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Department of Medical Assistance Services

As a Participating Provider You must. Accept as payment in full, the amount paid by MedicaidDetermine the patient's identityVerify the patient's ageVerify the patient's eligibilityMaintain records for minimum 5 years . . DOB: 05/09/1994 F CARD

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Department of Medical Assistance Services

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    1. Department of Medical Assistance Services Department of Education Medicaid Eligibility Verification Options and Billing October 8, 2010 www.dmas.virginia.gov

    2. As a Participating Provider You must Accept as payment in full, the amount paid by Medicaid Determine the patient's identity Verify the patient's age Verify the patient's eligibility Maintain records for minimum 5 years

    3. The most visible change will be the implementation of the new plastic Medicaid card. Here is an example of the format. The most visible change will be the implementation of the new plastic Medicaid card. Here is an example of the format.

    4. Medicaid Verification Options MediCall ARS- Medicaid Web Portal

    5. MediCall/ARS- Information Available Medicaid client eligibility/benefit verification Service limit information Claim status Prior authorization Provider check log Primary Payer Information Medallion Participation Managed Care Organization Assignment

    6. MediCall 800-884-9730 800-772-9996 804-965-9732 804-965-9733

    7. Medicaid Web Portal-ARS Web-based eligibility verification option Free of Charge Information received in “real time” Secure Fully HIPAA compliant

    8. Medicaid Web Portal Automated Response System A new enhance Web Portal will allow providers to transact all Medicaid business via one central location The web portal will provide access to: Member Eligibility Status Payment History Remittance Advices Service Authorizations

    9. Automated Response System- Registration First time users To establish a user ID and password go to: www.virginiamedicaid.dmas.virginia.gov By registering you are establishing yourself as a staff member with administrative rights for the organization

    10. Automated Response System- Registration Established Users-Delegated Administrators Received a letter containing their NPI and instructions on accessing the Web Portal must have accessed the Web Portal and changed their temporary password

    11. ACS Web Registration Support Call Center Questions regarding new user registration, existing user access letter, or temporay passwords 1-866-352-0496 Available after June 8, 2010 8 am – 5 pm Monday thru Friday No holidays Virginia.Websupport@acs-inc.com

    12. Provider Call Center Claims, covered services, billing inquiries: 800-552-8627 804-786-6273 8:30am – 4:30pm (Monday-Friday) 11:00am – 4:30pm (Wednesday)

    13. Provider Enrollment NPI enrollment, EFT sign up, or change of address: Provider Enrollment Unit P. O. Box 26803 Richmond, VA 23261 888-829-5373 804-270-5105 804-270-7027 - Fax

    14. Electronic Billing Electronic Claims Coordinator E-mail: virginia.edisupport@acs-inc.com Phone: (888) 352-0766 Fax: (888) 335-8460

    15. Billing on the CMS-1500

    16. MAIL CMS-1500 FORMS TO: Department of Medical Assistance Services Practitioner P. O. Box 27444 Richmond, VA 23261

    17. TIMELY FILING ALL CLAIMS MUST BE SUBMITTED AND PROCESSED WITHIN ONE YEAR FROM THE DATE OF SERVICE EXCEPTIONS Retroactive/Delayed Eligibility Denied Claims Submit claims with documentation attached explaining the reason for delayed submission.

    18. CMS-1500 CLAIM FORM Use ONLY the ORIGINAL RED & WHITE Invoice Photocopies are not Acceptable Computer generated claims must match NUBC uniform standards

    24. Locators 24A thru 24J These blocks have been divided into open areas and a shaded red line area The shaded area is ONLY for supplemental information

    27. Emergency Indicator-24C This locator will be used to indicate whether the procedure was an emergency DMAS will only accept a ‘Y’ for yes in this locator If there was no emergency leave blank

    34. Rendering Provider ID # Locator-24I-J The open area of 24J will contain the NPI of the provider rendering the service

    37. Total Charge Locator 28 DMAS now requires this locator to be completed Enter the total charges for the services in 24F lines 1-6

    40. Service Facility Location Information Locator 32 Enter information for the location where services were rendered First line-Name Second line-Address Third line-City, State, 9 digit zip code Multiple offices-the zip code must reflect the office location where services were rendered No punctuation in the address Space between city and state Include hyphen for the 9 digit zip code

    41. Service Facility Location Information Locator 32a-b Enter the 10 digit NPI number of the service location in 32a

    42. Locator 32: Service Facility Location Information

    43. Billing Provider Info & PH #-Locator 33 Enter the information to identify the provider that is requesting to be paid First line-Name Second line-Address Third line-City, State, 9 digit zip code No punctuation in the address Space between city and state Include hyphen for the 9 digit zip Phone number is to be entered in the area to the right of the field title, no hyphen or space used

    44. Service Facility Location Information Locator 33a-b Enter the 10 digit NPI number of the service location in 33a

    45. Locator 33: Billing Provider Info & PH #

    47. THANK YOU Department of Medical Assistance Services www.dmas.virginia.gov

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