New Mexico Medicaid E-News January 20, 2016 Focus On… Proper use of Taxonomy Codes (NEW) ICD-10 Denial Codes Updated (NEW) Update to HIPAA transaction 271 Response (NEW) Provider Enrollment Updates and Applications Web Portal - Update to Provider Eligibility Search Results PERM (Payment Error Rate Measurement Program) Information Supplements to Program Rules DME Billing 2012 ADA Paper Claim Forms Emergency Medical Services for Aliens (EMSA) Claim (COE 85) Resubmitting Claims and Submitting Adjustments Reconsideration Requests for Non-Duplicate Services ITU Service Providers o Albuquerque Area (RAM) o Navajo Area Providers (BOM) o IHS Monthly Call-in Session: Wednesday, February 10, 2016 Staying Informed & Trained on NM Medicaid Fee for Service o Training-Webinar: Tuesday, January 26 2016 o Top Ten Mediciad Denials o Eligibility Xerox Contact Information Proper use of Taxonomy Codes Taxonomy codes are used in conjunction with NPI numbers to determine the Medicaid provider ID number for provider that will receive payment. If you are a billing provider with more than one active NM Medicaid Provider IDs sharing the same NPI, PLEASE note that a corresponding taxonomy code has to be submitted on the claim. Including the correct taxonomy code will ensure a more accurate and timely processing of claims. The list of taxonomy codes per provider type can be found on the following link from the HSD website: Taxonomy Codes on HSD Website If a claim is submitted without the correct taxonomy code, denial code 0299 (Billing NPI Match Multiple Medicaid IDs) will be seen on your Remittance Advice for the corresponding claim. If you receive denial code 0299, your next step would be to resubmit the claim with the accurate taxonomy code using the link provided above. Please visit the Training Presentation section of the NM Medicaid Web Portal (https://nmmedicaid.acs-inc.com/static/ProviderInformation.htm#TrainingPresentations) regarding perspective billing instruction types that fit your need to determine how and where taxonomy codes are submitted on claims. _________________________________________________________________________________________________________ ICD-10 Denial Codes Updated The following ICD-10 exception codes have been updated in the New Mexico Medicaid claims system. 0440, 0446, 0450, 0458, 0460, 0470, 0472, 0480, 0488, 0490, and 1900 The codes are now set to deny when an incorrect diagnosis code is used on the claim. If you receive this denial code on a claim, please resubmit your claim with the correct ICD-10 diagnosis code(s). Update to HIPAA transaction 271 response Effective January 12th, HIPAA transaction 271 response will provide information for ALL Categories of Eligibility (COE) for a requested recipient. Providers will have the ability to view all open and closed COE with corresponding date spans. Previously the HIPAA Transaction 271 response would minimially display the benefit COE for Date of Service (DOS) queried. For any additional questions, please contact the HIPAA Helpdesk at 1-800-299-7304, option 6. Provider Enrollment Updates If you are an active provider please do not submit an application to request an update, such as an address change. Submitting an application for a routine update will result in a delay of processing. Providers wanting to update information must submit a Provider Update Form (MAD 304) which requires a signature and certificate of insurance. Examples of when to utilize a provider update form: o Adding an NPI to your provider number o Adding specialties o Requesting a Cross Reference Update o Address changes Provider Enrollment Applications For applications pending more than 20 days, please contact the Provider Relations Helpdesk at 800-2997304 or by email at NMPROVIDERSUPPORT@XEROX.COM to determine if any additional information is required. Web Portal - Update to Provider Eligibility Search Results The New Mexico Medicaid Web Portal provides information on ALL Categories of Eligibility (COE) for a recipient in response to a Provider eligibility inquiry. Providers are now able to view all open and closed eligibility categories for recipients with their corresponding eligibility date spans. Previously our portal responses to Provider eligibility inquiries would minimally display the benefit COE for each span within the Date of Service range inquired. This update allows providers and recipients see the same eligibility results on the New Mexico Medicaid Web Portal. PERM (Payment Error Rate Measurement Program) Information What is PERM? What can be expected of me when a PERM request arrives? Overview of the Payment Error Rate Measurement Program The purpose of the Payment Error Rate Measurement (PERM) program is to produce a national-level error rate for Medicaid and the Children’s Health Insurance Program (CHIP) in order to comply with the requirements of the Improper Payments Elimination and Recovery Improvement Act (IPERIA) (2012). Medical Record Request Process The PERM Review Contractor, A+ Government Solutions is responsible for requesting all medical record documentation associated with the randomly selected Medicaid Fee For Service (FFS) and CHIP FFS claims. Providers have a 75-day window to submit the medical record documentation. At a minimum, A+ Government Solutions will send four letters and make four phone calls to each provider throughout the 75-day window, as needed, to follow up on documentation not yet received. A+ Government Solutions first verifies the provider information by contacting either the performing provider or the billing provider by phone, using contact information provided by the State. A+ Government Solutions will provide information on the patient, date of service, and type of service and notify the provider that a written request is forthcoming. A+ Government Solutions will verify the provider’s name, phone number, and mailing address where medical records can be obtained and determine to whom the letter should be addressed. A+ Government Solutions will also determine the preferred method for the request (fax or first class mail). If A+ Government Solutions is unable to verify the provider information on the State’s claim files after using other means (e.g., internet, directory assistance), A+ Government Solutions will contact the State to obtain more current provider information. A+ Government Solutions will fax the PERM initial request letter package, with cover letter to the fax number provided within one hour of the telephone call or as reasonable during high volume times and constraints. If mail delivery is preferred, A+ Government Solutions will send the initial request letter package to the point of contact at the confirmed address via standard United States Postal Service (USPS) first class delivery within one business day of the telephone contact. The letter package includes a claim summary with details for the provider to identify the appropriate record (e.g., the beneficiary name; date of service; diagnostic code (ICD-9-CM); service code (CPT, HCPCS or prescription number); and total amount of claim or total amount for service). The letter package also includes a PERM Fax Cover Sheet that describes the specific documentation being requested (a request list is attached to the initial request letter) and asks that all medical documentation pertaining to the specific service rendered be submitted to A+ Government Solutions. Each claim is assigned a specific claim category and claim category specific components (i.e., history and physical, plan of care etc.) of records are listed on the record documentation request list. Finally, the letter indicates that the provider has 75 calendar days from the issue date of the letter to provide the requested medical record to A+ Government Solutions. The last enclosure of the letter package includes instructions for providers’ submission of medical records to A+ Government Solutions. Records may be submitted by the USPS, a toll free fax number, CD, or electronic submission of Medical Documentation (esMD) to A+ Government Solutions. For more information about esMD, see www.cms.gov/esMD. If the provider does not submit the requested information by the deadline, A+ Government Solutions sends a final letter that contains the detailed request information. The letter also informs the provider that failure to submit the requested medical record has resulted in a PERM error and that a notice of the error will be submitted to State officials who may seek recoveries for claims in which medical records are not received by A+ Government Solutions in a timely manner. If providers have any questions please contact the State PERM liaison Julio Maestas at: firstname.lastname@example.org, Phone number: 505-827-7308 Supplements to Program Rules HSD posted Supplement 15-03 on May 13, 2015. This Supplement lists multiple topics, including ICD10, Billing Using Paper Claims, etc. Xerox and HSD highly recommend you learn more about the addendums to MAD NMAC Program Rules by clicking on the link below: http://www.hsd.state.nm.us/providers/Registers_and_Supplements.aspx DME Billing New Mexico Medicaid encourages providers to become familiar with the NMAC rule which outlines how Durable Medicaid Equipment (DME), Medical Supplies and Nutritional products are reimbursed by Medicaid. NMAC Program Rule: 8.324.5 Section 8.324.5.17 - REIMBURSEMENT OF DME, MEDICAL SUPPLIES AND NUTRITIONAL PRODUCTS: Rental payments must be applied towards the purchase with the exception of ventilators. Unless otherwise specified the provider’s billed charges must be the usual and customary charge for the item or service. Reimbursement for rental of DME is made at the lesser of logic. Medical Assistance Division follows Medicare regulations regarding capped rental. For rental months one through three, the full fee schedule rental fee is allowed. For rental months four through 13, the rental fee schedule rental fee is reduced by 25 percent. No additional rental payments are made following the 13th month or to the most current schedule determined by Medicare. The provider may only bill for routine maintenance and for repairs, and oxygen contents to the extent as allowed by Medicare. If you have any questions please call the New Mexico Medicaid Call Center at 1-800-299-7304, option 6 or