Presented by Mina Reynaga Provider Field Representative

1. Presented by Mina Reynaga Provider Field Representative

2. 2 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. ACS Helpdesks

3. 3 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 ACS Info

4. 4 Important State Websites STATE WEBSITE: PROGRAM POLICY MANUAL http://www.hsd.state.nm.us/mad/policymanual.html BILLING INSTRUCTIONS http://www.hsd.state.nm.us/mad/billinginstructions.html REGISTERS AND SUPPLEMENTS: http://www.hsd.state.nm.us/mad/registers/

5. 5 Provider Field Representative: Mina Reynaga� (505) 246-9988 Ext. 233;(800) 282-4477 Ext 233 E-mail: Erminia.Reynaga@acs-inc.com ACS Field Representatives

6. 6 IMPORTANT UPDATE!Electronic Funds Transfers (EFT) As of May 1, Medical Assistance Division policy requires payment to be made only via electronic funds transfer (EFT). As stated in section 8.302.2.9, �MAD or its selected claims processing contractor issues payments to a provider using electronic funds transfer (EFT) only. Providers must supply necessary information in order for payment to be made.� (Please see Program Policy Manual)

7. 7 IMPORTANT UPDATE!Electronic Funds Transfers (EFT)

8. 8 All information will be verified and validated against the information ACS already has for the provider. While registering for EFT using the web portal, the Master Administrator will be asked to supply an e-mail address for receipt of notifications. This e-mail address will also provide a security purpose for EFT because a provider will be notified whenever a change is made to the banking information associated with EFT. IMPORTANT UPDATE!Electronic Funds Transfers (EFT)

9. 9 IMPORTANT UPDATE!Electronic Funds Transfers (EFT)

10. 10 Registered Web Portal users are no longer mailed an RA. The current RA and newsletter are available on the web portal, The current RA and newsletter are available on the web portal every Monday, along with last 8 RA�s. Please download your RA for future reference REMINDER!Remittance Advice Update

11. 11 Purpose of the Workshop Provide complete explanation of how to fill out the UB-04 paper claim form for: Primary Medicaid Medicaid secondary to a Third Party Liability (TPL) HMO copayments Medicare replacement plans Additional information Medicare Crossovers Inpatient claims for Medicare Part B-only clients. Medicaid Tertiary

12. 12 Date of Service � Make sure client is eligible on DOS Is the Client Fee for Service, SALUD!, or CoLTS? Limited Benefits � Check Category of Eligibility TPL, Medicare, Medicare Replacement Plans � There may be a payer primary to Medicaid The client may be required to pay a co-pay Eligibility Check List

13. 13 Eligibility Resources On-Line Eligibility Inquiry�Web Portalhttps://nmmedicaid.acs-inc.com/ Automatic Voice Response System (AVRS) (505) 246-2219 or (800) 820-6901

14. 14 Online Eligibility Inquiry

15. 15 Online Eligibility Inquiry

16. 16 Eligibility Reminder Eligibility denials are the most common denials for all provider types! Due to month end timing issues for the eligibility file from ISD, it is suggested providers wait until the 2nd of each month to check for monthly eligibility, if possible. This will assure you an accurate accounting of the client�s eligibility. This will assure you an accurate accounting of the client�s eligibility

17. 17 Claim Form Requirements All claims that do not require an attachment for payment must be submitted electronically. Professional claims are submitted on the 837I electronically and the UB-04 on paper. MAD requires that all paper UB-04 claim forms be on the original red claim forms. Photocopies of claim forms are returned to your billing office.

18. 18 Electronic Claim Submission All Fee For Service claims within 90 days from the initial date service that do not require an attachment for payment must be submitted electronically.

19. 19 Three Ways to Submit Claims Electronically Payerpath � Free HIPAA Compliant web-based claims entry system. TIE (Transaction Interface Exchange) � the State of NM�s HIPAA translator. If you have software that will generate a HIPAA compliant file you can directly submit the file to NM Medicaid via TIE. TIE is another free service. Through a Clearinghouse

20. 20 Three Ways to Submit Claims Electronically The URL to the registration form for PayerPath submissions and the Trading Partner Agreement to submit to TIE is: http://www.hsd.state.nm.us/mad/hipaa.html

21. 21 UB-04 Claim Submission The following claim is how a paper UB-04 claim form is generally filled out. You must use procedure codes, etc. that are specific to your claims.

