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I.H.S./Tribal 638

I.H.S./Tribal 638. Presented by Provider Field Representatives Mina Reynaga & Kristen Brice. Contact Xerox. Call 505-246-0710 or 800-299-7304 - to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL.

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I.H.S./Tribal 638

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  1. I.H.S./Tribal 638 Presented by Provider Field Representatives Mina Reynaga & Kristen Brice

  2. Contact Xerox Call 505-246-0710 or 800-299-7304 - to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL. • For all contact, Claims, and Correspondence Addresses information go to the following link on the New Mexico Medicaid Web Portal: • https://nmmedicaid.acs-inc.com/nm/general/loadstatic.do?page=ContactUs.htm • Email: NMPRSupport@xerox.com

  3. Important State Websites • STATE WEBSITE: • MAD • http://www.hsd.state.nm.us/mad/ • Registers • http://www.hsd.state.nm.us/mad/registers/2012.html • I.H.S. and Tribal 638 Policy and Billing • http://www.hsd.state.nm.us/mad/providerpackets/b2.html

  4. Important State Websites • WEB PORTAL REFERENCES: • UB-04 Form Instructions • https://nmmedicaid.acs-inc.com/nm/pages/static/PDFs/Medicaid%20Publications/ClaimFormInstr/UB-04%20instructions.pdf • Adjustment/Void Request Form • https://nmmedicaid.acs-inc.com/nm/pages/static/Docs/MedicaidPubs/ADJUSTMENT%20VOID%20Request%20Form.doc • Current Remittance Advice News letter • https://nmmedicaid.acs-inc.com/nm/pages/static/latest_dev/Current%20Week.doc

  5. Xerox Field Representatives Provider Field Representatives: • Mina Reynaga • (800) 282-4477 or • (505) 246-9988 Ext. 8131233 E-mail: Erminia.reynaga@Xerox.com • Kristen Brice • (800) 282-4477 or • (505) 246-9988 Ext. 8131216E-mail: Kristen.brice@Xerox.com • Cc: NMPRSUPPORT@Xerox.com; virginia.brooks@state.nm.us

  6. Ways to Check Eligibility • On-Line Eligibility Inquiry—Web Portal • https://nmmedicaid.acs-inc.com • Automatic Voice Response System (AVRS) (800) 820-6901 • Xerox Eligibility Help Desk: (800)-705-4452 • Monday - Thursday 8:00 a.m. - 5:00 p.m. • Friday (Mountain Time) 8:00 a.m. - 4:00 p.m.

  7. Medicaid Limited Benefit Categories of Eligibility • 072: Medicaid full benefits • 035: Pregnancy-related services only • 029: Family Planning Benefits • 074: Working Disabled Individuals • 041: QMB - Age 65 and Over • 044: QMB - Under 65 • For a Categories of Eligibility (COE) & description listing, go to: • http://www.hsd.state.nm.us/mad/pdf_files/GeneralInfo/Eligibility%20Pamphlet%202012_04-01-2012.pdf

  8. NCCI (National Corrective Coding Initiative) • Is a CMS program that consists of coding policies and edits. Medicaid NCCI Edits consist of two types: • NCCI procedure-to-procedure edits that define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for variety of reasons; and • Medically Unlikely Edits (MUE), units-of-service edits, that define for each HCPCS/CPT code the number of units of service beyond which the reported number of units of service is unlikely to be correct (e.g., claims for excision of more than one gallbladder or more than one pancreas).

  9. NCCI (National Corrective Coding Initiative) • RA EOB Codes: • 6501 or 6502 – Per the National Correct Coding Initiative, payment is denied because the service is not payable with another service on the same date of service. • 6503 through 6505 – Per the National Correct Coding Initiative, payment is denied because provider billed units of service exceeding limit. • Please visit the link below for any additional information: • http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-Correct-Coding-Initiative.html

  10. Claim Form Instructions

  11. Where to get a copy of claim form instructions Click on Provider Information

  12. Where to get a copy of claim form instructions Scroll down Open file

  13. Medicaid Primary Claim submission

  14. Medicaid Primary Outpatient Example Provider Name Street City, State Zip 131 11/14/2012 11/14/2012 Patient Name F 01 01/01/1931 Medical Encounter 0519 316.00 1

