December 2000 North Carolina Medicaid Bulletin title

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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:

Durable Medical Equipment Providers:

Home Health Providers:

Hospital Providers:

Inpatient Psychiatric Hospital Providers:

Mental Health Providers:

Physicians and CRNAs:

Prescribers:



 

Attention: All Providers
Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Monday, December 25 and Tuesday, December 26, in observance of Christmas, and on Monday, January 1, in observance of New Years Day.

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



 

Attention: All Providers
Penalties and Interest Assessments Implemented by the Medicaid Program as a Result of N.C. General Statute 147-86.10

This article serves as a reminder of the Medicaid program's responsibility for effective management of funds as stated in NCGS 147-86.10 and the impact of this legislation on the provider community.

Effective October 1, 1999, the Medicaid program implemented the legislation enacted by NCGS 147-86.10. The legislation requires state agencies to devise techniques and procedures for the receipt, deposit, and disbursement of moneys coming into their control and custody, which are designed to maximize interest-bearing investment of cash, and to minimize idle and nonproductive cash balances.

As a result of this legislation, all balances due to the Medicaid program NOT returned or paid within 30 days will automatically be assessed a one-time 10 percent penalty and interest on an accumulative basis. The assessed interest rate is based on the variable rate set by the N.C. Department of Revenue (NC DOR). The current interest rate is 8 percent. To ensure compliance with any changes made by the NC DOR, the interest rate will be updated.

The following list summarizes the primary changes initiated as a result of NCGS 147-86.10. Special Bulletin V issued in October 1999 provides additional details and examples of these processing changes.

  1. Penalty and Interest Assessments - Medicaid adjustments or other types of money due to the Medicaid program, whether identified by the Division of Medical Assistance (DMA), or initiated through audits and edits of the Medicaid program, or at the request of or known by the provider, which are not paid-in-full by claim payment or refunds within 30 days of processing are assessed a one-time 10 percent penalty and 8 percent interest on the outstanding balance. Interest is assessed on the total outstanding balance every subsequent 30-day period until the total balance is paid-in-full. DMA's Financial Operations section will consider provider's requests for a payment plan only in cases of extreme financial hardship. In such cases, DMA will establish the payment amount and a schedule for repayment.

  2.  
  3. Transfers of Adjustment Balances - Any aged adjustment balance will be transferred from an inactive provider (no claims payment) to an active provider (claims payment) if it has been determined that a provider is operating under the same identification number and, therefore, the same tax entity. Additionally, the appropriate assessment of penalty and interest will be applied and transferred. Interest will continue to accumulate on the transferred balance until the total balance is paid-in-full. Balances will be transferred for immediate collection based on the following criteria:
  1. Medicaid Remittance and Status Advice (RA) Modifications and New Explanation of Benefit - For each change noted above, the Medicaid RA has been modified to detail all financial transactions to support reconciliation between payment and claims transaction data.
This article summarizes the primary changes initiated as a result of the legislation enacted by NCGS 147-86.10. Refer to Special Bulletin V issued in October 1999 for additional details and examples of these changes.

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


Letter and Report Summary to All Providers from Secretary H. David Bruton 3

A study was recently conducted evaluating the prescription expenditures in North Carolina's Medicaid program. Three continuous years of data from July 1, 1997 through June 30, 2000 were analyzed to identify the factors contributing to the rapidly rising prescription expenditures. In 1998, Medicaid prescription costs totaled $461 million which increased to $748 million in 2000 - a 62% increase. The factors that were evaluated in the study included the number of people enrolled in Medicaid during the year, the length of enrollment, the number of prescriptions written, the costs of the medications, and physicians' prescribing patterns.

