Provider Bulletin Dec 2002
Contents
1. enrolled in health plan on dates of service The recipient must be in the Fee For Service program on the date of service and or date of admission 9 Provider tax ID number on the claim does not match those for the provider The provider tax ID number on the claim must match the information that HPMMIS has on file If your tax ID number changes please report the change to MQD on an 1139 form 10 Outpatient hospital claims with only the revenue code on the claim line and missing the appropriate CPT HCPCS codes Outpatient hospital claims must be billed with a CPT HCPCS code unless it is an emergency claim with revenue codes 25X and 63X 11 Claim requiring a prior authorization No prior authorization on file in HPMMIS If a prior authorization was obtained then resubmit the claim and attach a copy of the approved authorization Claims for the Medicaid Waiver Program should be resubmitted after contacting case Manager 12 Anesthesia claims billed without the minutes Also anesthesia claims billed without the ASA modifiers Anesthesia claims must include either an AA QK QY or QS modifier The minutes must be included on the claim with the units below the minutes Medicaid Provider Bulletin Volume 1 Issue 7 Dec 2002 Jan 2003 6 Good to Know New Provider Manual CDs Provider manuals on CDs have recently been mailed out Please contact ACS at 952 5700 if you have2. other applicable info is given you may start your next search e You have two chances to enter valid data in response to a prompt If you enter invalid data more than twice your call will be terminated In this instance hang up and try your call again e Press 7 to repeat the current prompt e Eligibility information is typically good for the entire month Example You call AVRS on Dec 13 and the recipient is eligible for that date of service Generally that recipient will remain eligible through Dec 31 However the recipient may not be eligible on a prior date i e December 1 Make sure to specify the date of service when checking eligibility e Itis important to note that recipients can gain eligibility mid month Example You call AVRS on Dec 15 and the recipient is not eligible On Dec 16 you call AVRS and the recipient is now eligible e Press to use the current date as the beginning and ending date of service You will not be able to look up eligibility information for future dates To request backdated eligibility info enter your start date as mm dd yyyy The end date must be within 30 days of the start date e Call 1 800 518 8887 AVRS Hotline to report technical difficulties e To obtain an AVRS User Manual go to www medifax com click on Products at the top of the page select User Manuals select Voice Response System and select Hawaii Medicaid Eligibility 4 A C S State Healthcare 1440 Kapiolan
3. 7 Continued Page 7 Medicaid Provider Bulletin Volume 1 Issue 7 Dec 2002 Jan 2003 7 Good to Know Continued Long Wait Times to the Provider Inquiry Unit We apologize for the long wait times you may have experienced Most of the calls are due to claims status inquiries which usually causes an increase in our talk time due to multiple claim look ups and explanations In order to improve access to our call center if you are checking status on your claims please complete the Medicaid Correspondence Inquiry Form below and fax to us at 808 952 5595 or mail to ATTN Provider Relations ACS State Healthcare 1440 Kapiolani Blvd Suite 1400 Honolulu HI 96814 Provide us with provider name and Medicaid ID 4 e patient s recipient s ID 4 e dates of service e claim number if available We will research the claim and get back to you ACS State Healthcare 1440 Kapiolani Blvd Ste 1400 4 Honolulu HI 96814 369 a c sMEDICAID CORRESPONDENCE INQUIRY FORM 1 Date of Inquiry 2 Provider Name Last First Middle Initial 3 Provider Number 4 Address U Pay to Address U Service Address 5 Telephone Number 6 Name of Contact 7 Correspondence Number 8 Claim Number if applicable 9 Purpose of Inquiry O Questionable Payment O Adjustment Correction O Claims Status O Claims Filing Procedure O Other 10 Patient Name 11 Patient ID Number 12 FM Code 13 Dates of Service 14 Payment Date 15 Charge 16 A
