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Department of Medical Assistance Services

2. OBJECTIVES The participants should be able to:. Verify Medicaid eligibilityProperly submit claimsUnderstand timely filing guidelinesIncluding submission of adjustment/voidsResolve rejected/denied claimsInterpret Medicaid Remittance Advice. 3. As a Participating Provider You must -. Determine

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Department of Medical Assistance Services

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    1. Department of Medical Assistance Services Assisted Living Facility Medicaid Eligibility Verification Options And CMS-1500 (08-05) Billing Guidelines 2008 www.dmas.virginia.gov

    2. 2 OBJECTIVES The participants should be able to: Verify Medicaid eligibility Properly submit claims Understand timely filing guidelines Including submission of adjustment/voids Resolve rejected/denied claims Interpret Medicaid Remittance Advice

    3. 3 As a Participating Provider You must - Determine the patient's identity. Verify the patient's age. Verify the patient's eligibility. Accept, as payment in full, the amount paid by Medicaid.

    4. 4 Important Contacts Provider Enrollment MediCall ARS- Web-Based Medicaid Eligibility Provider Call Center Customer Service

    5. 5 Provider Enrollment New provider numbers or change of address: First Health – PEU P. O. Box 26803 Richmond, VA 23261 888-829-5373 804-270-5105 804-270-7027 - Fax

    6. 6 Electronic Fund Transfer- EFT To participate in the Electronic Funds Transfer (EFT), please contact: First Health Provider Enrollment Unit (888) 829-5373 The EFT enrollment form is also available for printing or downloading on the DMAS web-site: www.dmas.virginia.gov

    7. The most visible change will be the implementation of the new plastic Medicaid card. Here is an example of the format. The most visible change will be the implementation of the new plastic Medicaid card. Here is an example of the format.

    8. 8 MediCall 800-884-9730 800-772-9996 804-965-9732 804-965-9733

    9. 9 MediCall Available 24 hours a day, 7 days a week Medicaid Eligibility Verification Claims Status Prior Authorization Information Primary Payer Information Medallion Participation Managed Care Organization Assignment

    10. 10 Automated Response System ARS Web-based eligibility verification option Free of Charge. Information received in “real time”. Secure Fully HIPAA compliant

    11. 11 Automated Response System (ARS) NPI Compliant ARS Web Site will allow: Access to claims status for bills submitted using an NPI Access to claims status for bills submitted by a Group Practice Enhanced delegated administration capability provided by the User Administration Console (UAC) With the new ARS system providers will be able to get claims status for bills submitted with NPIs and Group Practice submission. They will also have access to the UAC which has the enhanced capability of delegated administration. With the new ARS system providers will be able to get claims status for bills submitted with NPIs and Group Practice submission. They will also have access to the UAC which has the enhanced capability of delegated administration.

    12. 12 User Administration Console The UAC will: Allow providers to manage their own ARS access for one or more users Allow the provider to assign a Delegated Administrator for its office or facility Enable access to the ARS for anyone in the provider’s office or facility with a business need to information on the provider’s behalf The UAC will allow you, the provider, to manage your own ARS access for however many users you deem necessary for your practice. The UAC is an application that allows the provider to assign a Delegated Administrator for its office or facility. The UAC can then enable access to anyone in the provider’s office or facility with a business need to access ARS information on the provider’s behalf. There will no longer be a limitation of only one ARS user associated to an individual Provider Identification Number. The UAC will allow you, the provider, to manage your own ARS access for however many users you deem necessary for your practice. The UAC is an application that allows the provider to assign a Delegated Administrator for its office or facility. The UAC can then enable access to anyone in the provider’s office or facility with a business need to access ARS information on the provider’s behalf. There will no longer be a limitation of only one ARS user associated to an individual Provider Identification Number.