22. 22 Where to get a copy of claim form instructions

23. 23 Where to get a copy of claim form instructions

24. Medicaid Primary Claim Forms

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27. New Hospital Outpatient Payment Method for New Mexico Medicaid This new pricing method is effective for dates of service beginning 10/01/2010. All General Acute Hospitals and Rehabilitation Hospitals must include a procedure code on every line item to receive payment. It is recommended that you bill all outpatient services for the same date of service on the same claim form all inclusive.

28. New Hospital Outpatient Payment Method for New Mexico Medicaid The following resources are available on the HSD/MAD website located at http://www.hsd.state.nm.us/mad/PFeeSchedules.html Hospital Outpatient Payment Method FAQ Hospital Outpatient Payment Method Revenue Codes Hospital Outpatient Payment Method Procedure Codes Notice of Hospital Outpatient Prospective payment System Rates Explanation of Simulation Spreadsheet for Outpatient services

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35. Timely Filing Denials Re-filing Claims and Submitting Adjustments UB Form: Put the TCN in Form Locator 64 �Transaction Control Number� (TCN) matching the appropriate payer line, using a paper form.

36. Medicaid Third Party Liability (TPL) Claim Forms

37. 37 Third Party Liability (TPL) Tips TPL is commercial insurance TPL must be billed primary to Medicaid Medicaid does not consider Medicare TPL

38. 38 TPL Tips When filling out a Medicaid claim where TPL is primary payer, be sure to fill in all required primary and secondary payer information. Always enter the amount the insurance has paid in Box 54 on the UB-04. If Medicaid requires a PA for the service, then a PA issued by Medicaid Utilization Review is always required when TPL is involved, no matter if TPL paid or denied the service.

39. 39 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. TPL Tips

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41. Medicaid HMO/PPO Copayment Claim Forms

42. 42 HMO Co-Pay Tips Write �HMO Co-pay Due� on the claim. Attach the EOB. In the �amount paid� (field Box 54), enter the difference between the billed amount and the co-payment. Enter the co-payment amount in the �est. amount due� field (BOX 55).

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45. Medicare Replacement Plan Claim Forms

46. 46 Medicare Replacement Plan (MRP) Claim Tips Write �Medicare Replacement Plan Only� on the claim. Attach the EOB. In the �amount paid� field (BOX 54), enter the difference between the billed amount and the co-payment. Enter the co-payment amount in the �est. amount due� field (Box 55).

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49. Medicare Primary Claim Forms(Crossovers)

50. 50 When billing for clients covered by Medicare for which Medicare has paid something on the claim and the claim DID NOT automatically crossover from Medicare to ACS, submit those claims via paper to ACS with the Medicare EOMB attached. Medicare Primary Claims

51. 51 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. 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. Medicare Primary Claims

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53. Inpatient claims for Medicare Part B-only clients

54. 54 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. The claim will deny and the provider will need to resubmit on paper and include the following four things on the claim:

55. 55 Use type of bill �121�. Write �Medicare Part B only� on the claim form. 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).

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58. Medicaid Tertiary Claim Forms

59. 59 Submit a Medicaid tertiary claim as follows: Medicare primary TPL secondary Medicaid tertiary Fill out the information as you would for a Medicaid Secondary to a TPL claim and add a payer line for the Medicare information. Attach TPL EOB. Attach Medicare EOMB. Medicaid Tertiary Claims

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61. 61 Did you remember? Ensure the line item charges are correct and match the total charge. If you�re a for profit orginization, make sure gross receipts tax is included in the line items, if required. Rev codes, diagnosis codes, etc., are entered correctly.

62. 62 Did you remember? Date the claim. Include your NPI Billing number. Include all appropriate EOB�s for TPL, HMO, Medicare, etc. Attach proof of timely filing/TCN if needed.