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Department of Medical Assistance Services

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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 2, 2007 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- Web-Based Medicaid Eligibility

    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. Automated Response System (ARS) Web-based eligibility verification option Free of Charge. Information received in “real time”. Secure Fully HIPAA compliant

    8. Automated Response System (ARS) March 26, 2007 DMAS implemented a new ARS NPI Compliant ARS Web Site will allow: Access to claims status for bills submitted using an NPI/API Enhanced delegated administration capability provided by the User Administration Console (UAC) With the new ARS system providers will be able to get claims status for bills submitted with NPIs and Group Practice submission. They will also have access to the UAC which has the enhanced capability of delegated administration. With the new ARS system providers will be able to get claims status for bills submitted with NPIs and Group Practice submission. They will also have access to the UAC which has the enhanced capability of delegated administration.

    9. User Administration Console No longer will providers have the limitation of only one ARS user associated to an individual Provider Identification Number Providers are required to enroll and establish your new access to use the ARS beginning May 23, 2007. In order to register for the new features offered by the updated ARS you must follow these direction. We are encouraging all providers to begin accessing this system as soon as possible after March 26th so that any problems that may arise can be corrected well ahead of the federal mandate of May 23, 2007..In order to register for the new features offered by the updated ARS you must follow these direction. We are encouraging all providers to begin accessing this system as soon as possible after March 26th so that any problems that may arise can be corrected well ahead of the federal mandate of May 23, 2007..

    10. Automated Response System- Registration Registration virginia.fhsc.com Questions concerning registration process Web Support Helpline 800-241-8726

    11. ARS User Guide Located on the DMAS web-site under Provider Services section General information on ARS eligibility verification Instructions on the using the system “FAQ”(frequently asked questions) section

    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 New provider numbers or change of address: First Health – PEU P. O. Box 26803 Richmond, VA 23261 888-829-5373 804-270-5105 804-270-7027 - Fax

    14. Electronic Billing Electronic Claims Coordinator Mailing Address First Health Services Corporation Virginia Operations Electronic Claims Coordinator 4300 Cox Road Glen Allen, VA 23060 E-mail: edivmap@fhsc.com Phone: (800) 924-6741 Fax: (804) 273-6797

    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

    22. CHANGE - Is Patient’s Condition Related To? Block-10 If the condition is related to an auto accident place the postal code (i.e. VA, TN, WV) of the state in which the accident occurred.

    26. CHANGE – Blocks 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

    29. CHANGE – 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

    36. CHANGE – ID.QUAL Block-24I-J Qualifier ‘1D’ is to be used in 24I the red shaded area for claims being submitted using the Medicaid provider number or API. The following shaded red area of 24J will contain the current Medicaid provider number or the API

    37. CHANGE – Rendering Provider ID # Block-24I-J The open area of 24J will contain the NPI of the provider rendering the service. Qualifier ‘ZZ’ is to be used in the shaded red area of 24J to indicate the taxonomy code-only when the NPI is used and only if necessary to adjudicate the claim.

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

    44. CHANGE – Service Facility Location Information Block 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

    45. CHANGE – Service Facility Location Information Block 32a-b Enter the 10 digit NPI number of the service location in 32a. Enter ‘1D’ qualifier with the Medicaid PIN or API in 32b OR; Enter ‘ZZ’ qualifier with the taxonomy code if needed, when using the NPI in 32a

    46. CHANGE - Block 32: Service Facility Location Information

    47. CHANGE – Billing Provider Info & PH #-Block 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

    48. CHANGE – Billing Provider Info & PH #-Block 33a-b Enter the 10 digit NPI number of the service location in 33a. Enter ‘1D’ qualifier with the Medicaid PIN or API in 33b OR; Enter ‘ZZ’ qualifier with the taxonomy code if needed, when using the NPI in 33a

    49. Block 33: Billing Provider Info & PH #

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

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