    13. 13 UAC Registration Process Go to https://virginia.fhsc.com Select the ARS tab on FHSC ARS Home Page Choose “User Administration” Follow the on-screen instructions for help with registration, this is a 3-step process to request, register and activate a new account Answer the initial ‘Who are you?’ question by selecting ‘I do not have a User ID and need to be a Delegated Administrator’ Beginning on February 19, 2007, you may register for access to the new UAC by navigating to virginia.fhsc.com and selecting the ARS tab and then selecting the “User Administration” option. The registrant will be guided through a 3-step process to request, register, and activate a new account. The process can be started by answering the initial ‘Who are you?’ question by selecting ‘I do not have a User ID and need to be a Delegated Administrator’. The registration process is designed to include the provider in the decision-making process. Beginning on February 19, 2007, you may register for access to the new UAC by navigating to virginia.fhsc.com and selecting the ARS tab and then selecting the “User Administration” option. The registrant will be guided through a 3-step process to request, register, and activate a new account. The process can be started by answering the initial ‘Who are you?’ question by selecting ‘I do not have a User ID and need to be a Delegated Administrator’. The registration process is designed to include the provider in the decision-making process.

    14. 14 UAC Registration Process 3-Step Process Step One – Request PIN (will be mailed) Step Two – Register with a PIN Step Three – Activate your user login ID and password After this process you will need to log onto the UAC, in order to assign your access privileges to the ARS, set up additional local administrators and assign roles and providers to administrators To successfully complete the registration process you must follow all three steps. Step One is Requesting a PIN: The provider designates a requestor with the authority to access secure information on its behalf. The requestor will register online for each provider requiring access to the ARS. In response to the online PIN request, FHSC will send a PIN letter via the U.S. Postal Service to each provider for which ARS access is requested in order for the provider to verify authenticity. Step Two is Registering with your PIN: It is the responsibility of the provider to determine who will complete the registration process and who will be allowed access to the provider’s information. The PIN letter will provide instructions for completing the registration process. Once the registration process is complete, FHSC sends an activation email to the requestor. Step Three is Activating your user login ID and password: By selecting the activation link in the e-mail, the registration process is completed and the provider or authorized users can begin using the ARS. Once you activate your user login ID and password as a delegated administrator, you will need to access the UAC in order to assign your access privileges to the ARS. The UAC will also allow you to set up additional local administrators, as well as assign roles and providers to administrators. Please use the on-screen help and the users guide to assist you with setting up your access to the new ARS. To successfully complete the registration process you must follow all three steps. Step One is Requesting a PIN: The provider designates a requestor with the authority to access secure information on its behalf. The requestor will register online for each provider requiring access to the ARS. In response to the online PIN request, FHSC will send a PIN letter via the U.S. Postal Service to each provider for which ARS access is requested in order for the provider to verify authenticity. Step Two is Registering with your PIN: It is the responsibility of the provider to determine who will complete the registration process and who will be allowed access to the provider’s information. The PIN letter will provide instructions for completing the registration process. Once the registration process is complete, FHSC sends an activation email to the requestor. Step Three is Activating your user login ID and password: By selecting the activation link in the e-mail, the registration process is completed and the provider or authorized users can begin using the ARS. Once you activate your user login ID and password as a delegated administrator, you will need to access the UAC in order to assign your access privileges to the ARS. The UAC will also allow you to set up additional local administrators, as well as assign roles and providers to administrators. Please use the on-screen help and the users guide to assist you with setting up your access to the new ARS.

    15. 15 ARS –Users Web Support Helpline- 800-241-8726 You are required to enroll and begin using the new Web Site by May 23, 2007. You are required to enroll and begin using the new Web Site by May 23, 2007.