4. Medicaid Provider Bulletin Published for the Medicaid Providers of Hawaii ACS Commitment In This Issue ACS Commitment Page 1 Claims Tips Page 2 3 MQD PAs Page 3 4 Top 12 Reasons Page 5 Good to Know Page 6 7 AVRS Helpful Hints Pages 8 Effective November 1 2002 the Med QUEST Division MQD transitioned from the HMSA claims processing to a new Medicaid claims processing system As your new Medicaid fiscal agent we the staff at Affiliated Computer Services ACS extend this commitment to each member of the provider community 1 to explain how new billing requirements are affecting your claim payments 2 to help review your Remittance Advice in order to determine which Important Contact Information Provider Inquiry Unit Call Center Oahu 952 5570 VOLUME 1 Issue 7 Dec 2002 Jan 2003 claims have not paid due to system errors more stringent edit criteria keying errors missing data or billing errors 3 to work with you to determine what must be corrected on your claim form ECS record 4 to expedite the correction of billing or keying errors 5 to work diligently with MQD and SSD to fix payment problems Sharon N Foster Account Manager ACS Hawaii Medicaid Med QUEST Fiscal Agent Mail Prior Auth Requests to Not Applicable to Medicaid ACS Waiver Program Neighbor Islands 1 800 235 4378 Eligibility Line AVRS 1 800 882 4608 Email Provider Inquiri
5. are currently receiving a high volume of duplicate PA requests If a PA is sent via fax it doesn t need to be sent hard copy as well e Providers must specify the quantities of services requested per a time period i e 1 month 6 year etc to ensure accurate processing of PAs e DMEs for less than 50 do not require a PA PAs will be returned to providers e Please use the new revised PA forms They can be printed off of the new provider manual e Recipients with Medicare Primary do not require Prior Authorization unless it is a service not covered by Medicare e When submitting PA do not use group billing number use servicing provider number e On Prior Authorization form 1144 complete the Medicare coverage box below the recipient ID number Interisland Travel for Medical Services Med QUEST is currently in the process of revising the process for interisland travel for medical services Please look for further details in future bulletins and memos Dental Prior Authorizations ADA form should not be used as a Prior Authorization form Please use the 1144 Prior Authorization form Medicaid Provider Bulletin Volume 1 Issue 7 Dec 2002 Jan 2003 5 Top 12 Reasons Why Your Claim Didn t Get Paid Reason Corrective Action 1 Claim submitted with MMIS Provider ID without the middle zeros or claim submitted with an HPMMIS Provider ID without the leading zeros Provider numbers must include all 6 digits with or without th
6. ations in HPMMIS HPMMIS allows only one active PA for a single date of service amp service code Be aware that any new PA approved with the same dates of service amp service codes will take the place of previously approved PAs with the same dates of service and service codes Only service codes specified in the new PA will be approved Any service codes listed on the old PA that are not included on the new PA will be end dated the day before the start of the new PA Conditional Authorizations Recipients Pending Eligibility Providers should submit the PA with DHS Pending documented in the recipient ID field The provider must then resubmit the PA with a copy of the conditional letter when the provider has the actual recipient ID number Referring Provider Signature The conditional provider letter is sent out to vendors who submit urgent PA requests without the referring provider signature The vendor must get the referring provider signature within 30 days and submit it to ACS or the PA will be denied Pharmacy Prior Authorizations Prior Authorization requests for drugs need to be sent to the ACS PBM in Atlanta How to Prevent Delays in Prior Authorization Processing e Write legibly illegible PA requests will be returned All the required information must be clearly written or requests for services may be delayed e Excessive number of duplicate requests impacts productivity timeliness and delays responsiveness to PA requests We
