In This Issue..

Attention: All Providers

Holiday Observance

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

Attention: All Providers

Current Procedural Terminology Update for 2002

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

Attention: Adult Care Home Providers

Reimbursement Rate Increase for Adult Care Home Providers

The transportation rate (RC 229) has increased to $.60 per Medicaid resident per day. Providers must bill their usual and customary charges. Adjustments will not be made to previously processed claims.
 

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

Attention: Hospital Providers

Reimbursement Rates for Lower Level of Care, Ventilator Dependent Care, and Swing Bed

Adjustments will not be made to previously processed claims.
 

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

Attention: All Providers

Referrals and Service Coordination for the Community Alternatives Program for Disabled Adults

Providers of Medicaid home care services should refer to the list to coordinate with the client's CAP/DA case manager any services that they provide to a CAP/DA client. CAP/DA case managers need to be aware when home health services, personal care services, durable medical equipment, home infusion therapy, private duty nursing or hospice are being considered or provided to a CAP/DA client. A "CI" or "CS" in the CAP block of the Medicaid identification card identifies CAP/DA clients.

CAP/DA Lead Agency List
 

County	Lead Agency	City	Phone #
Alamance	Alamance County DSS	Burlington	(336) 229-3187
Alexander	Alexander County DSS	Taylorsville	(828) 632-1080
Alleghany	Alleghany Memorial Hospital	Sparta	(336) 372-4464
Anson	Anson Community Hospital	Wadesboro	(704) 695-3409
Ashe	Ashe Services for Aging, Inc.	West Jefferson	(336) 246-2461
Avery	Sloop CAP	Newland	(828) 733-1062
Beaufort	Beaufort County DSS	Washington	(252) 975-5500
Bertie	University Home Care - Cashie  (Lead Agency - East Carolina Health-Bertie)	Windsor	(252) 794-2622
Bladen	Bladen County Health Dept.	Elizabethtown	(910) 862-6221
Brunswick	Brunswick County DSS	Bolivia	(910) 253-2077
Buncombe	Buncombe County DSS	Asheville	(828) 250-5814
Burke	Burke County DSS	Morganton	(828) 439-2000
Cabarrus	Cabarrus County DSS	Kannapolis	(704) 920-1400
Caldwell	Caldwell County DSS	Lenoir	(828) 757-1180
Camden	Albemarle Regional Health Services	Elizabeth City	(252) 338-4066
Carteret	Carteret County DSS	Beaufort	(252) 728-3181
Caswell	Caswell County Health Dept.	Yanceyville	(336) 694-9592
Catawba	Catawba County DSS	Hickory	(828) 695-5600
Chatham	Chatham County Health Dept.	Pittsboro	(919) 542-8220
Cherokee	District Memorial Hospital	Andrews	(828) 321-4113
Chowan	Chowan Hospital Home Care	Edenton	(252) 482-6322
Clay	Clay County Health Dept.	Hayesville	(828) 389-1444
Cleveland	Cleveland Regional Medical Center  Care Solutions	Shelby	(704) 487-0968
Columbus	Columbus County Dept. of Aging	Whiteville	(910) 640-6602
Craven	Craven Regional Medical Center	New Bern	(252) 633-8240
Cumberland	Cape Fear Valley Health System, Inc.	Fayetteville	(910) 829-1720
Currituck	Albemarle Regional Health Services	Elizabeth City	(252) 338-4066
Dare	Dare County DSS	Manteo	(252) 473-1471
Davidson	Davidson County Senior Services	Thomasville	(336) 474-2754
Davie	Davie County Hospital	Mocksville	(336) 751-8340
Duplin	Duplin Home Care and Hospice  (Lead Agency - Duplin General Hospital)	Kenansville	(910) 296-0819
Durham	Durham County DSS	Durham	(919) 560-8659
Edgecombe	Edgecombe Home Care and Hospice	Tarboro	(252) 641-7518
Forsyth	Senior Services, Inc.  (Lead Agency - Forsyth County Health Dept.)	Winston Salem	(336) 725-0907
Franklin	Franklin County DSS	Louisburg	(919) 496-5721
Gaston	Gaston County DSS	Gastonia	(704) 862-7540
Gates	Chowan Hospital Home Care  (Lead Agency - Gates County DSS)	Gatesville	(252) 357-1117
Graham	Graham County Health Dept.	Robbinsville	(828) 479-4201
Granville	Granville Medical Center	Oxford	(919) 690-3242
