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In This Issue. . .
| All Providers:
Carolina ACCESS Providers:
Community Alternatives Program Lead Agencies:
|
Durable Medical Equipment Providers:
Head Start Programs:
Home Health Agencies:
Independent Practitioners:
Private Duty Nursing Providers:
|
Attention: All Providers
Holiday Observance
The Division of Medical Assistance (DMA) and EDS will be closed Monday, December
24, 2001 through Wednesday, December 26, 2001 in observance of Christmas, and
on Tuesday, January 1, 2002 in observance of New Year's Day.
EDS, 1-800-688-6696 or 919-851-8888
Attention: All Providers
Noninvasive Pulse Oximetry Reimbursement (CPT Codes 94760 and 94761)
Effective with date of service December 1, 2001, noninvasive pulse oximetry reimbursement
is included in the payment of other payable services provided on the same date
of service. The N.C. Medicaid program allows separate reimbursement for noninvasive
pulse oximetry when the following conditions are met:
- The noninvasive pulse oximetry determination is the only service provided.
- CPT procedure codes 94760 and 94761 are not billed with any other covered
Medicaid service.
EDS, 1-800-688-6696 or 919-851-8888
Attention: Durable Medical Equipment Providers
Change in HCPCS Codes for Oxygen Concentrators
In order to comply with HCPCS changes, the following code changes in the Oxygen
and Oxygen-Related Items section of the Durable Medical Equipment (DME) Fee Schedule
will become effective with date of service January 1, 2002.
Code E1390, "oxygen concentrator, capable of delivering 85 percent or greater
oxygen concentration at the prescribed flow rate," will replace all current
oxygen concentrator codes, E1400, E1401, E1402, E1403, and E1404. The maximum
reimbursement rate for monthly rental of code E1390 is $223.30. Providers
must bill their usual and customary rate.
Code E1390 will require prior approval. The coverage criteria is the same as
those previously established for codes E1400, E1401, E1402, E1403, and E1404.
These criteria are provided on pages F-3 and F-4 of the March 1, 1999 reprint
of the N.C. Medicaid Durable Medical Equipment Manual.
Providers who currently have temporary or permanent prior approvals for codes
E1400, E1401, E1402, E1403, and E1404 will be required to send a copy of the
approved Certificate of Medical Necessity and Prior Approval form to EDS Prior
Approval indicating the need for a change of coding in the system. These requests
must be sent to:
EDS
Attn: Prior Approval
P.O. Box 31188
Raleigh, NC 27622
Melody B. Yeargan, P.T., Medical Policy
DMA, 919-857-4020
Attention: Independent Practitioner and Head Start Programs
Change in Prior Approval Process
Effective December 1, 2001, the prior approval process for the Independent Practitioner
(IP) and Head Start programs has been suspended. It is no longer necessary to
submit forms to Purchase of Medical Care Services (POMCS) for review. However,
until a new process is implemented, the provider's records are subject to retrospective
review.
Providers should continue to submit claims for medically necessary services
to EDS. Claims that exceed current IP program limits will deny.
Carol Robertson, Medical Policy Section
DMA, 919-857-4020
Attention: Carolina ACCESS Providers
Reduction in Management Fee
Effective January 1, 2002, the Carolina ACCESS (CA) management fee for any CA
provider not linked with an ACCESS II and ACCESS III administrative entity will
be reduced to $2.00 per member per month. In addition, management fees paid to
ACCESS II and ACCESS III providers for the first 250 enrollees will be reduced
from $3.00 per member per month to $2.50 per member per month. The management
fee will continue to be paid on the first checkwrite of every month for the current
month.
Betty West, Managed Care Section
DMA, 919-857-4022
Attention: All Providers
Tax Identification Information
Alert - Tax Update Requested
The N.C. Medicaid program must have the correct tax information on file for all
providers. This ensures that 1099 MISC forms are issued correctly each year and
that correct tax information is provided to the IRS. Incorrect information on
file with Medicaid can result in the IRS withholding 30.5 percent of a provider's
Medicaid payments. The individual responsible for maintenance of tax information
must receive the information contained in this article.
How to Verify Tax Information
The last page of the Medicaid Remittance and Status Report (RA) indicates the
tax name and number on file with Medicaid for the provider number listed. Review
the Medicaid RA throughout the year to ensure that correct tax information is
on file for each provider number. If you do not have access to a Medicaid RA,
call EDS Provider Services at 919-851-8888 or 1-800-688-6696 to verify the tax
information on file for each provider.
The tax information listed for a group practice is as follows:
- group tax name and group tax number
- attending Medicaid provider number in the group
How to Correct Tax Information
All providers are required to complete a W-9
form for each provider number with incorrect information on file. Corrected
information must be received by December 15, 2001. The procedure for submitting
corrected tax information to the Medicaid program is determined by the provider
type.
- Physicians must submit completed and signed W-9
forms to their Blue Cross Blue Shield of North Carolina (BCBSNC) representative.