via email at NMProviderSUPPORT@xerox.com 2012 ADA Paper Claim Forms Xerox New Mexico Medicaid Fee for Service will no longer accept black and white ADA 2012 paper claim form(s). Black and white paper or photo copied claim forms are not recognized by the Optical Character Recognition (OCR) scanning system. Black and white paper or photo copied claim forms received by the Fiscal Agent will not be processed and will be returned to the Provider. Providers are encouraged to: Submit claims electronically either with your EDI solution or through the NM Medicaid Portal. Obtain and start using RED ADA 2012 paper claim form. Providers are reminded it is your responsibility to submit claims correctly and within the Timely Filing guidelines. Emergency Medical Services for Aliens (EMSA) Claim (COE 85): Recipient must obtain an approved MAD 310 from an ISD office and present the MAD 310 to the hospital or physician who rendered services. Providers must submit the EMSA claim on paper with the approved MAD 310 or Notice of Case Action and any other required documents such as ER notes, History and Physical for admission, discharge summary (if admitted), Surgical reports and Facility Transfer notes (if transported to another facility). Resubmitting Claims and Submitting Adjustments When resubmitting a claim or requesting an adjustment on a claim that is past the 90 day filing limit but originally met the filing limit, the “TCN” which appears on the Remittance Advice (RA), will be used by Xerox to review the claim. The provider must supply the TCN on the resubmitted claim. Do not include the RA as an attachment. CMS 1500 Form: Indicate the TCN in block 22 on the paper form. Leave the “Code” blank, and indicate the TCN in the “Original Reference No.” field. UB Form: Indicate the TCN in Form Locator 64 “Document Control Number” (DCN) matching the appropriate payer line, using a paper form. Dental Claim Form: Indicate the TCN on the left side in box 35 “Remarks”. Helpful Hints: There are two filing limits to meet - the initial filing limit and the grace period limit. Continuing to refile a claim does not extend the filing limit. It is to the Provider’s advantage to file or request an adjustment on the most recently filed claim that met the original filing limit. When requesting an adjustment on an adjusted claim, use the TCN of the final payment or denial, not the credit record which has a negative amount on the RA. The filing limit does not apply when the provider is returning an overpayment to the Medicaid program. Reconsideration Requests for non-duplicate services When billing for multiple services on the same day, such as ambulance outpatient and bilateral services, Providers should use a reconsideration request as proof of non-duplicate service for an initial duplicate denial. Please see the Reconsideration, Adjustment and Void Workshop on the web portal, https://nmmedicaid.acs-inc.com/static/ProviderInformation.htm for additional information. _________________________________________________________________________________________________________ ITU Service Providers Albuquerque Area (RAM) March, 2016 Navajo Area Providers (BOM) TBD For more information or questions about IHS matters, please contact the Xerox IHS Provider Liaison: Erminia.Reynaga@xerox.com IHS Monthly Call-in Sessions Topic: IHS Open Forum Date: The 2nd Wednesday of every month (February 10, 2016) Time: 2:00 pm, Mountain Daylight Time Meeting Number: 743 974 366 To start or join the online meeting, go to: https://xerox.webex.com/xerox/j.php?MTID=mc7771bcc7e49198db7d98e1c43c0a096 Teleconference information: 1-800-268-4017 Attendee access code: 816 791 7904 Staying Informed & Trained on NM Medicaid Fee for Service Live Provider Webinar Sessions: Are available at no cost to NM Medicaid Providers Providers are able to attend any session. No preregistration is required, unless stated for the specific session Webinar Power Point Presentations are available on the New Mexico Medicaid Portal – Training Presentations and Webinars to learn on your own and may be used as a guide or in training with your staff. Date Time Training Session Topic 1/26/2016 10:00 AM Top Ten Medicaid Denials 1/26/2016 2:00 PM Eligibility WebEx Sign-in information is the same for all sessions Provider Training Webinars For assistance: https://xerox.webex.com/xerox/mc If requested, enter your name and any other requested information Meeting Number (same for all sessions) 743 016 056 Meeting Password (same for all sessions) training Click “Join” and follow the instructions that appear on the screen Audio sign-on information is the same for all sessions Dial 1-800-268-4017 Access code: 816 791 7904 Xerox Contact Information Email: NMProviderSUPPORT@xerox.com Email: HIPAA.Desk.NM@xerox.com AVRS (Automated Voice Response System) 800-820-6901 Call Center 505-246-0710 or 800-299-7304 Disclosure- The objective of the E News, training, and webinars is to inform and educate. Articles reflect information at current time and may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their content. E News is published monthly and available on the NM Medicaid Web Portal.