BR200713 Banner Page, March 27, 2007
Contents
1. publications subscribe to the HCP E mail Notifications at http www indianamedicaid com ihcp mailing_list default asp EDS Page 4 of 4 P O Box 7263 Indianapolis IN 46207 7263 For more information visit http Avww indianamedicaid com2. 1500 Claim Form Implementation Timeline Change The timeline for mandating the use of the CMS 1500 08 05 claim form has been changed from the original date of April 1 2007 The Office of Medicaid Policy and Planning OMPP has not determined a new date for mandating the use of the new form Providers may continue submitting claims on the CMS 1500 12 90 until further notice The timeline change is due to errors in the formatting of this form by the print vendors Providers may continue submitting claims on the CMS 1500 12 90 until further notice During this time EDS will continue to accept both versions of this claim form However providers using the new CMS 1500 08 05 claim form must ensure that they use a correctly formatted version CMS published the following notice related to this finding Tt has recently come to our attention that there are incorrectly formatted versions of the revised form being sold by print vendors specifically the Government Printing Office GPO After reviewing the situation the GPO has determined that the source files they received from the NUCC s authorized forms designer were improperly formatted This resulted in the sale of both printed forms and negatives which do not comply with the form specifications Given the circumstances CMS has decided to extend the acceptance period of the Form CMS 1500 12 90 version beyond the original April 1 2007 deadline while this situation is resolved Medicare contra
3. INDIANA HEALTH COVERAGE PROGRAMS BANNER PAGE BR200713 MARCH 27 2007 All Providers Updates of Billing Instructions for Radioimmunotherapy Using Zevalin This article supplements articles published in the November 2004 Indiana Health Coverage Programs IHCP provider newsletter VL2004 and banner page BR200513 Effective for dates of service January 1 2006 and after the IHCP provides reimbursement for services reported with Healthcare Common Procedure Coding System HCPCS codes A9542 Indium In 111 ibritumomab tiuxetan diagnostic per study dose up to 5 millicuries and A9543 Yttrium Y 90 ibritumomab tiuxetan therapeutic per treatment dose up to 40 millicuries HCPCS codes A9542 and A9543 replace HCPCS codes C1082 and C1083 respectively which were end dated December 31 2005 All other billing requirements remain unchanged Previously denied claims for A9542 and A9543 will be reprocessed for dates of service January 1 2006 through the present Please direct questions to EDS Customer Assistance at 317 655 3240 in the Indianapolis local area or toll free at 1 800 577 1278 Outpatient Hospital Rates New outpatient hospital rates have been set for the new chemotherapy codes effective January 1 2006 Claims submitted on or after January 1 2006 will be reprocessed at the new rates Please direct questions to EDS Customer Assistance at 317 655 3240 in the Indianapolis local area or toll free at 1 800 577 1278 CMS
4. ctors will be directed to continue to accept the Form CMS 1500 12 90 until notified by CMS to cease At present we are targeting June 1 2007 as that date In addition during the interim contractors will be directed to return not manually key any Form CMS 1500 08 05 forms received which are not printed to specification By returning the incorrectly formatted claim forms back to you we are able to make you aware of the situation which will allow you to begin communications with your form supplier The following will help you to properly identify which form is which The old version of the form contains Approved OMB 0938 0008 FORM CMS 1500 12 90 on the bottom of the form typically on the lower right corner signifying the version is the December 1990 version The revised version contains Approved OMB 0938 0999 FORM CMS 1500 08 05 on the bottom of the form signifying the version is the August 2005 version The best way to identify if your CMS 1500 08 05 version forms are correct is by looking at the upper right hand corner of the form On properly formatted claim forms there will be approximately a 1 4 gap between the tip of the red arrow above the vertically stacked word CARRIER and the top edge of the paper If the tip of the red arrow is touching or close to touching the top edge of the paper then the form is not printed to specifications EDS Page I of 4 P O Box 7263 Indianapolis IN 46207 7263 For more infor