Compared to 1998, 2.3% (27,543) more people were served by the Medicaid program in 2000, and the average length of enrollment increased by 5.5% (0.5 months) to 9.6 months. These factors accounted for 14% of the increase in prescription expenditures. In 1998, a patient enrolled in Medicaid for the entire year filled an average of 13.0 prescriptions. This increased to an average of 15.5 prescriptions filled in 2000. This could suggest the physicians were prescribing more frequently. This change accounted for 36% of the increase in prescription expenditures from 1998 to 2000. The total number of patient visits and complexity of visits were measured to potentially explain the apparent rise in prescribing, but the levels remained unchanged or decreased.

The costs of the medications increased during this period. The average price per dose for the twenty drugs with the greatest expenditures increased by about 4.2% annually, or just slightly above the rate of inflation. However, the average cost per prescription increased by 27% from $39 in 1998 to $49 per prescription in 2000. This phenomenon reflects the change in prescribing patterns to favor more expensive drugs (Table 1).  For example, the number of tablets dispensed of H2-blockers (i.e. Zantac and Pepcid) is decreasing while the number of tablets dispensed of proton pump inhibitors (i.e. Prilosec and Prevacid) is increasing. This finding would suggest that physicians are more frequently prescribing proton pump inhibitors as first line therapy. In another example, the selective cyclo-oxygenase-2 inhibitors (i.e. Celebrex and Vioxx) introduced in 1999 have become among the most frequently prescribed medications in 2000. This change in prescribing patterns accounted for 50% ($143 million) of the increase in prescription expenditures. The more expensive medications are often more effective; some have been shown to reduce physician visits and hospitalizations and to improve patients' quality of life. The key factor in this, however, is that the correct medication needs to be prescribed for the right person.

The North Carolina Medicaid program has an open formulary, like all states, as required by the 1990 OBRA legislation. However, North Carolina's program does not restrict its formulary by using strategies such as prior authorization or therapeutic interchange, that are utilized by other states. The manner in which this state's Medicaid prescription program is conducted reflects the state's trust that physicians prescribe appropriately and judiciously. If prescription expenditures continue to increase, the state may need to implement strategies to control costs, which may interfere with physicians' autonomy.  Physicians can potentially avoid this by prescribing appropriately and judiciously.
 
 

Table 1. Physicians are Prescribing Expensive Drugs More Frequently
  1998 Units / Person*Year of Eligibility 1999 Units / Person*Year of Eligibility 2000 Units / Person*Year of Eligibility
Prilosec
6.5
8.4
9.9
Zyprexa
2.4
3.8
4.6
Risperdal
4.6
5.4
6.6
Prevacid
1.9
3.6
5.9
Celebrex
0.0
1.9
7.0
Claritin
3.5
4.8
5.8
Prozac
3.8
4.2
4.6
Norvasc
4.5
5.5
6.7
Depakote
8.5
10.0
10.9
Paxil
3.5
4.1
4.5
Zoloft
3.6
4.2
4.7
Lipitor
1.4
2.8
4.4
Zantac
9.5
8.5
8.2
Neurontin
3.8
5.9
9.1
Glucophage
5.6
7.8
10.4
Vioxx
0.0
0.0
3.2
Oxycodone
0.8
1.9
3.7
Pepcid
3.8
4.1
3.8
Buspar
4.3
4.5
4.4
Zithromax
0.4
0.5
0.6
Lorazepam
7.0
7.7
8.1
Cipro
1.2
1.2
1.3
 
  1998 Person*Years of Eligibility = 915,873
1999 Person*Years of Eligibility = 931,810
2000 Person*Years of Eligibility = 986,260


Attention: All Prescribers
Conversion from UPIN Numbers to DEA Numbers on Pharmacy Prescriptions and Claims

The Division of Medical Assistance (DMA) is now requiring DEA numbers on all recipient pharmacy claims instead of UPIN numbers. Providers must have their DEA registration number on file. Failure to do so may result in denied claims. If a prescriber does not have a DEA number and needs to issue prescriptions to recipients served by the Medicaid program, the prescriber should contact the DUR Section at 919-733-3590.

