March 2000 North Carolina Medicaid Bulletin

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Providers are responsible for informing their billing agency for information in this bulletin
In This Issue

All Providers:

Adult Care Home Providers:

All Physicians:

Durable Medical Equipment (DME) Providers:

Health Check Providers:

Home Health Providers:

Hospice Providers:

Local Education Agencies (LEA) Providers:

Personal Care Services (PCS) Provicers:

Private Duty Nursing (PCN) Providers:

Ambulance Providers:

Dental Providers:

ECS Submitters:

 

Attention: All Providers
Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Friday, April 21, 2000, in observance of Good Friday.

EDS, 1-800-688-6696 or 919-851-8888



Attention: Home Health Agencies, Hospices, Personal Care Services (PCS) Providers, and Private Duty Nursing (PDN) Providers

Corrections to UB-92 Instructions in the October 1999 Revision of the Community Care Manual

This article is to correct typographical errors in the UB-92 instructions in the October 1999 revision of the Medicaid Community Care Manual. The errors are in Illustration 14-3 in Section 14 of the Manual.

The instructions for form locator 22 on page 14-10 should be as shown below:
 

22. STAT

Home Health and PDN: Enter the code to show the status of the patient as of the last date of service being billed on this claim.

01 Discharged.

20 Expired.

30 Still a patient.

PCS: Leave blank.

Hospice: Enter the code to show the status of the patient as of the last date of service being billed on this claim.

01 Discharged.

30 Still a patient of this hospice.

40 Expired at home or in an adult care home.

41 Expired in a medical facility, such as a hospital, nursing facility or free-standing hospice.

42 Expired - place of death unknown.

The instructions for form locators 24-31 on page 14-11 should be as shown below:

24-31 CONDITION CODES

Home Health (for dates of service through 1/31/2000), Hospice, PDN, and PCS: If the services are for a Medicare/Medicaid dually-eligible patient, and Medicare has denied the claim as a non-covered service or the service does not meet Medicare criteria, enter the appropriate code.

87 Overrides Medicare Part A

89 Overrides Medicare Part B

Home Health beginning with date of service 2/1/2000: Leave blank


 

Please make the changes in your copy of the manual.

EDS, 1-800-688-6696 or 919-851-8888



Attention: Home Health Services Providers:

Correction to Billing Instructions for Skilled Nursing Visits - Effective February 1, 2000 Date of Service

Effective February 1, 2000, date of service, Home Health Services providers must use a HCPCS code in addition to the appropriate revenue code when billing for skilled nursing visits. Providers were first informed of this requirement in an October 1999 Medicaid Special Bulletin. The current instructions are in the 10/99 revision to Section 5 of the Medicaid Community Care Manual.

The instructions in the MEDICARE-Medicaid Billing Guide are amended to clarify that HCPCS code W9953 must be used for all skilled nursing visits for prefilling insulin syringes. These visits are limited to no more than one visit per calendar week. On page 5-18 of the manual, item C.6 of the Billing Guide should read as follows:
 
Skilled Nursing Visits - Continued
If patient has Medicaid only
If patient has MEDICARE
  1. Treatment - Continued
  1. For prefilling insulin syringes if the patient has a qualifying MEDICARE home health service. Visits are limited to no more than one visit per calendar week.
Use appropriate revenue code to bill Medicaid

Beginning 2/1/2000 date of service also use HCPCS 

code W9953

BILL MEDICARE

Contact: Dot Ling,
DMA -Community Care Section, 919 857-4021



Attention All Local Education Agencies (LEA) Providers:

Change of Documentation Requirements

Effective November 1, 1999, DMA no longer required the Division of Public Health, Women and Children's Health Branch to prior approve the recipients' plan of care. Providers do not have to submit authorization requests to the Purchase of Medical Care Services (POMCS).