  15. Medicaid Primary Outpatient Example 1 1 316 00 0001 100512 1234567890 MEDICAID Billing NPI 123456789 CONNIE CLIENT 431 9 332S00000X B3 Taxonomy Qualifier

  16. Medicaid Primary Dental Outpatient Provider Name Street City, State Zip 131 11/14/2012 11/14/2012 Patient Name F 01 01/01/1931 0512 D0150 316.00 Dental Encounter 1

  17. Medicaid Third Party Liability (TPL) Claim Forms

  18. Medicaid TPL Claim Example Attach the TPL EOB showing the payment/denial with the claim. Always include the explanation page of the EOB along with the page of the EOB that shows payment/denial. 011409 0001 1 1 316 00 1234567890 50 00 UNITED HEALTH TPL Payment Amount 266 00 MEDICAID 123456789 ABC, INC. 010203 CONNIE CLIENT 123456789 CONNIE CLIENT 431 9 1234567890 ALAN ATTENDING B3 282N00000X If primary EOB indicates that payment was applied to a deductible do not indicate an amount in box 54

  19. 111223333 Patient, Petunia 11 11 90 X Patient, Petunia 010203 X 09 22 90 ABC, Inc. United Health X when filling out a Medicaid claim where TPL is primary payer, be sure to fill in all required primary and secondary payer information.

  20. 65663 V283 1234567890 ZZ 273R00000X 76811 TC 12 400 00 1 05 30 07 05 30 07 11 76820 TC 170 00 1 12 05 30 07 05 30 07 11 Always enter the amount the insurance has paid in Box 29 on the CMS-1500. Attach a copy of the EOB along with the explanation of denials page Optional Optional 570 00 120 00 450 00 X Provider Med Gp 505 333-4444 1234 Rocky Road Mountain View, NM 8888 Situational Required 1234567890 ZZ363LF0000X

  21. Medicaid HMO/PPO Copayment Claim Forms

  22. “HMO COPAY ONLY” 111223333 Patient, Petunia 11 11 90 X Patient, Petunia 010203 X 09 22 90 ABC, Inc. United Health X

  23. 7213 64483 RT 1 271 85 1 05 30 07 05 30 07 24 RT 1 175 87 1 05 30 07 64484 05 30 07 24 Attach a copy of the EOMB along with the explanation of denials page Don’t fill out boxes 29 and 30. We’ll key this info directly from the EOMB. 50 00 Optional 447 72 397 72 Optional X Provider Med Gp 505 333-4444 1234 Rocky Road Mountain View, NM 8888 Situational Required 1234567890 ZZ273R00000X

  24. Medicare Replacement Plan Claim Submissions

  25. “Medicare Replacement Plan” 111223333 Patient, Petunia 11 11 1990 X

  26. Attach a copy of the EOB along with the explanation of denials page 65663 V283 ZZ 273R00000X 76811 TC 12 400 00 1 05 30 07 05 30 07 11 76820 TC 170 00 1 12 05 30 07 05 30 07 11 In the “amount paid” field, enter the difference between the billed amount and the co-payment. Enter the co-payment amount in the “net due” field. Optional Optional 570 00 120 00 450 00 X Provider Med Gp 505 333-4444 1234 Rocky Road Mountain View, NM 8888 Situational Required 1234567890 ZZ363LF0000X

  27. Medicare Primary Claim Forms(Crossovers)

  28. Medicare Primary Claims • When billing for clients covered by Medicare for which Medicare has processed and the claim DID NOT automatically crossover from Medicare to ACS, submit those claims via paper to ACS with the Medicare EOMB attached.

  29. Medicare Primary Claims • When primary Medicare claims are submitted on paper: • Fill out claim form exactly as the claim was submitted to Medicare (except for FQHCs.) • Claim must match Medicare EOMB. • Attach Medicare EOMB. Note: Medicaid does not consider Medicare to be TPL. If any of the TPL information is filled in for a Medicare claim, the claim will deny as “TPL indicated on claim” so be certain that you do not fill in any of the TPL information blocks.

