating provider must accept assignment for all covered services. 

In certain situations, a provider – regardless of participation status – must submit an assigned claim. For complete details on assignment of benefits, go here; click on Education and Support, Tools and materials, manuals and Medicare 101.

• 6.18 percent for providers billing on CMS 1500
• 0.44 percent for UB04 providers
• 3.81 percent for dental providers

Care Select
Marc Baker of MDwise reminded attendees that all Care Select claims should be sent to EDS.  He discussed Care Connect, MDwise’s provider portal. On Care Connect, primary medical providers (PMPs) can log in to obtain a copy of their Care Select patient panel and to observe case manager notes regarding those patients. 

Baker and Cassandra Davis-Titus of Advantage Health discussed issues with the two-digit certification codes that specialist offices must obtain from PMPs in order to be paid for services.

In a discussion, representatives explained that if a patient was auto-assigned to a PMP but had not yet visited that office, the PMP often was reluctant to give a certification code to a specialist office. Both Baker and Davis-Titus advised that while they cannot reveal the PMP’s certification code, they are willing to work on these issues on a case-by-case basis.

Both Care Select representatives acknowledged that as foster children and children who are wards of the state transition to Care Select, the organizations have been very active in recruiting additional physicians to their programs.

The state plans to have all of these children assigned to a PMP by Oct. 1.

Baker announced that MDwise is offering training on Care Select and the Healthy Indiana Plan (HIP). An Indianapolis session was held July 29 from 9 a.m. to 12 p.m. at Methodist Hospital. Additional information is available on the MDwise Web site.

Davis-Titus stated that Advantage Health’s provider portal, Flexport, will be available by the fourth quarter of 2008. Through this portal, providers will be able to communicate with their patients’ case managers.

Hoosier Healthwise
Jeane Maitland of Anthem reviewed forms and contact information for electronic remittance advice (ERA) and electronic funds transfer (EFT). She advised that any providers not receiving their ERAs should contact the EDI help desk at (800) 470-9630. 

Maitland assured attendees the issue over vision claims (whether they should be processed as medical or vision claims) would be resolved by July 31. There will be an auto-sweep of the system and adjustment checks will be issued. However, Matiland encouraged providers affected by this issue to e-mail her so she can confirm that their claims were reprocessed.

Maitland also provided attendees with a list of services that require prior authorization.

Michelle Spurlock of Managed Health Services (MHS) stated that MHS has a flood relief action plan in place. Providers should contact the MHS Provider Inquiry team at 1-877-MHS-4U4U (877-647-4848); choose Option 3 for more information. She also asked attendees to notify MHS as well as EDS about any changes to their provider profiles.

Spurlock discussed services available at www.managedhealthservices.com. On the Web site, provider offices can:

• Verify eligibility
• Check claims status
• Submit and view authorizations
• Check code audit logic
• Submit claims

Many MHS forms are available online as well. Spurlock said many forms have been updated and asked attendees to verify that they are using the most current forms. A new form allowing MHS members to change their PMP has also been added.

Spurlock reminded attendees that beginning with 2008, all MHS fax numbers are toll free with area code 866. She noted that MHS has undergone many staff changes, so providers may have a new provider relations specialist.

Sherri Miles from MDwise advised that attendees interested in submitting MDwise claims electronically must contact the appropriate delivery system.