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5010 BILLING FILE CONVERSION

All current billing files have been converted to the new HIPAA 5010 layout. You may experience some 5010-related denials, such as PO Box in the billing provider address or failure to use 9-digit zip codes. Medicare billing errors for injectable flu shots (90658) can be avoided by using the new "Q" codes. Make sure to consult the updated Medicare Preventive Services Guide for correct coding and billing procedures. Managed care billing reports now have a new numbering scheme based on the MCO being billed. For Presumptive Eligibility, contact DMS at 1-855-446-1245 on the day of approval. For immediate services, PE members can call the Medicaid Member Service line at 1-800-635-2570.

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5010 BILLING FILE CONVERSION

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  1. 5010 BILLING FILE CONVERSION • ALL CURRENT BILLING FILES HAVE BEEN CONVERTED TO THE NEW HIPAA 5010 LAYOUT. • YOU MAY EXPERIENCE SOME 5010 RELATED DENIALS. MOST COMMON WOULD BE FOR P.O. BOX IN THE BILLING PROVIDER ADDRESS, FAILURE TO USE 9 DIGIT ZIP CODES.

  2. MEDICARE • REMINDER: You must use the new “Q” codes instead of the 90658 for (injectable with preservative) flu shots. Billing files are being rejected at Medicare because of this coding error. Please make sure your providers are aware of this requirement.

  3. MEDICARE • New Preventive Services are now covered under the Obama Health Care Plan. • Many are co-pay waived (like flu) • Must have qualified provider • You must consult the updated Medicare Preventive Services Guide on CMS website to obtain correct coding and billing procedures. • KNOW THE RULES! • http://www.cms.gov/MLNProducts/35_PreventiveServices.asp

  4. MANAGED CARE • When entering managed care information on the registration screen, make sure the name on the card matches what is in the system. We expect the MCOs to validate billing against the member number AND member name. So, they need to match.

  5. MANAGED CARE • BILLING REPORTS • New numbering scheme based on which MCO is being billed. Passport-3, Coventry-6, Ky Spirit-7, Well Care-8. • Example: Invoice Register would be numbered 3083-Passport, 3086-Coventry, 3087-Ky Spirit, 3088-Well Care. • All Medicaid reports will reflect this change, including Passport for consistency.

  6. PRESUMPTIVE ELIGIBILITY • IS PART OF MANAGED CARE • Currently the PE approved member can contact DMS at 1-855-446-1245 on the day of approval and select an MCO • PE member’s needing services immediately can call the Medicaid Member Service line at 1-800-635-2570,

  7. QUESTIONS?? • LHO Website & email: http://chfs.ky.gov/dph/info/lhd/lhob.htm LocalHealth.HelpDesk@ky.gov Sharon Trivette sharon.trivette@ky.gov Local Health Operations Branch 502-564-7213, ext 3953

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