An identification number (ID) will be issued in lieu of the DEA number. The ID number, following the same format as the DEA number, will always begin with a Z (for example, ZF1234567). Prescribers will need to enter this number on their Medicaid prescriptions. This number is referred to as a MEDICAID IDENTIFICATION NUMBER only and should not be referred to as a DEA number.

If EDS Provider Enrollment does not have your updated information, please copy, complete, and return the DEA Number form for each prescriber in your practice. Please send the information to the following address:

EDS Provider Enrollment Unit
P.O. Box 300009
Raleigh, North Carolina 27622
FAX, 919-851-4014

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

DEA Number form
 

Sharman Leinwand, DUR Coordinator, Program Integrity Section
DMA, 919-733-3590 ext. 229
 


Attention: Adult Care Home Providers
Increase in Reimbursement Rates

Effective with date of service October 1, 2000 the per diem rates paid by Medicaid for Adult Care Home Personal Care Services are:
 
Description
Revenue
Code
HCPCS
Code
Maximum
Reimbursement
Rates
Basic ACH/PC (Facility Beds 1-30)
599
W8251
$12.32
Basic ACH/PC (Facility Beds 31 and above)
599
W8258
$13.67
Therapeutic Leave (TL) (Facility Beds 1-30)
183
W8251
$12.32
Therapeutic Leave (TL) (Facility Beds 31 and above)
183
W8258
$13.67
Enhanced ACH/PC (Eating)
599
W8256
$ 9.71
Enhanced ACH/PC (Toileting)
599
W8257
$ 3.47
Enhanced ACH/PC (Eating & Toileting)
599
W8259
$13.18
Enhanced ACH/PC (Ambulation/Locomotion)
599
W8255
$ 2.48

The transportation rate (RC 229) has increased to $.58 per Medicaid resident per day.

No adjustments will be made to previously filed claims.

Providers are expected to bill their usual and customary rates.
 

Jackie Burnette, Financial Operations
DMA, 919-857-4015


Attention: All Providers
Tax Identification Information

Alert - Tax Update Requested
North Carolina Medicaid must have the proper tax information for all providers. This ensures correct issuance of 1099 MISC forms each year and that the correct tax information is provided to the IRS. Inappropriate information on file can result in the IRS withholding 31% of a provider's Medicaid payments. Be sure the individual responsible for maintenance of tax information receives the following information.

How to Verify Tax Information
The last page of the Medicaid Remittance and Status Advice (RA) indicates the provider tax name and number that Medicaid has on file. Refer to the Medicaid RA throughout the year for each provider number to ensure Medicaid has the correct tax information on file. The tax information needed for a group practice is as follows: (1) Group tax name and group tax number (2) Attending Medicaid provider numbers in the group. If a Medicaid RA is needed, call EDS Provider Services 919-851-8888 or 1-800-688-6696 to verify the tax information on file for each provider number.

Providers should complete a Special W-9 (see next page) for all provider numbers with incorrect information on file. Instructions for completing the Special W-9 are listed below.

Send Completed and Signed Special W-9 Forms by December 8, 2000 to:

EDS
4905 Waters Edge Drive
Raleigh, NC 27606
Attention: Provider Services

OR
FAX to 919-851-4014
Attention: Provider Services

Change of Ownership
Contact DMA Provider Services at 919-857-4017 to report all changes in business ownership. If necessary, a new Medicaid provider number will be assigned and Provider Services will ensure the correct tax information is on file for Medicaid payments.

If DMA is not contacted and the incorrect provider number is used, that provider will be liable for taxes on income not necessarily received by the provider's business. DMA will assume no responsibility for penalties assessed by the IRS or for misrouted payments prior to written receipt of notification of ownership changes.

Group Practice Changes
When a physician leaves or a physician is added to a group practice, contact DMA Provider Services to update Medicaid enrollment and tax information.

Remember, without notifying DMA Provider Services, the incorrect tax information could remain on file and your business could become liable for taxes on Medicaid payments you did not receive.