Greene	Greene County DSS	Snow Hill	(252) 747-5932
Guilford	Guilford County Health Dept.	Greensboro	(336) 641-3331
Halifax	Halifax County DSS	Halifax	(252) 536-6537
Harnett	Harnett County Dept. on Aging	Lillington	(910) 893-7596
Haywood	Haywood County Council on Aging	Waynesville	(828) 452-2370
Henderson	Margaret R. Pardee Hospital	Hendersonville	(828) 696-1000
Hertford	Hertford County DSS	Winton	(252) 358-7830
Hoke	Duke / St Joseph Home Health  (Lead Agency - Hoke County DSS)	Raeford	(910) 875-8198
Hyde	Hyde County DSS	Swan Quarter	(252) 926-3371
Iredell	Iredell County DSS	Statesville	(704) 878-5086
Jackson	Harris Regional Hospital	Sylva	(828) 586-7410
Johnston	Johnston County DSS	Smithfield	(919) 989-5300
Jones	Jones County DSS	Trenton	(252) 448-2581
Lee	Lee County DSS	Sanford	(919) 718-4690
Lenoir	Lenoir Memorial Hospital	Kinston	(252) 522-7947
Lincoln	Lincoln County DSS	Lincolnton	(704) 732-1969
Macon	Macon County DSS	Franklin	(828) 349-2124
Madison	Madison County Dept. of Community Services	Marshall	(828) 649-2722
Martin	Martin County DSS	Williamston	(252) 809-6403
McDowell	McDowell County DSS	Marion	(828) 652-3355
Mecklenburg	Mecklenburg County Health Dept.	Charlotte	(704) 336-4700
Mitchell	Mitchell County DSS	Bakersville	(828) 688-2175
Montgomery	Montgomery County DSS	Troy	(910) 576-6531
Moore	FirstHealth Home Care  (Lead Agency - Moore County DSS)	West End	(910) 295-2211
Nash	Nash County Health Dept.	Rocky Mount	(252) 446-1777
New Hanover	New Hanover Health Network	Wilmington	(910) 343-7711
Northampton	Northampton County DSS	Jackson	(252) 534-5811
Onslow	Onslow Council on Aging	Jacksonville	(910) 455-2747
Orange	Orange County DSS	Hillsborough	(919) 245-2882
Pamlico	Pamlico County Senior Services	Alliance	(252) 745-7196
Pasquotank	Albemarle Regional Health Services	Elizabeth City	(252) 338-4066
Pender	Pender Adult Services	Burgaw	(910) 259-9119
Perquimans	Albemarle Regional Health Services	Elizabeth City	(252) 338-4066
Person	Person County DSS	Roxboro	(336) 599-8361
Pitt	Pitt County DSS	Greenville	(252) 413-1101
Polk	St. Luke's Hospital	Columbus	(828) 894-0564
Randolph	Randolph Hospital	Asheboro	(336) 625-5151
Richmond	FirstHealth Richmond	Rockingham	(910) 997-5800
Robeson	Southeastern Regional Medical Center	Lumberton	(910) 618-9405
Rockingham	Rockingham County Council on Aging, Inc.	Reidsville	(336) 349-2343
Rowan	CapCare Rowan Regional Medical Center	Salisbury	(704) 210-5626
Rutherford	Rutherford Hospital, Inc.	Forest City	(828) 245-3575
Sampson	Sampson County Dept. of Aging and In-Home Services	Clinton	(910) 592-4653
Scotland	Scotland Home Health  (Lead Agency - Scotland County Health Dept.)	Laurinburg	(910) 277-2484
Stanly	Stanly County DSS	Albemarle	(704) 982-6100
Stokes	Stokes County DSS	Danbury	(336) 593-2861
Surry	Surry County Friends of Seniors	Mount Airy	(336) 401-8500
Swain	Swain County Health Dept.	Bryson City	(828) 488-3792
Transylvania	Transylvania Community Hospital	Brevard	(828) 883-5473
Tyrrell	Tyrrell County DSS	Columbia	(252) 796-3421
Union	Union County DSS	Monroe	(704) 296-4300
Vance	Vance County DSS	Henderson	(252) 492-5001
Wake	Resources for Seniors, Inc.	Raleigh	(919) 872-7933
Warren	Warren County DSS	Warrenton	(252) 257-5974
Washington	Washington County Center for Human Services	Plymouth	(252) 793-4041
Watauga	Watauga County Project on Aging	Boone	(828) 265-8090
Wayne	Wayne Memorial Hospital, Inc.	Goldsboro	(919) 731-6314
Wilkes	Home Care of Wilkes Regional Medical Center	North Wilkesboro	(336) 903-7700
Wilson	WilMed Home Care	Wilson	(252) 399-8228
Yadkin	Yadkin County DSS	Yadkinville	(336) 679-3385
Yancey	Yancey County Health Dept.	Burnsville	(828) 682-7967

Barbara Schwab, CAP/DA Administrative Officer
DMA, 919-857-4021

Attention: Prescribers

Synagis Policy Revision

The following guidelines and procedures should be used in determining appropriate candidates for Synagis. Eligibility guidelines are based on the 1998 American Academy of Pediatrics recommendations as published in Pediatrics.