- Other providers, including Managed Care providers, must submit completed
and signed W-9 forms along with a completed and signed Notifcation
of Change in Provider Status form to the Division of Medical Assistance
(DMA) Provider Services Unit.
- Carolina ACCESS (CA) providers must also submit a Carolina
ACCESS Provider Information Change form to DMA Provider Services.
Copies of the change forms and the W-9 form can be obtained from the DMA website.
Refer to the following instructions for completing the W-9. Additional
instructions can be found on the IRS website at www.irs.gov
under the link "Forms and Pubs."
- List the N.C. Medicaid provider number in the block titled "List account
number(s) here."
- List the N.C. Medicaid provider name in the block titled "Business Name."
It should appear EXACTLY as the IRS has on file.
- Indicate the appropriate type of business.
- Fill in either a social security number OR a tax identification
number. Indicate the number EXACTLY as the IRS has on file for the
provider's business. (Do not insert a social security number unless the
business is a sole proprietorship or individually owned and operated.)
- An authorized person MUST sign and date this form or it will be
returned as incomplete and the tax information on file with Medicaid will
not be updated.
Change of Ownership
- Physicians must contact BCBSNC to report all changes in business ownership.
- All other providers, including Managed Care providers, must report changes
to DMA Provider Services using the Notifcation
of Change in Provider Status form.
- CA providers must also report changes to DMA Provider Services using the
Carolina ACCESS Provider Information Change
form.
DMA Provider Services will assign a new Medicaid provider number if necessary
and will ensure the correct tax information is on file for Medicaid payments.
If DMA is not contacted and the incorrect tax id 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.
Physician Group Practice Changes
When a physician leaves or a physician is added to a group practice, contact
BCBSNC to update Medicaid enrollment and tax information. CA providers must
also report changes to DMA Provider Services using the Carolina
ACCESS Provider Information Change form.
EDS, 1-800-688-6696 or 919-851-8888
- Form W-9 Request for
Taxpayer Identification Number and Certification
Attention: Durable Medical Equipment Providers
Completion of Certificate of Medical Necessity and Prior Approval Form
Current efforts to resolve problems with incomplete Certificate of Medical Necessity
and Prior Approval (CMN/PA) forms are delaying the review and disposition of durable
medical equipment (DME) requests. EDS will not process incomplete forms. All incomplete
forms will be returned to the DME provider for correction and resubmission. Correction
fluid and strips are not permitted on the CMN/PA form and forms will be returned
to the provider without review if they have been used on the form.
Please ensure that each request corresponds to the instructions for completion
of the CMN/PA form given in Step 2 of Subsection 6.4 of the N.C. Medicaid Durable
Medical Equipment Manual. It is not necessary to complete fields 3, 6, and 10.
Entering ICD-9-CM codes in fields 11 and 12 and a CPT-4 code in field 13 is
optional. All of the remaining fields must be completed. Field 24 is required
for the following HCPCS codes: E0608, E0609, E0480, E0784, E0202, E0935, W4006,
and W4007.
N/A must only be used in the following fields under the following circumstances:
- field 4 - if the patient does not have a Medicare number
- field 16 - if the patient is an infant or child, or the request is not
for a bed
- field 24 - if the request is not for one of the HCPCS codes listed above
When completing field 26, be sure to fully identify the equipment that is being
requested. The provider's return address must be entered in field 29. Failure
to do so will delay the return of the form. A stamped address may be used.
All of the information provided must be accurate and thorough.
Note: Each page of documentation with the CMN/PA must contain
the recipient's name and Medicaid identification number. Effective immediately,
EDS will retain all documentation attached to the CMN/PA. It is the provider's
responsibility to maintain copies for their records.
EDS, 1-800-688-6696 or 919-851-8888
Attention: Home Health Agencies, Private Duty Nursing
Providers, and Community Alternatives Program Lead Agencies
HCPCS Code W4646
Effective with date of service December 31, 2001, HCPCS code W4646 (Nebulizer
kit, plastic or glass) will be end-dated because of low utilization. However,
if a physician specifically orders this item and it meets the criteria listed
in Section 5.1.6 of the N.C. Medicaid Community Care Manual,
providers may bill Medicaid using HCPCS code W4655.
Providers must bill their usual and customary rates.
Dot Ling, Medical Policy Section
DMA, 919-857-4021
Checkwrite Schedule
| December 11, 2001 |
January 15, 2002 |
February 12, 2002 |
| December 18, 2001 |
January 23, 2002 |
February 19, 2002 |
| December 28, 2001 |
January 30, 2002 |
February 27, 2002 |
Electronic Cut-Off Schedule
| December 7, 2001 |
January 11, 2002 |
February 8, 2002 |
| December 14, 2001 |
January 18, 2002 |
February 15, 2002 |
| December 21, 2001 |
January 25, 2002 |
February 22, 2002 |
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.
| ______________________ |
|
_______________________ |
| Nina M. Yeager, Director |
|
Ricky Pope |
| Division of Medical Assitance |
|
Executive Director |
| Department of Health and Human Services |
EDS |
|