Special W-9 form
 

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


Attention: All Providers
Mail Service Center Addresses

Effective January 2, 2001, all mail to the Division of Medical Assistance (DMA) must be addressed to the appropriate Mail Service Center address. Mail sent to any address other than the Mail Service Center addresses will not be forwarded and will be returned to the sender. Refer to the table below for DMA's Mail Service Center addresses.

UPS, FEDEX, Airborne, and other freight companies will continue to deliver to DMA's physical address, 1985 Umstead Drive, Raleigh NC, 27626. Include the DMA employee's name and section with the address to ensure that the delivery is routed correctly.

If you are using forms that have not been updated with DMA's Mail Service Center addresses, refer to the table below for the correct Mail Service Center address.
 

Administration and Regulatory Affairs
Division of Medical Assistance
2504 Mail Service Center
Raleigh, NC 27699-2504

Audit
Division of Medical Assistance
2507 Mail Service Center
Raleigh, NC 27699-2507

Carolina ACCESS; Managed Care
Division of Medical Assistance
2516 Mail Service Center
Raleigh, NC 27699-2516
Claims Analysis and Medicare Buy-In
Division of Medical Assistance
2519 Mail Service Center
Raleigh, NC 27699-2519
Community Care
Division of Medical Assistance
2502 Mail Service Center
Raleigh, NC 27699-2502
DHHS Accounts Receivable
Division of Medical Assistance
2022 Mail Service Center
Raleigh, NC 27699-2022
Director or Deputy Director
Division of Medical Assistance
2517 Mail Service Center
Raleigh, NC 27699-2517
Eligibility Unit
Division of Medical Assistance
2512 Mail Service Center
Raleigh, NC 27699-2512
Financial Operations
Division of Medical Assistance
2509 Mail Service Center
Raleigh, NC 27699-2509
Hearing Office
Division of Medical Assistance
2505 Mail Service Center
Raleigh, NC 27699-2505
Information Services
Division of Medical Assistance
2514 Mail Service Center
Raleigh, NC 27699-2514
Mail Management
Division of Medical Assistance
2513 Mail Service Center
Raleigh, NC 27699-2513
Medicaid Mgt. Info. System (MMIS)
Division of Medical Assistance
2510 Mail Service Center
Raleigh, NC 27699-2510
Medical Policy/Utilization Control
Division of Medical Assistance
2511 Mail Service Center
Raleigh, NC 27699-2511
Program Integrity
Division of Medical Assistance
2515 Mail Service Center
Raleigh, NC 27699-2515
Provider Services
Division of Medical Assistance
2506 Mail Service Center
Raleigh, NC 27699-2506
Quality Control
Division of Medical Assistance
2518 Mail Service Center
Raleigh, NC 27699-2518
Third Party Recovery or Health Insurance Premium Payment Program (HIPP)
Division of Medical Assistance
2508 Mail Service Center
Raleigh, NC 27699-2508

If you do not know which DMA section or unit's address to use, send your correspondence to the following general address:

(Name of DMA employee)
Division of Medical Assistance
2501 Mail Service Center
Raleigh, NC 27699-2501
 

Clarence Rogers, Financial Operations
DMA, 919-857-4015


Attention: All Providers
Coverage of 7-Valent Pneumococcal Polysaccharide-Protein Conjugate Vaccine (PCV7)

Distribution of PCV7 (7-valent pneumococcal polysaccharide-protein conjugate vaccine, CPT code 90669) began on November 1, 2000 through the Universal Childhood Vaccine Distribution Program (UCVDP). PCV7 is available for all Medicaid-eligible children aged 0 through 59 months through the Vaccines for Children Program (VFC). Effective with dates of service November 1, 2000, the N.C. Medicaid program will reimburse providers for the administration fee (W8012) when billing criteria is met (see Billing Information below).

Prevnar is the brand name for PCV7 and is marketed by Wyeth Lederle Vaccines. Currently, it is the only pneumococcal polysaccharide-protein conjugate vaccine available.