7. e check digit for old MMIS ID complete with all zeros Zeros must be included Use your new Provider ID number 2 Claim submitted with recipient ID without the leading zeros with or without the check digit Recipient numbers must include all 10 digits without the check digit 3 Claim submitted with tax line Z9020 S9999 D9020 or 091 revenue code To expedite processing of your claim please do not include charges for tax For UB 92 providers charges for taxes will cause the entire claim to deny 4 Dental claim without CDT 3 codes looks like anesthesia codes Dental claims billed without CDT 3 codes will deny 5 Interim claims for inpatients and long term care with a discharge hour or a discharge hour of O Interim claims should have a blank discharge hour 6 Medicare information submitted on the wrong part of the claim form deductibles and coinsurance should be listed in FL39 41 on the UB 92 as opposed to FL 55 Medicare deductibles and coinsurance should be listed in FL 39 41 on the UB 92 The EOB must be attached 7 Claim does not include an indication of payment from other payors when the recipient has other insurance or Z codes are being used for TPL amounts Payment from other payors should be indicated on the claim If the service is not covered by the other payor include a payment received amount of zero 8 Recipient not eligible for dates of service and or recipient
8. es to hi providerrelations acs inc com Fax Provider Inquiries to 808 952 5595 Fax Urgent Prior Auth Requests to 808 952 5562 Not Applicable To Medicaid Waiver Program Med QUEST Website The Med QUEST website is unexpectedly down A new website will be coming soon we will keep you informed P O Box 2561 Honolulu HI 96804 2561 Mail Returned Checks to ACS P O Box 1206 Honolulu HI 96807 1206 Mail MQD Claims to ACS P O Box 1220 Honolulu HI 96807 1220 Mail Medicaid SSD Waiver Claims to ACS P O Box 4631 Honolulu HI 96812 4631 Medicaid Provider Bulletin Volume 1 Issue 7 Dec 2002 Jan 2003 2 Claims Tips Group Provider ID Number PIN vs Individual Provider ID Number What to Use When Billing e Never use your group provider ID for claims submission Use hospital provider ID number to bill facility charges i e room amp board Use individual PIN for other charges such as professional fees e Reminder Please use your new eight digit provider ID to prevent the delay of your claims from being processed Coupons e When resubmitting a claim that originally required a coupon attach a copy of the eligibility coupon HCPCS Modifiers e Providers must use valid 2 character HCPCS modifiers e Like Medicare the Medicaid fee schedule has two distinct rates for certain procedures 1 when performed in facility settings and 2 when performed in settings other than facil
9. i Boulevard Suite 1400 Honolulu HI 96814
10. ill type for room and board charges The bill type for ancillary services should be the same Use appropriate HCPCS for ancillary services Continued Page 3 Medicaid Provider Bulletin Volume 1 Issue 7 Dec 2002 Jan 2003 3 Billing for Room Charges and Ancillary Charges Continued Level Of Care Bill Type Room amp Board Rev Code Subacute 17X or 27X 19X ICF 61X 1XX ICF MR 65X 1XX SNF 21X 1XX Swing Bed SNF 28X 1XX Swing Bed ICF 68X 1XX Waitlisted subacute 17X 19X Waitlisted ICF 11X or 21X 11X w occurrence span code 74 Waitlisted SNF 11X 11X w occurrence span code 75 Electronic Claims Submission e After successfully passing the ECS process remember to change your Transmission Indicator from test to production e For HAWI ID s a k a recipient ID s submit with full 10 characters include leading zeros Do not submit with check digits If the HAWI ID number is submitted without leading zeros the claim will deny e The Transmission Window for ECS is from Midnight to 6 00 p m HST Monday through Thursday and from Midnight to 4 00 p m HST on Friday The transmissions must be completed within this time frame Medicare Crossover e Medicare crossover claims do not require the referring provider s Medicaid ID number for consult procedures DME Rental Charges e When billing for rental charges for an entire month providers should use the first date of service as both the beg
11. inning and end dates i e 12 01 02 12 01 02 instead of 12 01 02 12 31 02 Med QUEST Prior Authorizations Definition of Urgent Request for Prior Authorizations Urgent medical conditions are conditions that require medical care within four days 32 working hours If the care is not received during this time a person s life or health may be jeopardized e Truly urgent requests will be reviewed within 48 hours two business days of receipt e Retro authorization of services and incontinent supply requests are not considered urgent e Submitting a request for routine care at the last minute is not urgent e Please kokua Marking urgent on requests that are not truly urgent slows down the process and clogs up the system Multiple PA Letters We are aware that the PA correspondence is producing multiple letters each being mailed separately We are working to modify the correspondence to list multiple lines on the same letter Behavioral Health Alert Behavioral Health Providers must submit the correct CPT codes include the number of visits per time period Continued Page 4 Medicaid Provider Bulletin Volume 1 Issue 7 Dec 2002 Jan 2003 4 Med QUEST Prior Authorizations Continued from Page 3 and the dates of service to ensure timely processing of PAs and associated claims If a provider is using more than one CPT code they must state how many visits per code Prior Authoriz