Contact: Jency L. Abrams R.N., B.S.N. M.S.
Independent Practitioners Service (IPP), 919-857-4051
 



Attention: Health Check Providers

Health Check Next Screening Date Changes

Effective March 1, 2000, providers may enter the next screening date (NSD) for Health Check in block 15 of the HCFA-1500 or have the next screening date systematically entered during claims processing. This date will be calculated according to the (predetermined) Medicaid periodicity schedule. The periodicity schedule can be found in the Health Check Billing Guide. Below is an explanation of options for the NSD.

Provider-Entered Next Screening Date

Providers have the option of entering the NSD in block 15 if they prefer. If this date is within the periodicity schedule, the system will keep this date. In the event the NSD entered by the provider is out of range with the periodicity schedule, an appropriate NSD will be systematically entered during claims processing. A claim will deny for NSD only if the date entered is not in the correct format. For example 12/54/1999 or 44/10/2000 are not actual dates and the claim would deny with EOB 621 (date of next Health Check screening is not in required MM/DD/CCYY format).

Systematically-Entered Next Screening Date

The NSD will be systematically entered according to the Medicaid periodicity schedule, if the provider does one of the following in block 15 of the HCFA-1500 claim form:

The NSD is used to track children per the Medicaid periodicity schedule by the Health Check Coordinator.

Contact: Angela Rey, RN
DMA - Managed Care Section, 919-857-4218



Attention: Health Check Providers (excluding Health Departments)

Rate Increase: Health Check

Effective with date of service January 1, 2000 the maximum reimbursement rate for Health Check screenings increased to $77.75. Providers are to continue billing claims as usual.

EDS, 1-800-688-6696 or 919-851-8888



Attention: ECS Submitters

Electronic Filing Tips

Providers are encouraged to begin using the new NCECS software as soon as possible. These issues make this very important:

In working with providers who have implemented the new NCECS software, we have identified several factors in the providers' PC environment that are preventing completion of the implementation of the software. Below are some tips that may assist you in having a successful implementation of the new NCECS software:

DURING INSTALLATION

Do's.

Don'ts. Tips. DURING OPERATION

Do's.

Don'ts. Tips.


DURING TRANSMISSION

Do's.

Don'ts. Tips. The conversion to the new NCECS software has generated an increase in questions to the Electronic Commerce Services (ECS) department. We recognize and apologize for the increasing hold time when calling the ECS department. To help minimize 'hold' times we offer the following recommendations: Tips for Using NCECS
  1. Key claims using the "claims entry" item in the software
  2. Submit claims using the "claims submission" item in the software. NOTE: At this point, EDS has not received the claims. This process creates a claim submission file on the computer's hard drive. It does not transmit the claims
  3. Transmit claims using HyperTerminal and your modem
Note: Current Medicaid billers using NCECS are not required to submit test claims to EDS prior to actual submission of claims. Claim file formats are controlled by the software and this testing was completed prior to distribution of the NCECS software to providers.

EDS, 1-800-688-6696 or 919-851-8888



Attention: All Physicians

Change to Injectable Drug List

Effective with date of service April 1, 2000, the code J2500 will replace the current code W5191 Zemplar (Paricalcitol) 5 mcg. The code W5191 will be end-dated effective with date of serviceMarch 31, 2000. Payment will be denied if W5191 is used for dates of service on or after April 1, 2000. The reimbursement rate will remain the same.

EDS, 1-800-688-6696 or 919-851-8888


Attention: All Providers

Changes to CPT 2000 Coverage

Upon further review of the new CPT codes for 2000, the Division of Medical Assistance made changes in the covered/noncovered codes.  Those changes are listed below.  This notification supercedes the list published in the January 2000 North Carolina Medicaid Bulletin.