Please see the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) Statement, released October 6, 2000, regarding usage and dosage recommendations. The document can be found on the Internet at www.cdc.gov/nip.

Billing Information
Providers must report PCV7 (CPT code 90669) when billing the vaccine administration fee (W8012). CPT code 90669 must be listed with the appropriate modifiers. Health departments may not bill an administration fee (W8012) if the vaccine is given on the same day as a Health Check screening. Private physicians may bill an administration fee (W8012) on any day a vaccine is administered, even if it is given on the same day as a Health Check screening.

EDS, 1-888-668-8669 or 919-851-8888


Attention: Inpatient Psychiatric Hospital Providers
Reminder of Importance of Timely "Peer-to-Peer" Reviews

First Health of Tennessee (FH) performs utilization reviews of inpatient services in all psychiatric hospitals and in specified general hospitals for individuals under the age of 21, and through 64 years of age in psychiatric units of specified general hospitals. This includes preadmission and concurrent review. As a result of this review, either additional days are certified because the information is completed and the client meets criteria for continued stay, or the case is referred for a physician consultation due to insufficient information to justify the stay.

At this time, FH arranges a "peer-to-peer" telephone conference between the consulting physician and the attending physician to discuss the case and to obtain more information. Reasonable attempts (two phone calls) by FH to contact the attending physician within a 24-hour period will be made.

Should the facility wish to set up a peer-to-peer review, the facility representative will provide the FH reviewer with the phone number of the client's physician. The FH customer service representative for North Carolina will then schedule a time for the completion of the peer-to-peer review. The Division of Medical Assistance requests all participants to follow through with the peer-to-peer review within a 72-hour time frame. The physician should designate a back-up to participate in the review in the event that they are unable to participate. If a conference is scheduled and it is subsequently decided that the conference is not needed, please call and cancel.

Failure of the client's physician to keep the appointment for the peer-to-peer consultation results in denial of continued stay for the client. This denial is an administrative or technical denial and there is no appeal process for the client.
 

Carolyn Wiser, Behavioral Health Services Unit
DMA, 919-857-4025


Attention: All Providers
Renovation of the MMIS System - Identification Tracking Measurement Enhancement (ITME) Project

The Division of Medical Assistance (DMA) is upgrading and enhancing the Medicaid Management Information System (MMIS). The goals of the renovation, as noted in the April, 2000 Bulletin, are:

The enhancements will include minimal changes to the Remittance and Status Advice (RA), submission of adjustment requests, prior approval, and voice response and eligibility verification systems.

Changes to the following parts are detailed in the Provider Impact section of this article.

Part I - Remittance and Status Advice
Part II - Adjustment Requests - NEW FORM
Part III - Prior Approval (PA)
Part IV - Automated Voice Response (AVR) System and Eligibility Verification System (EVS)

Implementation Schedule

Updated Implementation Date: The implementation of system changes for the ITME project has been extended to February 9, 2001. The revised date of February 9, 2001 supercedes the original implementation date reflected in the September and October, 2000 ITME bulletin articles. Please note that all references to effective dates in the remainder of this article have been revised to reflect the extended date of February 9, 2001.

The RA will reflect the changes noted in Part I beginning February 9, 2001. Part II reflects the new N.C. Medicaid adjustment form. Use of this form is required as of February 9, 2001. Part III provides new instructions for submitting services that have been prior approved. Part IV addresses changes to the AVR System and EVS resulting from this enhancement.

Provider Impact

Part I: Remittance and Status Advice (RA) - See Example 1

RA modifications/format changes will be kept to only those that are necessary in conjunction with the ITME project. Overall, the RA will look very similar to the current format. Please note the format changes on the RA sample following this article (Example 1).