12. ities Codes subject to rates applicable when performed in facilities are identified in the Medicare fee schedule with an asterisk To expedite claims processing for these asterisked procedures please enter the modifier 32 when asterisked procedures are performed in non facility settings UB 92 e Do not submit claim with a tax line RC 091 Including a tax line will result in denial of your entire claim e The total amount paid by the TPL must be entered in FL 54 If the recipient has more than one TPL the amount paid by each TPL must be indicated on each line If the TPL denied the claim then indicate 0 on every line where no TPL payment was received Dental e Remember to submit claims using CDT 3 procedure codes All of these codes have a leading D which is required on your claims e Dental claims must be submitted on the ADA 1999 version 2000 dental claim form or a claim form in identical format e Enter the rendering provider s ID number in block 44 If the visit was the result of a referral enter the referring provider s ID number in block 47 If a procedure requires a tooth number you must submit a double digit number for permanent teeth i e 08 Single characters are accepted only for primary teeth Billing for Room Charges and Ancillary Charges e Long Term Care ancillary charges that are reimbursed in addition to the PPS rate should be submitted on a separate claim form e Use the appropriate level of care b
13. llowance 17 Remarks 18 Response to Provider U Claim Paid on U Denied on Reason U Claim Reviewed Maximum payment made O Adjustment claim initiated U Please submit claim with O Patient name and ID not in DHS files O Claim is in the processing system Please allow additional processing time QO Referred to DHS for determination and response directly to you 0 Unable to match above claim data with computer file data Please submit copy of claim Comments Shaded area for Medicaid use only Medicaid Provider Bulletin Volume 1 Issue 7 Dec 2002 Jan 2003 8 AVRS Helpful Hints e You must call from a Touch tone phone with Touch tone dialing enabled e Program the AVRS 1 800 882 4608 on speed dial e Have your new 8 digit provider ID and recipient s 10 digit HAWI or SSN ready e Once you are familiar with the AVRS you can key ahead responses to most prompts You need not wait until the prompt has been completely spoken to press a key or enter your response e Typical call flow 1111 PIN amp 1 HAWI amp 3 3 to start new search HAWI amp 3 3 to start new search e All menu options may be bypassed by entering your next selection The only menu option that cannot be bypassed is the verification of recipient information This is because you should be verifying that the recipient information is correct After the recipient information eligibility info TPL and any
14. not received your manual Changes to Your Provider Profile If you need to make any demographic changes please submit changes on an 1139 form and mail to DHS MQD HCMB P O Box 700190 Kapolei HI 96709 0190 Medicaid Waiver Providers should submit changes on an SSD Medicaid Waiver Provider Application Change Request form and mail to Social Services Division Contracts Monitoring 810 Richards Ste 501 Honolulu HI 96813 Claims Resubmission We are constantly updating and refining our claims system If you have determined that a claim has been denied in error please resubmit your claim Codes for Which No Separate Payment Is Made Effective 02 01 03 the Med QUEST Division will no longer pay separately for the codes in the table below Consistent with Medicare policy when these codes are covered payment for them is bundled into payment for other services R0076 78891 92533 93770 99002 99071 36540 78891 TC 92534 93770 TC 99024 99078 78890 78891 26 93740 937 70 26 99052 99090 78890 TC 92531 93740 TC 96902 99054 99091 78890 26 92532 93740 26 99001 99056 99288 Non Covered Codes The following is a list of CPT 4 codes that are not currently covered by Medicaid Medicare considers theses as B status codes for which separate payment is not allowed A4270 99000 99116 99142 99372 99379 90885 99050 99135 99361 99373 99380 90889 99058 99140 99362 99374 96545 99100 99141 99371 9937
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