The following new CPT codes were under review and are now covered by North Carolina Medicaid effective with date of service March 1, 2000:


The following new CPT codes require further review by the Division of Medical Assistance and are currently not covered:


The new 2000 CPT codes that are noncovered by North Carolina Medicaid are:


(Note: Synagis is covered through the Medicaid pharmacy program)

EDS, 1-800-688-6696 or 919-851-8888



Attention: All Providers

Additional Medicaid Fair Handbooks Still Available

Providers unable to attend the Medicaid Fair in September 1999 still have an opportunity to purchase the handbook that was distributed. The handbook is a large spiral-bound book that incorporates many of the handouts and notes covered by the workshops. It is an excellent resource with 396 pages of policies, procedures, and helpful billing information.

To obtain copies of the Medicaid Fair Handbook (while supplies last), send a check in the amount of $20 per book payable to EDS. Please complete the Medicaid Fair Handbook Request Form and mail to the following address:

EDS
c/o Jennifer Eichas
Provider Services
P.O. Box 300009
Raleigh, NC 27622

EDS, 1-800-688-6696 or 919-851-8888


Attention: Hospice Providers

Hospice Participation Reporting Requirements

On February 1, 2000, Hospice providers began notifying EDS whenever a Medicaid recipient elected the Medicaid Hospice benefit, started a new benefit period, transferred to another hospice, revoked the benefit or was discharged. In April EDS will send each hospice a report of confirmation numbers issued to the hospice during February and March 2000. This one-time report is intended to assist providers in assuring that their internal controls for reporting are working. The report will either provide a list of the patients reported with each patient's name, Medicaid ID number and diagnosis as well as the date of hospice's call and the confirmation number, or it will indicate that EDS records show no patients reported during the period. The hospice should reconcile the report with its records and notify the EDS Prior Approval (PA) unit of any discrepancies.

Please see the Medicaid Special Bulletin, Number VI, dated December 1, 1999, for additional details.

Reminders

EDS, 1-800-688-6696 or 919-851-8888

Attention: Adult Care Home Providers

Correction to Medicaid Special Bulletin - Number VII, December 1999

A typographical error appears on page one of the North Carolina Medicaid Special Bulletin, Number VII, December 1999, ATTN.: Adult Care Home Providers. Under the Implementation heading (second "bullet", line seven), the per diem rate for HCPCS Code W8258 for ACH/PC should read $12.95, not $12.65. Please correct this in your Bulletin.

All rate information displayed in the reimbursement grid on page two of the Special Bulletin is correct.

EDS, 1-800-688-6696 or 919-851-8888


Attention: All Providers

Hospice Participation Information on Automated Voice Response (AVR) System

Effective with date of service May 1, 2000, the Automated Voice Response (AVR) will provide Medicaid Hospice participation information. The information in the AVR system is based on reports from hospices. This replaces the use of Hospice stickers on Medicaid ID Cards.

Hospice participation may affect your payment for Medicaid services. The following services are included under Hospice when the service is related to the patient's terminal illness:

A Medicaid recipient's participation in Hospice can be determined through the AVR system by dialing 1-800-723-4337. Listen to the options given. Select Option 6 for Recipient Eligibility then press the selection for Hospice information. The AVR will validate your provider number and the recipient's Medicaid identification number. There are two options to obtain date specific information:
  1. To determine if the recipient is on Hospice for the current date, press the (#) pound key. The AVR response will tell you if the recipient has been reported on Hospice for the current date
  2. To determine if the recipient is on Hospice for an earlier date, enter that date of service
The appropriate response for Hospice coverage is given. The AVR system does not provide the name of the hospice covering the recipient. That information may be obtained from the recipient or the recipient's representative.

Remember that the AVR information is based on information reported to EDS. If the AVR states that it has no report of Hospice participation and this contradicts information from the recipient or the recipient's representative, ask the recipient or representative for the name of the hospice agency and contact the agency before rendering services.

Please watch future Medicaid Bulletins for additional instructions on using the AVR system.