Addition of Financial Payer Code
A financial payer code follows the claim internal control number (ICN) in the first line of the claim data reflected on the RA. This financial payer code denotes the entity responsible for payment of the claims listed on the RA. Upon implementation, N.C. Medicaid will be the only financially responsible payer; therefore, the N.C. Medicaid payer code of NCXIX (five characters) will be reflected.

Addition of Population Group Payer Code
The RA reflects the population payer code for each claim detail. The population payer code is printed at the beginning of each claim detail line on the RA. The population payer code denotes the special program/population group from which a recipient is receiving Medicaid benefits. Examples of population payer codes are as follows:
 
Code Name Description
CA-I Carolina ACCESS All recipients enrolled in Medicaid's Carolina ACCESS program
CA-II ACCESS II All recipients enrolled in Medicaid's ACCESS II program
CAB ACCESS III - Cabarrus County All recipients enrolled in Medicaid's ACCESS III program for Cabarrus County
PITT ACCESS III - Pitt County All recipients enrolled in Medicaid's ACCESS III program for Pitt County
HMOM Health Management Organization (HMO) All recipients enrolled in Medicaid's HMO program
NCXIX Medicaid All recipients not enrolled in any of the above noted population payer programs. Any recipient not identified with Carolina ACCESS, ACCESS II, ACCESS III, or HMO will be assigned the NCXIX population payer code to identify them with the Medicaid fee-for-service program.

Other population payers may be designated by DMA in the future.

Addition of new totals following the current claim total line
An additional line is added following each claim total line of the paid and denied claim sections of the RA for the following claim types: Medical (J), Dental (K), Home Health, Hospice and Personal Care (Q), Medical Vendor (P), Outpatient (M), and Professional Crossover (O). This additional line reflects original claim billed amount, original claim detail count, and total number of financial payers. Upon implementation February, 2001, N.C. Medicaid will be the only financial payer; these new totals will reflect the submitted claim totals.

These additional totals do not appear for claim types Drug (D), Inpatient (S), Nursing Home (T), and Medicare Crossover (W) since they are not processed at the claim detail level and will not have multiple financial payers assigned, based on current N.C. Medicaid billing policy.

Addition of a new summary page at end of RA
For each Medicaid population payer identified on the paper RA, a new summary page showing total payments by population payer is provided at the end of the RA. This provides population payer detail information for tracking and informational purposes.

New specifications for Tape RA
Updated specifications have been mailed to all Tape RA Providers. If you are currently receiving a Tape RA and have not received the updated specifications, or have questions regarding the changes, please contact Glenda Raynor, Manager of EDS Electronic Commerce Services, at 919-851-8888 extension 5-3099.

Part II: Adjustment Requests - NEW FORM (Example 2)

The N.C. Medicaid program will begin using a new RA format in February 2001. This new format affects the way adjustment request forms are completed by the provider and processed by EDS. The appropriate "financial payer" information found on the new RA will be required on all adjustment request forms after February 9, 2001. DMA and EDS have implemented a new adjustment request form to help with these changes. One of the predominant changes is in the "claim number" field. This area is now identified with twenty boxes, each box for one number of the referenced claim number. Until February 9, 2001, there will be five empty boxes at the end of the claim number. After the February 9, 2001 implementation of the MMIS enhancements, these spaces will be used for the financial payer code information. Providers may begin using this new adjustment request form now if it facilitates implementing these changes. (Refer to example of claim field below.) Please contact EDS Provider Services with questions about the new format and processing of an adjustment request. Claim # field on Adjustment form from RA prior to February 9, 2001:
Claim #:
# # # # # # # # # # # # # # #
Claim # field on Adjustment form from RA after February 9, 2001:
Claim #: # # # # # # # # # # # # # # # N C X I X
Part III: Prior Approval (PA)

Effective February 9, 2001, entering the prior approval number on the claim form by the provider to receive payment for services rendered will no longer be required. This holds true for all prior approved Medicaid services, regardless of the entity giving the prior approval.

