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Billing Presentation
 

Billing Presentation

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

Billing Presentation Billing Presentation Presentation Transcript

  • Department of Medical Assistance Services Department of Education Medicaid Eligibility Verification Options and Billing October 6, 2009 www.dmas.virginia.gov
  • As a Participating Provider You must
    • Accept as payment in full, the amount paid by Medicaid
    • Determine the patient's identity
    • Verify the patient's age
    • Verify the patient's eligibility
    • Maintain records for minimum 5 years
  • DOB: 05/09/1994 F CARD # 00001 DEPARTMENT OF MEDICAL ASSISTANCE SERVICES COMMONWEALTH OF VIRGINIA V I RG I N I A J. R E C I P I E N T 9 9 9 9 9 9 9 9 9 9 9 9 002286
  • Medicaid Verification Options
    • MediCall
    • ARS- Web-Based Medicaid Eligibility
  • MediCall/ARS- Information Available
    • Medicaid client eligibility/benefit verification
    • Service limit information
    • Claim status
    • Prior authorization
    • Provider check log
    • Primary Payer Information
    • Medallion Participation
    • Managed Care Organization Assignment
  • MediCall
    • 800-884-9730
    • 800-772-9996
    • 804-965-9732
    • 804-965-9733
  • Automated Response System (ARS)
    • Web-based eligibility verification option
      • Free of Charge
      • Information received in “real time”
      • Secure
      • Fully HIPAA compliant
  • Automated Response System- Registration
    • Registration
      • virginia.fhsc.com
    • Questions concerning registration process
      • Web Support Helpline 800-241-8726
  • ARS User Guide
    • Located on the DMAS web-site under Provider Services section
    • General information on ARS eligibility verification
    • Instructions on the using the system
    • “ FAQ”(frequently asked questions) section
  • 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)
  • 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
  • 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: [email_address]
    • Phone: (800) 924-6741
    • Fax: (804) 273-6797
  • Billing on the CMS-1500
  • MAIL CMS-1500 FORMS TO :
    • Department of Medical Assistance Services
    • Practitioner
    • P. O. Box 27444
    • Richmond, VA 23261
  • TIMELY FILING
    • ALL CLAIMS MUST BE SUBMITTED AND PROCESSED WITHIN ONE YEAR FROM THE DATE OF SERVICE
    • EXCEPTIONS
      • Retroactive/Delayed Eligibility
      • Denied Claims
    • Submit claims with documentation attached explaining the reason for delayed submission.
  • CMS-1500 CLAIM FORM
    • Use ONLY the ORIGINAL
    • RED & WHITE
    • Invoice
    • Photocopies are not Acceptable
    • Computer generated claims must match NUBC uniform standards
  • MEDICAID (Medicaid #) Locator 1: Medicaid CHAMPUS (Sponsor's SSN) 1. MEDICARE (Medicare #) MEDICAID CLAIM 2. PATIENT'S NAME (Last Name, First Name, Middle Initial) TRICARE
  • 1a. INSURED'S I.D. NUMBER (FOR PROGRAM IN ITEM 1) Locator 1a: Recipient ID Number (Be sure to include all 12 digits) 123456789014
  • Locator 2: Patient's Name 2. PATIENT'S NAME (Last name, First Name, Middle Initial) Smith, Sam 5. PATIENT'S ADDRESS (No., Street)
  • Locator 10: Accident-Related 10. IS PATIENT'S CONDITION RELATED TO: a. EMPLOYMENT? (CURRENT OR PREVIOUS) b. AUTO ACCIDENT? c. OTHER ACCIDENT? YES NO PLACE (State) YES YES NO NO You MUST check YES or NO for a, b & c
  • 21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY 1. 2. 3. 4. 3441 Locator 21: Diagnosis Codes May enter up to 4 codes Omit decimals 2963
  • Locators 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
  • 24. A. DATE(S) OF SERVICE From To MM DD YY MM DD YY Locator 24A : Dates of Service 06 30 08 06 30 08 07 01 08 07 07 08 1 2 Both FROM and TO dates must be completed Dates must be within same calendar month
  • B. Place of Service Locator 24B: Place of Service 11 11-Office location 12 – Patients Home Medicaid accepts the same 2 digit CMS Place of Service codes as Medicare Note: Type of Service is no longer required
  • Emergency Indicator-24C
    • This locator will be used to indicate whether the procedure was an emergency
    • DMAS will only accept a ‘Y’ for yes in this locator
    • If there was no emergency leave blank
  • C. EMG Locator 24C: EMG Medicaid will accept a ‘Y’ in this Locator to indicate that the procedure was an emergency Y
  • D. Locator 24D: Procedure Codes PROCEDURES, SERVICES, OR SUPPLIES (Explain Unusual Circumstances) CPT/HCPCS MODIFIER S9129 90806
  • 21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY 1. 2. 3. 4. 34431 Locator 24E: Diagnosis Code E. DIAGNOSIS POINTER 1 2963 1,2 Enter the entry identifier of the ICD-9-CM diagnosis code listed in Locator 21. To identify more than one diagnosis code, separate the indicators with a comma.
  • F. $ CHARGES Locator 24 F: Charges Enter the usual and customary charges
  • G. DAYS OR UNITS Locator 24G: Days or Units 3 Enter the number of times or hours the procedure, service, or item was provided during the service period
  • H. Locator 24H: EPSDT/Family Plan 1 EPSDT Family Plan 1-EPSDT 2-Family Planning Service
  • Rendering Provider ID # Locator-24I-J
    • The open area of 24J will contain the NPI of the provider rendering the service
  • Locator 24I: ID. Qual. & 24J: Rendering Provider ID # I. ID. QUAL J. RENDERING PROVIDER ID. # NPI 12345647890
  • 26. PATIENT ACCOUNT NUMBER Locator 26: Patient’s Account Number (Optional) 12345678918765 Can not exceed 17 alphanumeric digits
  • Total Charge Locator 28
    • DMAS now requires this locator to be completed
    • Enter the total charges for the services in 24F lines 1-6
  • 28. TOTAL CHARGE Locator 28: Total Charges $
  • 31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS (I certify that the statements on the reverse apply to this bill and are made a part thereof. ) SIGNED DATE Locator 31: Signature & Date If there is a signature waiver on file, you may stamp, print, or computer-generate the signature
  • Service Facility Location Information Locator 32
    • Enter information for the location where services
    • were rendered
      • First line-Name
      • Second line-Address
      • Third line-City, State, 9 digit zip code
    • Multiple offices-the zip code must reflect the office location where services were rendered
    • No punctuation in the address
    • Space between city and state
    • Include hyphen for the 9 digit zip code
  • Service Facility Location Information Locator 32a-b
    • Enter the 10 digit NPI number of the service location in 32a
  • Locator 32: Service Facility Location Information 32. SERVICE FACILITY LOCATION INFORMATION a. b. NPI 1234567890
  • Billing Provider Info & PH #-Locator 33
    • 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
  • Service Facility Location Information Locator 33a-b
    • Enter the 10 digit NPI number of the service location in 33a
  • Locator 33: Billing Provider Info & PH # 33. BILLING PROVIDER INFO & PH # a. b. NPI 1234567890
  • 22. MEDICAID RESUBMISSION CODE ORIGINAL REF. NO. Locator 22 : Adjustments and Voids 1032 xxxxxxxxxxxxxxxx Adjustment or Resubmission Code From original remittance Void Chap. V, Medicaid Physician’s Manual has code list.
  • THANK YOU
    • Department of Medical Assistance Services
    • www.dmas.virginia.gov