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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
  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> </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)
  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> </li></ul>