Online enterprise
Lindy Lady, with Provider Outreach and Education at the Centers for Medicare & Medicaid Services (CMS), announced a new online enterprise application that will allow physicians to access, update and submit information over the Internet. Details about the application will be made known as they become available.
However, physicians are encouraged to set up an online account now. Find step-by-step instructions. If you need help with registration, call (866) 484-8049.
Enrollment
Mike Davis, manager of Provider Outreach, advised there are no back-logs with applications. Clean applications are being processed in a quick and timely manner.
Education and EDI information
Sonja Racke, team lead with Provider Outreach and Clinical Education, encouraged physician offices to use the online tool for education. You may send an e-mail for education information.
Kellie Templin, Part B EDI consultant, announced that National Government Services (NGS) has released a new Professional Provider Telecommunication Network (PPTN) manual. Using the PPTN, you may view the status of all claims as they appear in the Medicare processing system, including paid, denied, pending, assigned and non-assigned claims. Online eligibility and other features also are available through this new manual.
Templin provided a Medicare Part B 1500 crosswalk for electronic claims; find it online under EDI/Specifications.
Tips for successful use of the Interactive Voice Response (IVR) system may also be found online.
Facts and figures
According to the 2008 National Government Services Fact Sheet, in 2007 NGS responded to:
• 11.2 million phone calls
• 94,400 written inquiries
• 1,500 congressional inquiries
• 330 walk-ins from the Medicare community
There were 208.8 million Medicare claims and administered benefits of more than $94.6 billion from the Medicare Trust Fund in 2007.
Customer care
A.J. Hannah, director of Provider Outreach, said Customer Care is trying to manage a large call volume at this time and is conducting a series of invitation-only calls. When providers call for 855 instructions or regarding NPI issues, they are invited to a call hosted by Customer Care.
NGS is working to resolve the call volume issue and watching for call patterns. Data is being collected about offices that make above average numbers of phone calls to Customer Care. NGS intends to contact these offices to provide education.
RAC
Coalition attendees discussed the Recovery Audit Contractor (RAC) issue. The RAC is due in Indiana this spring and will place initial emphasis on hospitals.
Claims instructions
Carolyn Henson, Provider Outreach and Education, gave an update on ordering, referring, attending, operating and other service facility provider or purchased service provider (item 17). If a service requires the NPI and the office is unable to obtain it after several attempts, the office may report its own name and NPI in Item 17.
Henson provided a list of required items for the 1500 claim form. Find this information in manual 100-04, chapter 26, section 10.2.
Please watch listserves for educational opportunities or find information listed under ACT call, seminars.
Also, remember to mark your calendars for the NGS Annual Convention, August 25-28, 2008.
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NPI updates
Bill Woodruff of EDS stressed that beginning with claims received on May 24, 2008, those claims without the National Provider Identifier (NPI) and zip+4 for the service location will be denied.
The edit is currently an “information only” edit; therefore, claims are continuing to process for payment. However, on May 24, 2008, Medicaid will deny your claim if it does not contain the proper information in box 33!
Woodruff informed attendees that the Indiana Health Coverage Program (IHCP) home page contains a link to the NPI reporting tool. He urged use of this tool to confirm that EDS has the correct taxonomy and NPI link to the legacy provider number.
Verify this billing information online. Contact your EDS representative if EDS records have an incorrect zip+4.
Nancy Robinson of Hoosier Healthwise (HHW) Managed Health Services stated they will accept NPI only on claims beginning April 1. Dan Westlake with HHW MDwise and Tye Demby of HHW Anthem stated they will operate on the same time frame as EDS.
Tamper resistant prescription pads
Woodruff reminded attendees that the federal mandate requiring all non-electronic Medicaid prescriptions to be on tamper-resistant prescription pads will go into effect April 1, 2008. Faxed prescriptions must be on tamper–resistant paper effective Oct 1.
CareSelect
Chris Kern, MDwise representative for the CareSelect program, discussed the importance of confirming eligibility each time an insured is seen.
Maximus is the enrollment broker for the CareSelect plan. Direct questions regarding enrollment to them at (866) 963-7383.
Prior authorization (PA) requests are handled by the Care Management Organizations (CMOs). MDwise PAs can be sent via fax, mail, telephone and Web interchange.
Kern also stated that providers are still being enrolled and specialty providers can enroll as Primary Medical Providers (PMPs). PMPs will receive a $15 administrative fee per member per month and have flexibility to determine their panel size.
The CMO will coordinate with CareSelect PMPs to perform care coordination conferences to review a member’s progress and care management plan. The PMPs (or designated physician extender) are eligible to be reimbursed in the amount of $40 for the time devoted to these case conferences. Each CareSelect PMP is limited to two one-hour care coordination conferences per 12 rolling-month period for each Care Select member.
Kelvin Orr, Advantage representative for the CareSelect program, reminded attendees that Advantage processes PA requests for Medicaid fee for service, dental and restricted card program, as well as CareSelect Advantage.
He also announced that starting June 1, wards and fosters will become eligible for the CareSelect program. Pediatricians will likely be contacted about becoming PMPs.
Other updates
Both Tye Demby and Nancy Robinson reminded attendees to be aware of timely filing limits for claims. Demby also stated that on April 1 the Anthem HHW fee schedule will be updated. All claims paid under the incorrect fee schedule will be adjusted.
Dan Westlake asked that the appropriate sub-network of HHW MDwise be contacted with questions on individual claims. |