5. der User Lists will be updated to allow the user to enter NPI or LPI data for each provider in his or her User List When sending NPI including the taxonomy codes and nine digit postal codes increases the chances for matching a unique LPI For more information about NPI including how to receive and report NPI to the IHCP visit the NPI section of the IHCP Web site at http www indianamedicaid com ihcp ProviderServices npi asp Claims Reprocessing Procedure Code V5264 The IHCP is reprocessing medical claims submitted for procedure code V5264 Ear mold insert not disposable any type for claims billed between September 5 2006 and February 1 2007 During that period claims billed with procedure code V5264 inappropriately denied for edit 4209 No Pricing Segment for Procedure Modifier Combination The reprocessed claims will appear on remittance advice RA statements dated April 10 2007 March RAI and MDS Supportive Documentation Guideline Changes CMS announced the following March 2007 revision to the Long Term Care Facility Resident Assessment Instrument RAI User s Manual In the March 2007 Revision Table referencing Section P1 page number 3 182 the words or biological e g contrast material are deleted from the following sentence Includes any drug er bielesicalte e contrast materah given by intravenous push or drip through a central or peripheral port No change is necessary for the Minimum Data Set Support
6. he LPI The 1D qualifier indicates the value to the immediate right If the 1D qualifier is not used the claim will be returned to the provider EDS Page 2 of 4 P O Box 7263 Indianapolis IN 46207 7263 For more information visit http Avww indianamedicaid com Indiana Health Coverage Programs March 27 2007 Banner Page BR200713 Field 17a Referring Provider Number Field 33b Billing Provider Qualifier and 1D Number 33 BILLING PROVIDER INFO amp PH a b 1D 100000000A 17a 1D 100000000 17b NPI Fields 24I and 24J Rendering Provider Number 241 24J ID RENDERING QUAL PROVIDER ID 1D 100000000 NPI Timeline for Revised Paper Claim Forms The following information does not apply to providers rendering services in the risk based managed care RBMC delivery system These providers should contact the managed care organization MCO with whom they are contracted for information about paper claim form transition The National Uniform Claim Committee NUCC the National Uniform Billing Committee NUBC and the American Dental Association ADA have revised the layouts of the institutional professional and dental paper claim forms The current institutional UB 92 claim form will be replaced with the institutional UB 04 The current professional CMS 500 health insurance claim form will be revised to the 08 05 version The ADA dental claim for
7. ive Documentation Guidelines RUG II Version 5 12 34 Grouper document as this reference has already been omitted Please note there is a change to the Supportive Documentation Guidelines Consolidated Q amp A section on page 17 of 21 The second sentence in the first A paragraph currently states Either the initial assessment for new treatment or the documentation of ongoing respiratory assessments on or before the A3a date is acceptable This sentence has been changed to read Either the initial assessment for new treatment or the documentation of ongoing respiratory assessments during the observation period are acceptable Billing on the CMS 1500 Form The NPI implementation date is May 23 2007 During the transition period providers must use the 1D qualifier when submitting the Legacy Provider Identifier LPI on the CMS 1500 claim form Qualifiers indicate the value of the next field and allow for multiple uses of the same field Qualifiers for referring rendering and billing must be submitted when supplying an LPI or a taxonomy code If a valid qualifier is not used the claim will be returned to the provider Field 17a Referring Provider Number Fields 24 and 24J Rendering Provider Number and Field 33b Billing Provider Qualifier and 1D Number must contain the 1D qualifier when submitting an LPI on the claim form Providers submitting claims with LPI during the transition period must use the 1D qualifier to the left of t
8. lis IN 46207 7263 For more information visit www indianamedicaid com Indiana Health Coverage Programs March 27 2007 Banner Page BR200713 All Dental Providers ADA 2006 Claim Form The adoption of the new ADA 2006 claim form causes changes in IHCP billing requirements Effective April 15 2007 emergency services rendered must be noted in field 2 Predetermination Preauthorization Number on the new claim form by entering the word Emergency These services were previously noted in box 53 on the ADA 2000 claim form under radiographs Failure to comply may result in claim denials Please direct questions to EDS Customer Assistance at 317 655 3240 in the Indianapolis local area or toll free at 1 800 577 1278 Topical Fluoride Brush on Application As outlined in the Indiana Administrative Code IAC 405 IAC 5 14 4 Reimbursement is available for one 1 topical application of fluoride every six 6 months per recipient only for patients who are twelve 12 months of age or older but who are younger than twenty one 21 years of age Topical applications of fluoride are not covered for recipients twenty one 21 years of age or older A provider using the appropriate Current Dental Terminology CDT codes for services rendered to members less than 21 years of age may be reimbursed for the topical application of fluoride using the brush on method versus using a dental tray Coverage is limited to one unit every six months for i