EDS, 1 800-688-6696 or 919 851-8888


Attention: All Providers

Basic Medicaid Seminar Schedule

Seminars for Basic Medicaid are scheduled in April and May 2000. The seminars are intended for providers who are new to North Carolina Medicaid. Topics to be discussed will include, but are not limited to, form instructions, eligibility issues, and Managed Care, including Carolina ACCESS and HMOs. Persons inexperienced in billing North Carolina Medicaid are encouraged to attend.

Due to limited seating, pre-registration is required. Providers not registered are welcome to attend when reserved space is adequate to accommodate. Please select the most convenient site and return the completed registration form to EDS as soon as possible. Seminars begin at 10:00 a.m. and end at 1:00 p.m. Providers are encouraged to arrive by 9:45 a.m. to complete registration.

Directions
 
Thursday, April 6, 2000
Ramada Inn
I-85 & 62 South
2703 Ramada Road
Burlington, NC
Tuesday, April 11, 2000
A-B Technical College
340 Victoria Road
Asheville, NC
Laurel Auditorium
Thursday, April 13, 2000
Ramada Inn Plaza
3050 University Parkway
Winston-Salem, NC
Wednesday, April 26, 2000
WakeMed 
MEI Conference Center
3000 New Bern Avenue
Raleigh, NC
Park at East Square Medical Plaza
Tuesday, May 9, 2000
Martin Community College
Kehakee Park Road
Williamston, NC
Auditorium
Thursday, May 11, 2000
Four Points Sheraton
5032 Market Street
Wilmington, NC
Wednesday, May 17, 2000
Holiday Inn Conference Center
530 Jake Alexander Blvd., S.
Salisbury, NC
Wednesday, May 31, 2000
WakeMed 
MEI Conference Center
3000 New Bern Avenue
Raleigh, NC
Park at East Square Medical Plaza
 

Please fill out Basic Medicaid Seminar Registration Form and return to:

Provider Services
EDS
P.O. Box
Raleigh NC, 27622



Attention: Ambulance Providers

Individual Visits

EDS is offering individual provider visits for ambulance providers. Please complete and return the form below. An EDS Provider Representative will contact you to schedule a visit and discuss the type of issues to be addressed.

Please fill out Ambulance Provider Visit Request Form and return to:

Provider Services
EDS
P.O. Box
Raleigh NC, 27622



Attention: Dental Providers

Dental Seminars

Dental seminars are scheduled in May 2000. The April Medicaid Bulletin will have the registration form and a list of site locations for the seminars. Please list any issues you would like addressed at the seminars by filling out the Dental Seminars Issues Form and returning the form to the following address.
 

Provider Services
EDS
P.O. Box 300009
Raleigh, NC 27622
EDS, 1-800-688-6696 or 919-851-8888


Attention: Durable Medical Equipment (DME) Providers

Durable Medical Equipment Seminar Schedule

Seminars for DME providers are scheduled for April 2000. These seminars will focus on Medicaid guidelines for DME and supplies, prior approval procedures, Certificate of Medical Necessity and Prior Approval form, claims filing, and post payment review.
 

Note: Please bring your North Carolina Medicaid Durable Medical Equipment Manual, March 1, 1999 Reprint. 

Due to limited seating, pre-registration is required. Providers not registered are welcome to attend when reserved space is adequate to accommodate.

Please select the most convenient site and return DME Provider Seminar Registration Form to EDS as soon as possible. Seminars begin at 10:00 a.m. and end at 1:00 p.m. Providers are encouraged to arrive by 9:45 a.m. to complete registration.

Directions
 
Wednesday, April 12, 2000
Four Points Sheraton
5032 Market Street
Wilmington, NC
Tuesday, April 18, 2000
Holiday Inn Conference Center
530 Jake Alexander Blvd., S.
Salisbury, NC
Wednesday, April 19, 2000
A-B Technical College
340 Victoria Road
Asheville, NC
Laurel Auditorium
Tuesday, April 25, 2000
WakeMed 
MEI Conference Center
3000 New Bern Avenue
Raleigh, NC
Park at East Square Medical Plaza
Thursday, April 27, 2000
Ramada Inn Plaza
3050 University Parkway
Winston-Salem, NC
 

 

Directions to the Durable Medical Equipment (DME) and Basic Medicaid Seminars

The Registration forms for the DME and Health Check seminars are on page 13 and 17 of this bulletin.

