DMAS is requiring the use of nine-digit ZIP codes on all claim submissions for all locations where an address is required.
Effective May 23, 2008, DMAS will only accept the Legacy Medicaid PIN in limited situations from providers who do not have an NPI (i.e., because the provider retired) and if the date(s) of service on the claim is prior to May 23, 2008.
These claim submissions will be researched and handled in an individual basis. In this situation, a claim or adjustment with the Legacy Medicaid PIN must be submitted on a paper claim form and mailed to :
All PAs should be requested using the Rendering (Servicing) Provider’s NPI. PAs should not be requested using the Group Practice organization NPI; and claims will deny if it is obtained with a Group NPI.
Effective May 23, 2008, the web-based Automated Response System (ARS), MediCall and the EDI Batch 276/277 must be accessed using your NPI/API.
An exception regarding direct supervision is found in Section 54.1 – 2952 of the Code of Virginia applying to the additional supervisory and oversight requirements place on Physician Assistants in hospitals and emergency departments.
DMAS policy will conform with the standards stipulated in State law regarding the provision of care in a Hospital setting by Physician’s Assistants.
Physician Assistants are allowed to bill for Medicaid covered services within their scope of practice through their supervising Physician’s National Provider Identifier (NPI), as long as the Physician is enrolled in the Virginia Medicaid program.
DMAS has not changed the covered services for which Physician’s Assistants are authorized to bill and receive reimbursement.
Effective January 1, 2008-the quantity of each NDC and unit of measure qualifier (F2, ML, GR or UN) will be required
Claims submitted on or after January 1, 2008 will be denied if this additional information is not listed on your claim
24. A. DATE(S) OF SERVICE From To MM DD YY MM DD YY Block 24A : Dates of Service 03 01 08 03 01 08 03 01 08 04 15 08 1 2 Both FROM and TO dates must be completed Dates must be within same calendar month N400026064871
For file reviews showing the patient’s deductible was previously considered from the traditional Medicare Plan and a second deductible was applied to the Medicare Advantage Plan, the 0922 denial is correct.
The deductible issue must be resolved between the two Medicare Plans.
Providers should contact the Medicare Advantage Plan and the traditional Medicare Plan and have them research the application of the Part B deductible(s).