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Billing Presentation

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Billing Presentation

  1. 1. Department of Medical Assistance Services Department of Education Medicaid Eligibility Verification Options and Billing October 6, 2009 www.dmas.virginia.gov
  2. 2. As a Participating Provider You must <ul><li>Accept as payment in full, the amount paid by Medicaid </li></ul><ul><li>Determine the patient's identity </li></ul><ul><li>Verify the patient's age </li></ul><ul><li>Verify the patient's eligibility </li></ul><ul><li>Maintain records for minimum 5 years </li></ul>
  3. 3. 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
  4. 4. Medicaid Verification Options <ul><li>MediCall </li></ul><ul><li>ARS- Web-Based Medicaid Eligibility </li></ul>
  5. 5. MediCall/ARS- Information Available <ul><li>Medicaid client eligibility/benefit verification </li></ul><ul><li>Service limit information </li></ul><ul><li>Claim status </li></ul><ul><li>Prior authorization </li></ul><ul><li>Provider check log </li></ul><ul><li>Primary Payer Information </li></ul><ul><li>Medallion Participation </li></ul><ul><li>Managed Care Organization Assignment </li></ul>
  6. 6. MediCall <ul><li>800-884-9730 </li></ul><ul><li>800-772-9996 </li></ul><ul><li>804-965-9732 </li></ul><ul><li>804-965-9733 </li></ul>
  7. 7. Automated Response System (ARS) <ul><li>Web-based eligibility verification option </li></ul><ul><ul><li>Free of Charge </li></ul></ul><ul><ul><li>Information received in “real time” </li></ul></ul><ul><ul><li>Secure </li></ul></ul><ul><ul><li>Fully HIPAA compliant </li></ul></ul>
  8. 8. Automated Response System- Registration <ul><li>Registration </li></ul><ul><ul><li>virginia.fhsc.com </li></ul></ul><ul><li>Questions concerning registration process </li></ul><ul><ul><li> Web Support Helpline 800-241-8726 </li></ul></ul>
  9. 9. ARS User Guide <ul><li>Located on the DMAS web-site under Provider Services section </li></ul><ul><li>General information on ARS eligibility verification </li></ul><ul><li>Instructions on the using the system </li></ul><ul><li>“ FAQ”(frequently asked questions) section </li></ul>
  10. 10. Provider Call Center <ul><li>Claims, covered services, billing inquiries: </li></ul><ul><li>800-552-8627 </li></ul><ul><li>804-786-6273 </li></ul><ul><li>8:30am – 4:30pm (Monday-Friday) </li></ul><ul><li>11:00am – 4:30pm (Wednesday) </li></ul>
  11. 11. Provider Enrollment <ul><li>New provider numbers or change of address: </li></ul><ul><li>First Health – PEU </li></ul><ul><li>P. O. Box 26803 </li></ul><ul><li>Richmond, VA 23261 </li></ul><ul><li>888-829-5373 </li></ul><ul><li>804-270-5105 </li></ul><ul><li>804-270-7027 - Fax </li></ul>
  12. 12. Electronic Billing <ul><li>Electronic Claims Coordinator </li></ul><ul><li>Mailing Address </li></ul><ul><li>First Health Services Corporation Virginia Operations Electronic Claims Coordinator 4300 Cox Road Glen Allen, VA 23060 </li></ul><ul><li>E-mail: [email_address] </li></ul><ul><li>Phone: (800) 924-6741 </li></ul><ul><li>Fax: (804) 273-6797 </li></ul>
  13. 13. Billing on the CMS-1500
  14. 14. MAIL CMS-1500 FORMS TO : <ul><li>Department of Medical Assistance Services </li></ul><ul><li>Practitioner </li></ul><ul><li>P. O. Box 27444 </li></ul><ul><li>Richmond, VA 23261 </li></ul>
  15. 15. TIMELY FILING <ul><li>ALL CLAIMS MUST BE SUBMITTED AND PROCESSED WITHIN ONE YEAR FROM THE DATE OF SERVICE </li></ul><ul><li>EXCEPTIONS </li></ul><ul><ul><li>Retroactive/Delayed Eligibility </li></ul></ul><ul><ul><li>Denied Claims </li></ul></ul><ul><li>Submit claims with documentation attached explaining the reason for delayed submission. </li></ul>
  16. 16. CMS-1500 CLAIM FORM <ul><li>Use ONLY the ORIGINAL </li></ul><ul><li>RED & WHITE </li></ul><ul><li>Invoice </li></ul><ul><li>Photocopies are not Acceptable </li></ul><ul><li>Computer generated claims must match NUBC uniform standards </li></ul>
  17. 17. 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