WINSTON-SALEM, NORTH CAROLINA

RAMADA INN PLAZA

I-40 Business to Cherry Street Exit. Continue on Cherry Street for approximately 2-3 miles. Turn left at the IHOP Restaurant. The Ramada Inn Plaza is located on the right.

ASHEVILLE, NORTH CAROLINA

A-B TECHNICAL COLLEGE Directions to the College:

I-40 to Exit 50. Travel North on Hendersonville Road which turns into Biltmore Avenue. Continue on Biltmore Avenue toward Memorial Mission Hospital. Turn left onto Victoria Road.

Campus:

Stay on Victoria Road and turn right between the Holly Building and the Simpson Building. The Laurel Building/Auditorium is located on the right, behind the Holly Building.
 
  WILMINGTON, NORTH CAROLINA

FOUR POINTS SHERATON

I-40 East into Wilmington to Highway 17 - just off I-40. Turn left onto Market Street and the Four Points Sheraton is located approximately ½ mile on the left.

SALISBURY, NORTH CAROLINA

HOLIDAY INN CONFERENCE CENTER

Traveling South on I-85: Take exit 75 and turn right on Jake Alexander Blvd. Traveling North on I-85: Take exit 75 and turn left on Jake Alexander Blvd. Travel approximately ½ mile and the Holiday Inn is located on the right.

RALEIGH, NORTH CAROLINA

WAKEMED MEI CONFERENCE CENTER Directions to the Parking Lot:

Take the I-440 Raleigh Beltline to New Bern Avenue, Exit 13A (New Bern Avenue, Downtown). Travel toward WakeMed. Turn left onto Sunnybrook Road and park at the East Square Medical Plaza which is a short walk to the conference facility. Parking is not allowed in the parking lot in front of the Conference Center. Vehicles will be towed if not parked in the East Square Medical Plaza parking lot located at 23 Sunnybrook Road.

Directions to the Conference Center from Parking Lot:

Cross Sunnybrook Road and follow sidewalk access up to Wake County Health Department. Walk across the Health Department parking lot and ascend steps (with blue handrail) to MEI Conference Center. Entrance doors at left.

BURLINGTON, NORTH CAROLINA

RAMADA INN

I-40 to Exit 143. Turn left at the first stoplight onto Ramada Road. The Ramada Inn is located on the right.

WILLIAMSTON, NORTH CAROLINA

MARTIN COMMUNITY COLLEGE

Highway 64 into Williamston. Martin Community College is approximately 1-2 miles west of Williamston. The Auditorium is located in Building 2.

EDS, 1-800-688-6696 or 919-851-8888


Attention: Nursing Facility Providers, Hospital Providers, County Departments of Social Services, Hospice Providers, Physicians, Home Health Providers, Area MH/DD/SAS Programs

PASARR (Preadmission Screening and Annual Resident Review) Seminars

The Division of Medical Assistance (DMA) has requested that our PASARR contractor, First Mental Health, Inc. (FMH), conduct Statewide training sessions on PASARR Level I and Level II screens. PASARR is a federally mandated program that requires screening of all applicants to and residents of Medicaid certified nursing facilities, regardless of pay source. We strongly encourage your attendance at one of these seminars.

Seminars will be held March 20 - 24, 2000 beginning at 9 a.m. and ending at 12:00 noon. There is no cost to attendees; however, pre-registration is required to assure adequate seating. Please select the most convenient site and return the completed registration form to FMH by March 13, 2000. If you have questions, please contact Chris Lowry at FMH (800) 598-6462.