1. Chronic Lung Disease and Less Than Two Years of Age - Synagis prophylaxis should be considered for infants and children younger than two years of age with chronic lung disease (CLD) who have required medical therapy for their CLD within six months before the anticipated RSV season.
2. History of Premature Birth - Infants born at 32 weeks gestation or earlier, without CLD, may benefit from RSV prophylaxis.

a. Infants born at 28 weeks of gestation or earlier may benefit from RSV prophylaxis up to 12 months of age.

b. Infants born at 29 to 32 weeks of gestation may benefit most from prophylaxis up to six months of age.

c. Infants born from 32 to 35 weeks of gestation with additional risk factors may be considered for prophylaxis up to six months of age. Risk factors include underlying conditions that predispose to respiratory complication (e.g., neurologic disease in very low birth weight infants), number of young siblings, child care center attendance, exposure to tobacco smoke in the home, anticipated cardiac surgery, and distance to and availability of hospital care for severe respiratory illness.

3. Synagis is not recommended for children with cyanotic congenital heart disease.

Sharman Leinwand, MPH, RPH, Pharmacy Program Manager
DMA, 919-857-4034

Attention: Ambulance Services Providers

Reimbursement Rate Increase for Ambulance Services

Providers are reminded to bill their usual and customary charges. Adjustments will not be made to previously processed claims.
 

Janet Choplin, Financial Operations
DMA, 919-857-4015

Attention: Physicians, Nurse Practitioners, and Dialysis Treatment Facilities

Ferrlecit (Sodium Ferric Gluconate Complex, HCPCS Code J2915, 625 mg.) Coverage Criteria

Ferrlecit is covered for recipients under the following conditions:

• The recipient has a diagnosis of chronic renal failure (ICD-9-CM 585), or anemia in end-stage renal disease (ICD-9-CM 285.21), and

• The recipient has one of the following ICD-9-CM diagnoses: 280.0 - 280.1; 280.8 - 280.9; or 284.0 - 285.9; and

• The recipient is receiving erythropoietin therapy, and

• The recipient is undergoing chronic hemodialysis.

• File the claim using the HCFA-1500 claim form.

• Enter ICD-9-CM diagnosis code 585 or 285.21, and one of the following diagnosis codes in block 21: 280.0 - 280.1; 280.8 - 280.9; or 284.0 - 285.9.

• Enter the date of service in block 24A.

• Enter the place of service in block 24B.

• Enter HCPCS code J2915 in block 24D.

• Enter the total charges in block 24F.

• Enter the units given in block 24G (62.5 mg/5 ml ampule = 1 unit).

Note: Physicians cannot bill an Evaluation and Management code in addition to an injection administration code, CPT 90782. This drug should be added to the list of injectable drugs published in the November 2000 general Medicaid bulletin.

Billing Requirements for Dialysis Treatment Facilities:

• File the claim using the UB-92 claim form.

• Enter revenue code 250 in form locator 42.

• Enter the description of the drug in form locator 43.

• Enter HCPCS code J2915 in form locator 44.

• Enter the date of service in form locator 45.

• Enter the units given in form locator 46 (62.5 mg/5ml ampule = 1 unit).

• Enter the total charges in form locator 47.

• Enter diagnosis code 585 or 285.21 in form locator 67, and

• Enter a diagnosis code from the following list in form locators 68 through 75: 280.0 - 280.1; 280.8 - 280.9; 284.0 - 285.9.

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

Attention: All Providers

Medicaid Identification Cards

The new MID cards will be printed on 8.5" x 11" watermarked laser paper. The lighter weight paper is more pliable and will be perforated, allowing the recipient to detach the card. However, the card is still valid if it is not detached. The new cards also include a postal bar code, which is expected to improve delivery.

There is no change to the way recipients will use the MID cards. On occasion, Medicaid recipients may receive blue, pink or buff cards printed on the heavier stock paper. These cards are still valid.
 

