Administrative changes
Review administrative changes.

DME suppliers
Medicare durable medical equipment (DME) suppliers are required to obtain a National Provider Identifier (NPI) for every location. (More information about NPI appears later in this report.)

The only exception to this requirement is a situation in which a Medicare DME supplier is the sole proprietor. A sole proprietor is eligible for only one NPI regardless of the number of locations the supplier may service.

The requirement for Medicare DME suppliers to obtain NPIs for every practice location applies also to Medicare DME suppliers who do not send electronic claims to Medicare. Federal regulations require unique enumeration of every Medicare DME supplier’s location regardless of how claims are submitted. Again, sole proprietors are eligible for only one NPI.

Timelines and backlogs
Mike Davis, External Affairs, explained that currently ASF is allowed 120 seconds to answer calls under CMS requirements. ASF is pushing for an internal standard of 60 seconds.

Provider enrollment open inventory is 3,000 applications. About 50 percent of those are incomplete applications that must be developed internally. ASF will keep an incomplete application and handle it internally. The application will not be returned to the physician for completion of missing items. This may cause a slow-down in processing. There are 711 applications in enrollment older than 60 days.

National recovery contractor
Please refer to the ASF Web site, under Carrier/News to read an article regarding the new National Recovery Contractor. The article is dated Sept. 22, 2006.

Rod King discussed budget performance requirement changes. Becke Harmon, manager of External Affairs Clinical Provider Outreach and Education Advisory Group, will work out of the Cincinnati office with responsibilities for progressive corrective action, provider outreach and clinical staff for Part A and B. Officials are currently setting up and developing staff for this area.

Attendees received a table of all listserves. Sign up for listserve to receive updated information and news of changes at ASF.

If filing paper claims, do not add only the NPI number as it will cause the claim to be rejected. Please see the following NPI information, which was shared at the meeting.

National Provider Identifier (NPI)
Reminder: Health care providers are required by law to apply for an NPI.
Apply online>>

NPI transition plans>>

Introduction
Review introduction.
The next coalition meeting is scheduled for Friday, Nov. 3, at 1 p.m.

EDS updates
Daryl Davidson, Provider Relations, reminded attendees that the 2007 diagnosis codes became effective Oct. 1, and no grace period exists.

EDS has begun collecting National Provider Identifier (NPI) numbers from physicians who have received them. Beginning Oct. 1, letters are being mailed to physicians who have one location ID. Beginning Nov. 1, letters will be sent to physicians who have multiple location IDs.

Once letters are received, NPI reporting is available on the IHCP Web site. Note that before you report your NPI, make sure your provider profile is updated and accurate with service location addresses as well as pay-to addresses.

OMPP update
Ann Alley, Policy, Communications and Provider Relations manager, and Mark Vonderheit, Managed Care Operations manager, provided the following news.

• The OMPP is still in contract negotiations and hopes to finalize things by mid-October.
• For 2007, Medicaid recipients will be asked to choose a managed care organization (MCO) and then locate a provider in that plan. According to Alley, 42 percent of the Hoosier HealthWise population will transition from one MCO to another.
• The OMPP is still working toward a Nov. 1, 2006, deadline to have all MCO contracts in place.
• The OMPP is developing future communications for physicians to answer questions and address concerns.
• No new Medicaid patients will be assigned during December 2006.
• Physicians can contract with more than one MCO for 2007. A physician’s primary panel must include at least 150 members before contracting with a second or third MCO will be allowed.
• Attendees raised prior authorization questions; however, OMPP will clarify those issues at the next coalition meeting, or you may contact the ISMA’s Sandy Distler.

CareSource

Harmony

MDwise

MHS

Anthem

Molina was invited, but did not attend.