  18. 18. 1a. INSURED'S I.D. NUMBER (FOR PROGRAM IN ITEM 1) Locator 1a: Recipient ID Number (Be sure to include all 12 digits) 123456789014
  19. 19. Locator 2: Patient's Name 2. PATIENT'S NAME (Last name, First Name, Middle Initial) Smith, Sam 5. PATIENT'S ADDRESS (No., Street)
  20. 20. 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. 21. 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
  22. 22. Locators 24A thru 24J <ul><li>These blocks have been divided into open areas and a shaded red line area </li></ul><ul><li>The shaded area is ONLY for supplemental information </li></ul>
  23. 23. 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
  24. 24. 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
  25. 25. Emergency Indicator-24C <ul><li>This locator will be used to indicate whether the procedure was an emergency </li></ul><ul><li>DMAS will only accept a ‘Y’ for yes in this locator </li></ul><ul><li>If there was no emergency leave blank </li></ul>
  26. 26. C. EMG Locator 24C: EMG Medicaid will accept a ‘Y’ in this Locator to indicate that the procedure was an emergency Y
  27. 27. D. Locator 24D: Procedure Codes PROCEDURES, SERVICES, OR SUPPLIES (Explain Unusual Circumstances) CPT/HCPCS MODIFIER S9129 90806
  28. 28. 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.
  29. 29. F. $ CHARGES Locator 24 F: Charges Enter the usual and customary charges
  30. 30. 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
  31. 31. H. Locator 24H: EPSDT/Family Plan 1 EPSDT Family Plan 1-EPSDT 2-Family Planning Service
  32. 32. Rendering Provider ID # Locator-24I-J <ul><li>The open area of 24J will contain the NPI of the provider rendering the service </li></ul>
  33. 33. Locator 24I: ID. Qual. & 24J: Rendering Provider ID # I. ID. QUAL J. RENDERING PROVIDER ID. # NPI 12345647890
  34. 34. 26. PATIENT ACCOUNT NUMBER Locator 26: Patient’s Account Number (Optional) 12345678918765 Can not exceed 17 alphanumeric digits
  35. 35. Total Charge Locator 28 <ul><li>DMAS now requires this locator to be completed </li></ul><ul><li>Enter the total charges for the services in 24F lines 1-6 </li></ul>
  36. 36. 28. TOTAL CHARGE Locator 28: Total Charges $
  37. 37. 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
  38. 38. Service Facility Location Information Locator 32 <ul><li>Enter information for the location where services </li></ul><ul><li>were rendered </li></ul><ul><ul><li>First line-Name </li></ul></ul><ul><ul><li>Second line-Address </li></ul></ul><ul><ul><li>Third line-City, State, 9 digit zip code </li></ul></ul><ul><li>Multiple offices-the zip code must reflect the office location where services were rendered </li></ul><ul><li>No punctuation in the address </li></ul><ul><li>Space between city and state </li></ul><ul><li>Include hyphen for the 9 digit zip code </li></ul>
  39. 39. Service Facility Location Information Locator 32a-b <ul><li>Enter the 10 digit NPI number of the service location in 32a </li></ul>
  40. 40. Locator 32: Service Facility Location Information 32. SERVICE FACILITY LOCATION INFORMATION a. b. NPI 1234567890
  41. 41. Billing Provider Info & PH #-Locator 33 <ul><li>Enter the information to identify the provider that is requesting to be paid </li></ul><ul><ul><li>First line-Name </li></ul></ul><ul><ul><li>Second line-Address </li></ul></ul><ul><ul><li>Third line-City, State, 9 digit zip code </li></ul></ul><ul><li>No punctuation in the address </li></ul><ul><li>Space between city and state </li></ul><ul><li>Include hyphen for the 9 digit zip </li></ul><ul><li>Phone number is to be entered in the area to the right of the field title, no hyphen or space used </li></ul>
  42. 42. Service Facility Location Information Locator 33a-b <ul><li>Enter the 10 digit NPI number of the service location in 33a </li></ul>
  43. 43. Locator 33: Billing Provider Info & PH # 33. BILLING PROVIDER INFO & PH # a. b. NPI 1234567890
  44. 44. 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.
  45. 45. THANK YOU <ul><li>Department of Medical Assistance Services </li></ul><ul><li>www.dmas.virginia.gov </li></ul>

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