Conference Update
NGS Provider Outreach Manager Mike Davis said questions from the Medicare conference in Louisville, Ky., will be posted on the National Government Services (NGS) Web site under specialty topics.

The 2008 conference will be held Aug. 25-28 in Indianapolis at the Convention Center. The conference will be a joint effort of Part A, B, DMERC and RHHI. Watch the NGS Web site for more information.

Local Medical Policy (LCD)
Medicare Director Carolyn Cunningham, M.D., explained changes to 20 policies were caused by ICD-9 changes for 2008. A listserv will be sent regarding these policies.

The first batch of LCD changes, due to the consolidation, will be effective Dec.1, 2007. A second batch of policy changes will be discussed at the open door meeting Oct. 22 at Anthem.

Dr. Cunningham also said local carriers can have separate SIAs (Supplemental Instructions Articles) for national policy. This information will be posted on the NGS Web site.

Provider Enrollment
There are less than 567 applications in inventory, and enrollment is processing clean applications in less than 45 days. Areas of problems on applications are:

• Missing signatures, missing NPI numbers
• Missing PIN or NPI when changing information

EDI
Kellie Templin, Part B EDI consultant, said all enrollment forms have been updated and posted on the National Government Services (NGS) Web site. If the old form is used after Oct. 1, 2007, it will be returned.

Phone lines are open for password reset. Dial (877) 273-4434, option 4.

Please use Web-base if possible, but if you use Web-base for password reset DO NOT call; use one or the other. Also, there is a 30-day trial period with the Web-base reset. More information>>

Also note, effective Oct. 8, 2007, NGS began editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. If a match cannot be located on the crosswalk, claims will be rejected or returned to the physician. The physician must then verify the correct NPI was submitted. If correct, the physician must verify the legacy identifier (PIN) corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). For further information, contact NGS customer care at (866) 250-5665.

For clarification, you may continue to file claims with the legacy only, legacy and NPI, or NPI only.

Provider enrollment revalidation effort
All fiscal intermediaries, carriers and Part A/B Medicare administrative contractors have been requested by the Centers for Medicare and Medicaid Services (CMS) to begin a provider enrollment revalidation effort. This effort will focus on the top 100 billers for each contractor.

If you are one of the top 100 billers, a revalidation request letter was mailed to you no later than Sept. 30, 2007. You have 60 days from the postmark date to respond by submitting a complete and accurate CMS 855 application, along with all of the applicable supporting documentation, including the Electronic Funds Transfer Authorization Agreement. Failure to submit the requested revalidation information will result in the revocation of your enrollment and Medicare billing privileges.

Find CMS applications>>

Comprehensive Error Rate Testing
Sonja Racke, Provider Outreach/Clinical Education, gave an in depth presentation on CERT. Program goals include:

• Measure contractor performance, provider compliance
• Pay it right

CERT requests include:

• Random
• Post pay
• Hard copy letter
• Additional documentation request

You have 75 days to respond to CERT requests via fax, (240) 568-6222. There are appeal rights. For details, visit the NGS Web site and click on CERT.

Those attending seminars, workshops and ISMA coalition meetings seem to have a decreased number of errors on their claims and a lower accounts receivable, noted Mike Davis, NGS Provider Outreach manager.

Customer Care
David Concannon, Customer Care representative, presented the following breakdown of the top calls to customer care

• Provider enrollment
• Coding error
• Modifiers
• Claim status

Intermittent problems with the IVR are being addressed.

Coalition questions>>

Correction from July 20
Modifier 52 vs. Modifier 53
Modifier 52 is used to indicate that a reduced service has been performed and is being billed. Under certain circumstances, a service or procedure is partially reduced or eliminated at the physician’s discretion.

In addition, Modifier 53 indicates a procedure was started but discontinued prior to completion due to extenuating circumstances or situations that threaten the well-being of the patient.

Modifier 53 is for a procedure not completed. Modifier 52 is for a procedure completed, but not to the fullest.

NGS Changes
NGS is in the process of consolidating mail and distribution areas in order to better support customers throughout the states NGS serves. This initiative includes the consolidation of some of the existing post office boxes and some street addresses for certain types of mail.

With each transition, physicians will be notified. Post office box mail will be redirected from the old addresses to the new ones for a short period of time in order to minimize the impact on physicians.

Watch the NGS Web sites and sign up for the listserv for more information on this consolidation.

MDwise
Chris Kern, MDwise Provider Relations, spoke to attendees on the new Indiana Care Select product. MDwise was selected as one of the Care Management Organizations (CMO) to provide services to the aged, blind and disabled population within Medicaid.

Kern stressed the importance of separating MDwise — Care Select and MDwise — Hoosier Healthwise. Refer to Medicaid bulletin BT200723 where the new components of the Care Select program are discussed.

Physicians who want to remain PMPs within this program must have contracts completed prior to the Nov. 1 implementation.

Components of the new program include:

• Care management (securing community and social resources)
• Holistic care
• Prior authorization functions
• Chronic disease management
• Provider relations

Kern also discussed physicians with patients in this program who need interpretive services or who are hearing impaired. Please contact MDwise prior to the patient’s office visit and MDwise will provide an interpreter, at no cost to the physician.

Advantage
Kelvin Orr, Advantage representative, introduced himself and his organization as one of the Care Management Organizations (CMO) within the Care Select program. Orr urged physicians to call Advantage’s toll-free number (866) 504-6708 with any questions.

Beginning Nov. 1, Advantage will be responsible for prior authorization services for traditional fee-for-service Medicaid members, in addition to Care Select Advantage members. Advantage is currently working with Health Care Excel to ensure a seamless transition.

Advantage also will provide interpreter services or translator services to members who need them when visiting physicians. Physicians should call Advantage prior to the scheduled appointment to ensure the services are scheduled and paid for by the CMO.

Hoosier Healthwise
Jeane Maitland, Anthem Hoosier Healthwise (HHW) representative, introduced herself as the interim attendee from Anthem. She also introduced her successor, Renee Hudson-Johnson, as Anthem’s newest provider relations representative. Hudson-Johnson can be reached at (317) 287-2670.

Maitland advised attendees utilizing the pre-service review forms to write “urgent” on top if a response is urgent and requires a response within 24 hours. Maitland encouraged attendees to access Anthem’s Web site for new functionality and forms.

Maitland reviewed Anthem’s policy on providing sign language or other language interpreters. As long as the physician contacts Anthem prior to the appointment time, Anthem will arrange for language assistance services at no cost to the physician.

Sherri Miles, HHW MDwise Provider Relations manager, said her staff will be available at EDS’s annual meeting in October to address specific claims issues. Miles also confirmed that if a Hoosier Healthwise member needs language or interpreter services, the contracted physician should notify MDwise prior to the meeting. MDwise will provide and pay for this member service.

Nancy Robinson, HHW MHS Provider Relations representative, confirmed that MHS is not requiring National Drug Code (NDC) information on claim submissions.

MHS will also provide and pay for language or interpreter services for HHW members if the physician contacts MHS in advance.

Robinson did note that 72 hours is typically the required timeframe needed to secure these services and that MHS will attempt to accommodate any last minute appointment situations that arise.