  30. 7213 64483 RT 1 1683 00 1 05 30 07 05 30 07 24 RT 1 906 00 1 05 30 07 64484 05 30 07 24 Attach a copy of the EOMB along with the explanation of denials page Don’t fill out boxes 29 and 30. We’ll key this info directly from the EOMB. Optional 2589 00 Optional X Provider Med Gp 505 333-4444 1234 Rocky Road Mountain View, NM 8888 Situational Required 1234567890 ZZ273R00000X

  31. Multiple Encounters

  32. Multiple Encounters on Same Date of Service • You can bill up to 3 encounters on same DOS • You can bill on one line or • You can bill on 3 individual lines

  33. Multiple Encounters on Same Date of Service Provider Name Street City, State Zip Required if pay to is different than physical address. 131 05/30/2010 05/30/2010 Patient Name 01 01/01/1931 F 05/30/2010 0519 3 94800

  34. Multiple Encounters on Same Date of Service Provider Name Street City, State Zip Required if pay to is different than physical address. 131 05/30/2010 05/30/2010 Patient Name 01 01/01/1931 F 05/30/2010 0519 1 316.00 0519 1 316.00 0519 1 316.00

  35. 1 1 94800 0001 05/30/2010 1234567890 MEDICAID Billing NPI 123456789 CONNIE CLIENT 123 9 B3 282N00000X TAXONOMY QUALIFIER

  36. Inpatient claims for Medicare Part B-only clients

  37. Inpatient claims for Medicare Part B-only clients • Certain Medicaid/Medicare clients only have Medicare Part B coverage. • Medicare may cross over the Part B claim with type of bill 121. This claim does not have an accommodation revenue code on it.

  38. Inpatient claims for Medicare Part B-only clients • The claim will deny and the provider will need to resubmit on paper and include the following four things on the claim: • Use type of bill “121”. • Write “Medicare Part B only” on the claim form. • Change revenue code to 0100 • Indicate Medicare paid amount in previous payment box (form locator 54). • Attach a copy of the EOMB indicate Medicare paid amount in previous payment box (form locator 54).

  39. Inpatient claims for Medicare Part B-only clients “MEDICAID PART B ONLY” Provider Name Street City, State Zip Required if pay to is different than physical address. 121 11/15/2012 11/16/2012 Patient Name 01 01/01/1931 F 05/30/2007 80 1 00 Covered days are entered in FL 39 Room and Board/Semi 0100 1 216500

  40. Inpatient claims for Medicare Part B-only clients 1 1 2165 00 0001 08282007 1234567890 MEDICARE 1590 00 MEDICAID 123456789 CONNIE CLIENT 123456789 CONNIE CLIENT Attending physician is only required on inpatient services 431 9 1234567890 ALAN ATTENDING B3 332S00000X

  41. Did you remember? • Ensure the line item charges are correct and match the total charge. • Date the claim. • Include your NPI Billing number. • Include all appropriate EOB’s for TPL, HMO, Medicare, etc. • Rev codes, diagnosis codes, etc., are entered correctly.

  42. When is it necessary to fill out an adjustment form for a claim?

  43. Adjustments • Incorrectly PAID claims must be adjusted. • DO NOT resubmit a denied claim with an adjustment sheet attached. • Adjustments will not be considered unless submitted on the adjustment request form, with a copy of the remittance advice and claim attached.

  44. Completing an Adjustment/Void Form

  45. Adjustment/Void Request Form Always fill out corrected claim (replacement claim) exactly as you originally filled the claim out, with the exception of the information you will be changing.

  46. X ALWAYS FILL IN THE INFORMATION BOXES BELOW THIS INFORMATION IS FROM THE TCN THAT PAID INCORECTLY

  47. WHY DO YOU WANT TO ADJUST THIS CLAIM? WRONG DATE OF SERVICE, WRONG AMOUNT OF UNITS, WRONG PROC CODE, FORGOT MODIFIER……. “LINE 2, PROCEDURE CODE INCORRECT. CHANGE TO D0150– SEE CORRECTED ATTACHED CLAIM. X ALWAYS DATE FORM ALWAYS SIGN FORM

  48. Adjustments – Filing Guidelines Recap • Complete Adjustment/Void form • Fill out corrected claim. • Complete all information as it was on the claim previously submitted, with the exception of the changes being made. • Mail to Xerox PO Box 27418 Albuquerque, NM 87125-7418, Attn: Claims Adjustment (keep a copy for your files

  49. X ALWAYS FILL IN THE INFORMATION BOXES BELOW THIS INFORMATION IS FROM THE TCN THAT PAID INCORECTLY

  50. CLAIM WAS BILLED INCORRECTLY PLEASE VOID CLAIM X ALWAYS DATE FORM ALWAYS SIGN FORM

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