2013 medicaid school based services
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2013 Medicaid School Based Services PowerPoint PPT Presentation

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2013 Medicaid School Based Services. Presented by Kristen Brice Provider Field Representative. Contact Xerox. Call 505-246-0710 or 800-299-7304 - to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL.

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2013 Medicaid School Based Services

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2013 Medicaid School Based Services

Presented by

Kristen Brice

Provider Field Representative

Contact Xerox

Call 505-246-0710 or 800-299-7304 - to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL.

  • For all contact, Claims, and Correspondence Addresses information go to the following link on the New Mexico Medicaid Web Portal:

    • https://nmmedicaid.acs-inc.com/nm/general/loadstatic.do?page=ContactUs.htm

    • Email: [email protected]

Important State Websites



  • http://www.hsd.state.nm.us/mad/policymanual.html


  • http://www.hsd.state.nm.us/mad/billinginstructions.html


  • http://www.hsd.state.nm.us/mad/registers/2012.html

Xerox Field Representative

Provider Field Representative:

  • Kristen Brice– (505) 246-9988 Ext. 8131233

    • E-mail: [email protected]

    • Cc: [email protected]

      [email protected]


  • Overview of NM Medicaid Web Portal

  • Timely Filing Guidelines

  • Claim Form Instructions

  • Medicaid Primary Claim Instructions

  • School Based Claims Reminders

NM Medicaid Web Portal Overview

The Xerox New Mexico Medicaid Web Portal

  • Billing Instructions

  • Trainings

  • FAQ’s

  • HSD Link

  • RA Newsletter


Eligibility Check List

  • Date of Service – Make sure client is eligible on DOS

  • Limited Benefits – Check Category of Eligibility

Ways to Check Eligibility

  • On-Line Eligibility Inquiry—Web Portal

  • https://nmmedicaid.acs-inc.com

  • Automatic Voice Response System (AVRS) (800) 820-6901

  • Xerox Eligibility Help Desk: (800)-705-4452

  • Monday - Thursday 8:00 a.m. - 5:00 p.m.

  • Friday (Mountain Time) 8:00 a.m. - 4:00 p.m.

Online Eligibility Inquiry

Online Eligibility Inquiry

What is a Transaction Control Number (TCN)?

The twelfth digit in an adjustment/ void TCN will either be:

1= Debit

2= Credit


The first digit indicates what the claim “media” is:

2 = electronic crossover

3 = other electronic claim

4 = system generated claim or adjustment

8 = paper claim

Batch number

The last two digits of the year the claim was received

The claim number within the batch.

The numeric day of the year.

This is the Julian Date - this represents the date the claim was received by Xerox: this claim - the 323rd day of 2008, or November 18, 2008

Claim Status Inquiry by Criteria

Claim Detail - Underlined Text

Clicking underlined text in Claim Detail will generate a pop up defining that text

Reports and Data Files

Step 1

Reports and Data Files

Step 2

Reports and Data Files

Click on icon to view report

Step 3

  • Only the last 8 RA’s are assessable via the web portal

  • RA’s are still available on the NM Medicaid Web Portal even if providers are setup for 835’s

Timely Filing Guidelines

Electronic Claim Submission

  • All Fee For Service claims within 120 days from the initial date of service that do not require an attachment for payment must be submitted electronically.

  • For any assistance regarding Electronic Claims Submissions, contact the HIPAA Helpdesk

  • [email protected]

  • or call 800-299-7304

Three Ways to Submit Claims Electronically

  • PayerPath – Free HIPAA Compliant web-based claims entry system.

  • The URL to the registration form for PayerPath submissions is:

  • http://www.hsd.state.nm.us/mad/hipaa.html

  • *Pay attention to the RA Newsletter, for upcoming updates to the PayerPath.

    • Through a Clearinghouse

    • EDI Gateway

    • The URL for additional information regarding EDI Gateway electronic submissions is:

    • http://www.hsd.state.nm.us/mad//pdf_files/Converting%20from%20TIE%20to%20ACS%20EDI.pdf

  • Timely Filing Limits

    • For schools, the filing limits are 120 days for the initial filing period and 120 days for the grace period (rather than 90 days).

    • If you need to verify your ProviderNPI Number please follow link below.

    • http://www.npinumberlookup.org

    Timely Filing Limits

    • When the recipient has retroactive eligibility, the initial filing limit is 120 days from the date the eligibility was added to the Xerox eligibility file and was therefore available to providers.

    Exceptions to the filing limit

    • When the provider was not originally enrolled as a MAD provider on the date of service, the filing limit of 90-days is counted from the date the provider was notified of the enrollment, but must not exceed 210 days from the date of service.

    • A provider should submit a provider participation agreement in sufficient time to allow processing and still meet the Medicaid 210 day limit for submitting the claim.

    Timely Filing Denials

    • Helpful Hints

    • There are two filing limits to meet:

    • The initial filing limit – 120 days from date of service

    • The grace period limit – 90 days from paid/denial date

    • Continuing to re-file a claim does not continue to extend the filing limit. So it is to the provider’s advantage to file or request an adjustment on the most recently filed claim that met the original filing limit.

    • When requesting an adjustment on an adjusted claim, use the TCN of the final payment or denial, not the credit record which has a negative amount on the RA.

    • The filing limit does not apply when the provider is returning an overpayment to the Medicaid program.

    Timely Filing Denials

    • Re-filing Claims and Submitting Adjustments

    • CMS 1500 form: Put the TCN in block 22 on the paper form. Leave the “Code” blank, and put the TCN in the “Original Reference No.” field.

    Claim Form Instructions

    Where to get a copy of claim form instructions

    Click on Provider Information

    Where to get a copy of claim form instructions

    Scroll down

    Open file

    Medicaid Claim Forms


    Patient, Petunia

    11 11 90


    If a referring provider is required in order to be paid or if you simply wish to enter this information on the claim, enter the referring provider’s name in box 17 and the referring provider’s NPI in box 17b.

    Doe, John












    78 01


    05 30 07

    05 30 07



    • Health care providers:

      • If you are a health care provider, you must submit your NPI.

      • The NPI goes in Box 33a.

      • If the NPI is not submitted, the claim will deny.



    78 01


    Provider Med Gp 505 333-4444

    1234 Rocky Road

    Mountain View, NM 8888





    • Taxonomy: If you wish to submit rendering provider taxonomy code, it goes in Box 33b preceded by the qualifier “zz”.

    • Do not enter a space between the qualifier and the taxonomy code. An example of a correctly submitted taxonomy code is: zz103T00000X.

    Enter TCN for proof of Timely Filing in box 22 (ORIGINAL REF. NO)







    05 30 07

    05 30 07









    78 01


    Provider Med Gp 505 333-4444

    1234 Rocky Road

    Mountain View, NM 8888





    School Based Claims Reminders

    Place of Service

    • Use place of service (POS) 03 when services are provided at school

    • Use POS 11 when services are provided at the office

    • Use POS 99 for all other sites/venues

    Did you remember to?

    • Verify that the CPT, HCPS, Diagnosis, etc. that you are billing for:

    • are covered services with Xerox

    • are covered for the appropriate age range

    • are covered for the appropriate gender

    • do not exceed the max allowed of units per line

    • If invoice is required remember to attach the invoice

    • does have the billing and rendering provider type selected to bill/render the services

    Did you remember to? Continued

    • Ensure the line item charges are correct and match the total charge

    • Procedure and diagnosis codes are entered correctly

    • Sign and date the claim

    Taxonomy Code

    • For School Based billingprovider type 345, the valid Taxonomy Code is:

    • 251300000X

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