    16. 16 Provider Call Center Claims, covered services, billing inquiries: 800-552-8627 804-786-6273 8:30am – 4:30pm (Monday-Friday) 11:00am – 4:30pm (Wednesday)

    17. 17 Billing Inquiries Customer Services Department of Medical Assistance Services 600 East Broad Street, Suite 1300 Richmond, VA 23219

    18. 18 Electronic Billing Electronic Claims Coordinator Mailing Address First Health Services Corporation Virginia Operations Electronic Claims Coordinator 4300 Cox Road Glen Allen, VA 23060 E-mail: edivmap@fhsc.com Phone: (800) 924-6741 Fax: (804) 273-6797

    19. 19 Billing on the CMS-1500

    20. 20 MAIL CMS-1500 FORMS TO: DEPARTMENT OF MEDICAL ASSISTANCE SERVICES PRACTITIONER P. O. Box 27444 Richmond, Virginia 23261

    21. TIMELY FILING ALL CLAIMS MUST BE SUBMITTED AND PROCESSED WITHIN ONE YEAR FROM THE DATE OF SERVICE EXCEPTIONS: 1. Retroactive Eligibility/Delayed Enrollment 2. Previously rejected or denied claims Submit claims with documentation attached explaining the reason for delayed submission.

    22. 22

    27. Block 11d - Is There Another Health Benefit Plan? d. IS THERE ANOTHER HEALTH BENEFIT PLAN?

    29. 29 Blocks 24A thru 24J These blocks have been divided into open areas and a shaded red line area The shaded area is ONLY for supplemental information Instructions will be given on when the use of the shaded area is required for claims processing

    33. 33 Assisted Living Services Regular T1020 (no modifier) $3.00/day Not to exceed $90.00 monthly Intensive T1020 (U1 modifier required) $6.00/day Not to exceed $180.00 monthly

    37. 37 ID.QUAL Block-24I Qualifier ‘1D’ is to be used in the red shaded area for claims being submitted using the Medicaid provider number or Atypical Provider Identifier (API). Qualifier ‘ZZ’ is to be used to indicate the taxonomy code. Taxonomy code should only be listed if required with the NPI to adjudicate the claim.

    38. 38 Rendering Provider ID # Block-24J The shaded red area will contain the current Medicaid provider number/API OR The open area will contain the NPI of the provider rendering the service.

    45. 45 Block 32 Service Facility Location Information Enter information for the location where services were rendered First line-Name Second line-Address Third line-City, State, 9 digit zip code No punctuation in the address Space between city and state Include hyphen for the 9 digit zip code

    46. 46 Block 32 Block 32, cont’d. Service Facility Location Information Providers with multiple offices/locations - the zip code must reflect the office/ location where services were rendered Enter the 10 digit NPI number of the service location in 32a. OR Enter ‘1D’ qualifier with the Medicaid PIN (during Dual Use) or ‘1D” qualifier with the API in 32b

    47. Block 32: Service Facility Location Information

    48. 48 Block 33 Billing Provider Info & PH #- Enter the information to identify the provider that is requesting to be paid First line-Name Second line-Address Third line-City, State, 9 digit zip code No punctuation in the address Space between city and state Include hyphen for the 9 digit zip Phone number is to be entered in the area to the right of the field title, no hyphen or space used

    49. 49 Billing Provider Info & PH #- Block-33a-b Enter the 10 digit NPI number of the service location in 33a. OR Enter ‘1D’ qualifier with the Medicaid PIN (during Dual Use) or ‘1D’ qualifier with the API in 33b

    50. Block 33: Billing Provider Info & PH #

    52. REMITTANCE VOUCHER Sections of the Voucher APPROVED - for payment. PENDING - for review of claims. DENIED - no payment allowed. DEBIT (-) - adjusted claims creating a positive balance. CREDIT (+) - adjusted/Voided claims creating a negative balance.

    53. REMITTANCE VOUCHER Sections of the Voucher FINANCIAL TRANSACTION EOB DESCRIPTION ADJUSTMENT DESCRIPTION/REMARKS- STATUS DESCRIPTION REMITTANCE SUMMARY- PROGRAM TOTALS.

    54. THANK YOU Department of Medical Assistance Services www.dmas.virginia.gov

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