Prior approval requirements and the criteria for approval of services have not changed. Those services that previously required prior approval before the implementation of the enhanced MMIS will continue to require prior approval. If a service was approved prior to February 9, 2001 but was not provided or billed until after February 9, 2001, the original prior approval is still valid. The MMIS will verify that prior approval was obtained before claims payment can occur. If the services being submitted on the claim form require prior approval, and approval has not been obtained, that claim will be denied. The only change is that the input of the prior approval number is no longer required on the claim form by the provider as of February 9, 2001.

Part IV: Automated Voice Response (AVR) System and Eligibility Verification System (EVS)

These systems will be enhanced with new messages that will explain under which special Medicaid program or programs a recipient is enrolled as a participant. Additional information regarding these system enhancements will be provided in subsequent bulletin articles.

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


Attention: Durable Medical Equipment Providers
Rate Decrease

Effective with date of service December 1, 2000, the maximum reimbursement rate for the following code is reduced. Please make this change on the Durable Medical Equipment Fee schedule dated August 1, 2000. Providers are expected to bill their usual and customary rate.
 
Code
Description
Maximum Reimbursement Rate
W4633
Eggcrate Mattress pad
$19.67, new

 

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


Attention: Hospital Providers
Lower Level of Care and Swing Bed Reimbursement Rates

Effective with date of service October 1, 2000, the hospital lower level of care and swing bed maximum reimbursement rates per day of patient care are as follows.
 
Level of Care
Maximum Reimbursement Rate
Skilled Nursing Care
$122.14
Intermediate Care
$ 93.11
Ventilator Dependent Care
$357.67

No adjustments will be made to previously filed claims.
 

Carolyn Brown, Financial Operations
DMA, 919-857-4015


Attention: Physicians and CRNAs
Billing for Dental Anesthesia

Physicians and CRNAs administering anesthesia for dental procedures must bill procedure code 40899 appended with either modifier YA or QS. The time, in units, must be entered in block 24G of the HCFA-1500 claim form. One minute equals one unit. The detail will deny if procedure code 40899 is billed without an anesthesia modifier.
 

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



 

Attention: Home Health Providers
Home Health Seminars

Home Health seminars are scheduled for February 2001. The January General 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. Return the Home Health Seminar form to:

Provider Services
EDS
P.O. Box 300009
Raleigh, NC 27622
 

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


Attention: Mental Health Providers
Direct Enrollment Seminars

The Division of Medical Assistance will begin enrolling Licensed Psychologists (PhDs), Licensed Clinical Social Workers, Mental Health Certified Nurse Practitioners, and Clinical Nurse Specialists in the Medicaid program effective February 1, 2001. Direct Enrollment seminars are scheduled for February 2001. The January General 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. Return the Direct Enrollment Seminar form to:

Provider Services
EDS
P.O. Box 300009
Raleigh, NC 27622
 

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


 

ATTENTION PHYSICIANS

Medical Doctors, Optomotrists, Chiropractors, Podiatrists, Osteopaths, and Dentists

Changes in Provider Status
Must be Reported to Your Local Blue Cross Representative  
Charlotte
1-704-562-2740
Greensboro
1-336-316-5374
Greenville
1-252-758-4745
Hickory
1-877-889-0002
Raleigh
1-919-461-5246
Wilmington
1-877-889-0001
Border Areas
1-919-765-2471
Out-of-State*
1-919-765-2471

Do Not Notify DMA or EDS
Blue Cross will forward the updated information to 
DMA's Provider Services Unit

*Enrolled providers within 40 miles of the North Carolina border

 



Checkwrite Schedule
December 5, 2000 January 9, 2001 February 6, 2001
December 12, 2000 January 17, 2001 February 13, 2001
December 21, 2000 January 25, 2001 February 22, 2001


Electronic Cut-Off Schedule
December 1, 2000 January 5, 2001 February 2, 2001
December 8, 2000 January 12, 2001 February 9, 2001
December 15, 2000 January 19, 2001 February 16, 2001


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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