9. m will be replaced with J400D The EDS pharmacy claim forms will be revised to include NPI information The pharmacy claim forms will be available May 16 2007 and may be obtained from the Forms page of the IHCP Web site at http www indianamedicaid com ihcp Publications forms asp Links to the other new claim forms will be added to the IHCP Web site Forms page according to the start date listed in Table 1 The IHCP will transition to the new paper claim forms with the timelines noted in Table 1 During the transition period both old and new claim forms will be accepted All claim forms will have a transition period except the Pharmacy claim form Table 1 outlines the transition period and cutover dates for each type of paper claim form The availability date of the pharmacy claim forms was changed to allow providers additional time to familiarize themselves with the forms Table 1 Timeline Revised Paper Claim Forms Transition Period Only New Forms Current Old and New Forms Accepted Accepted Form New Form Start Date End Date Cutover Date CMS 1500 08 05 February 15 2007 UB 92 UB 04 April 1 2007 May 22 2007 May 23 2007 ADA 2000 ADA 2006 April 15 2007 May 22 2007 May 23 2007 No Transition Period May 23 2007 Contact Information Please direct questions to EDS Customer Assistance at 317 655 3240 in the Indianapolis local area or toll free at 1 800 577 1278 EDS Page 3 of 4 P O Box 7263 Indianapo
10. mation visit www indianamedicaid com Indiana Health Coverage Programs March 27 2007 Banner Page BR200713 Web interChange is being updated for NPI Effective April 1 2007 Web interChange will begin accepting the National Provider Identifier NPI for all Web transactions requiring provider identification The functionality of Web interChange remains the same however the layout of some of the screens is changing to allow users to choose to send either the NPI or the Legacy Provider Identifier LPI which is the current IHCP provider number Existing Web interChange security mechanisms will ensure that any user is only allowed to view the information for which he or she has been granted access NPI information will only be available if the provider has reported its NPI to the IHCP The following is an overview of the changes Inquiry Pages Member Eligibility Inquiry Claim Inquiry Check Inquiry Prior Authorization Inquiry and Provider Profile Inquiry If an NPI has been reported the user will have the ability to select between NPI or LPI in the search criteria If an NPI has not been reported the user will not have the ability to select between NPI or LPI in the search criteria Claim Submission Prior to the mandatory NPI date currently May 23 2007 all of the Claim Submission pages on Web interChange will allow the user to enter his or her NPI or LPI The tabbing order on the Claim Submission screens remains the same Provi
11. nstitutional and non institutional members Topical fluoride includes varnish gel or foam All Pharmacy and Prescribing Providers State Maximum Allowable Cost Update Effective May 4 2007 State MAC rates for the following drugs will be added as listed below in Table 2 Table 2 Additions to the State MAC Rates for Legend Drugs State MAC State MAC Drug Name Rate Drug Name Rate FLUOROURACIL 50 MG ML VIAL 0 28030 PROMETHAZINE 12 5 MG TABLET 0 40440 Effective May 4 2007 State MAC rates for the following drugs will be decreased as listed below in Table 3 Table 3 Decreases to the State MAC Rates for Legend Drugs State MAC State MAC Drug Name Rate Drug Name Rate CITALOPRAM HBR 20 MG TAB 0 07464 LEVOTHYROXINE 88 MCG TABLET 0 16842 FLUOCINONIDE 0 05 CREAM 0 04730 LEVOTHYROXINE 100 MCG TABLET 0 25389 GABAPENTIN 300 MG CAPSULE 0 11335 LEVOTHYROXINE 200 MCG TABLET 0 28185 HYDROCODONE APAP 10 500 TABLET 0 14490 SPIRONOLACTONE 25 MG TABLET 0 18599 Contact Information Direct questions about the State MAC for legend drugs to the Myers and Stauffer Pharmacy Unit at 317 816 4136 in the Indianapolis local area or at 1 800 591 1183 or by e mail at pharmacy mslc com If you need additional copies of this banner please download them from the IHCP Web site at http www indianamedicaid com ihcp Publications banner_results asp To receive e mail notifications of future IHCP
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