NOTE: All training sessions will begin at 9:00 a.m. and end at 12:00 noon. All locations are handicap accessible. Please fill out and return N.C. PASARR Seminar Registration Form to:

Chris Lowry
First Mental Health, Inc.
501 Great Circle Road, Suite 300
Nashville, Tennessee, 37288

Directions
 
Monday, March 20, 2000
Renaissance Asheville Hotel
One Thomas Wolfe Plaza
Asheville, NC
(828) 252-8211
Tuesday, March 21, 2000
Adam's Mark Hotel and Resorts
 425 N. Cherry Street
Winston-Salem, NC
(336) 725-3500
 Wednesday, March 22, 2000
 Durham Marriott
201 Foster Street
Durham, NC
(919) 768-6000
Thursday, March 23, 2000
Coast Line Inn
501 Nutt Street
Wilmington, NC
(910) 763-6739
 Friday, March 24, 2000
 Hilton
207 Greenville Blvd.
Greenville, NC
(252) 355-5000

Directions to the PASARR Seminars

ASHEVILLE, NORTH CAROLINA

RENAISSANCE:

Take Exit 53B off I-40 (I-240 W) then exit at 5A (Merrimon Ave) turn left. Take a left at the next light (Woodfin). Hotel is one block down on right.

WINSTON-SALEM, NORTH CAROLINA

ADAM'S MARK:

I-40 to Business I-40. Exit at Cherry Street (one way). Hotel is on the right past 4th Street

.DURHAM , NORTH CAROLINA

MARRIOTT AT THE CIVIC CENTER:

From I-40 West (Raleigh, Wilmington areas) to Durham Freeway, Exit 279B, approx. 4 miles, exit at Roxboro Street/Mangum St. (Exit #12-B). At bottom of ramp, turn right onto Roxboro St., follow signs to Downtown. At the 3rd light, bear left onto the Downtown Loop (Morgan St.). go to the 3rd light; turn left onto Foster St.; Marriott on the right; From I-40 East (Asheville, Winston-Salem) take I-85 North when I-40 and I-85 split and follow I-85 North directions; From I-85 North (Charlotte, Greensboro areas) take Exit #172 (Hwy. 147S) 4 miles to exit 13 (Chapel Hill St.) turn left to 6th traffic light. Turn left on Foster St. hotel on left; From I-85 South (Henderson, Oxford) take Durham Downtown exit 177-A turn right on Roxboro St. Roxboro St. leads directly to Mangum St. Follow "Downtown" signs. Approximately 1 mile turn right onto Morgan St., go two blocks turn left onto Foster. Marriott on right.

WILMINGTON, NORTH CAROLINA

COAST LINE INN:

I-40 to end (Downtown Wilmington- Market Street. Take right on Market Street. Drive 4-5 miles to Water Street, go right. 1 block from Hilton, Coast Line Inn on Nutt St. behind Railroad Museum.

GREENVILLE, NORTH CAROLINA

HILTON

Highway-264 towards Wilson. Exit @ Downtown Greenville (Greenville Blvd.). Approximately 5 miles on right.


Checkwrite Schedule
March 7, 2000
April 11, 2000
May 9, 2000
March 14, 2000
April 18, 2000
May 16, 2000
March 21, 2000
April 27, 2000
May 23, 2000
March 30, 2000
May 31, 2000

 

Electronic Cut-Off Schedule
March 3, 2000
April 7, 2000
May 5, 2000
March 10, 2000
April 14, 2000
May 12, 2000
March 17, 2000
April 21, 2000
May 19, 2000
March 24, 2000
May 26, 2000

 

Electronic claims must be transmitted and completed by 5:00 p.m. on the cut-off date to be included in the next checkwrite. Any claims transmitted after 5:00 p.m. will be processed on the second checkwrite following the transmission date.



Paul R. Perruzzi, Director John W. Tsikerdanos
Division of Medical Assistance Executive Director
Department of Health and Human Services EDS

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