Andy Wilson, Medicaid Eligibility Unit
DMA, 919-857-4019

Attention: Hospice Providers

Reimbursement Rate Increase for Hospice Services

Note: Providers must bill their usual and customary charges. Adjustments will not be made to previously processed claims.

Key to Hospice Rate Table:

SC = Specialty Code
RC = Revenue Code

1. A minimum of eight hours of continuous home care per day must be provided.
2. There is a maximum of five consecutive days including the date of admission but not the date of discharge for inpatient respite care. Bill for the sixth and any subsequent days at the routine home care rate.
3. Payments to a hospice for inpatient care are limited in relation to all Medicaid payments to the agency for hospice care. During the 12-month period beginning November 1 of each year and ending October 31, the aggregate number of inpatient respite and general inpatient days may not exceed 20 percent of the aggregate total number of days of hospice care provided during the same time period for all the hospice's Medicaid patients. Hospice care provided for patients with acquired immune deficiency syndrome (AIDS) is excluded in calculating the inpatient care limit. The hospice refunds any overpayments to Medicaid.
4. Date of Discharge: For the day of discharge from an inpatient unit, the appropriate home care rate must be billed instead of the inpatient care rate unless the recipient expires while an inpatient. When the recipient is discharged as deceased, the inpatient rate (general or respite) is billed for the discharge date.
5. When a Medicare/Medicaid recipient is in a nursing facility, Medicare is billed for routine or continuous home care, as appropriate, and Medicaid is billed for the appropriate long-term care rate. When a Medicaid only hospice recipient is in a nursing facility, the hospice may bill for the appropriate long-term care (SNF/ICF) rate in addition to the home care rate provided in revenue code 651 or 652. See section 8.15.1, page 8-12, of the N.C. Medicaid Community Care Manual for details.

Attention: All Providers

Medicare Crossovers

In order to process these crossover claims, providers must submit a Medicare Crossover Reference Request form, which allows EDS to cross reference the provider's Medicare number with their Medicaid number and process the claim. Without this information, EDS cannot identify the provider's Medicaid number and cannot process Medicare crossover claims.

Providers must complete the Medicare Crossover Reference Request form if they file Medicare claims with any of the Medicare carriers listed on the form to ensure that the claim will cross over to Medicaid for payment.

Medicare Crossover Reference Request form

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

Attention: All Providers

Breast and Cervical Cancer Control Program Guidelines

• have been enrolled and screened under the North Carolina Breast and Cervical Cancer Control Program (NCBCCCP) and found to need treatment for breast and cervical cancer including pre-cancerous conditions and early stage cancer; and

• are uninsured (have no major medical coverage including Medicaid and Medicare); and

• are 18 through 64 years of age; and

• meet Medicaid citizenship requirements and other general eligibility requirements for Medicaid.

Effective January 1, 2002, NCBCCCP screening providers will complete a Medicaid eligibility application for women who have been screened through the NCBCCCP and found to need treatment for either breast or cervical cancer or pre-cancerous conditions.

Providers may refer women who meet the criteria listed above to their local health department to be screened under the NCBCCCP. The NCBCCCP screening program has specific age and income requirements. Contact the local health department for these requirements.

The period of Medicaid eligibility is based on the individual's course of treatment for cancer established by a statement from her physician. The certification period ends when the course of treatment ends. Women in this new coverage group will receive a blue Medicaid identification card, which entitles them to all Medicaid covered services during the breast or cervical cancer treatment period.
 

Denise Rogers, Medicaid Eligibility Unit
DMA, 919-857-4019

Attention: Mecklenburg County Providers

Managed Care Update

Julia McCollum, Managed Care Section
Darryl Frazier, Managed Care Section
DMA, 919-857-4022

Attention: Hospital Providers

ICD-9-CM Diagnosis Codes - Additions and Changes

New Diagnosis Codes
 

Code	Description
256.31	Premature menopause
256.39	Other ovarian failure
277.7	Dysmetabolic Syndrome X
464.00	Acute laryngitis, without mention of obstruction
464.01	Acute laryngitis, with obstruction
464.50	Unspecified supraglottitis, without mention of obstruction
464.51	Unspecified supraglottitis, with obstruction
521.00	Unspecified dental caries
521.01	Dental caries limited to enamel
521.02	Dental caries extending into dentine
521.03	Dental caries extending into pulp
521.04	Arrested dental caries
521.05	Odontoclasia
521.09	Other dental caries
525.10	Unspecified acquired absence of teeth
525.11	Loss of teeth due to trauma
525.12	Loss of teeth due to periodontal disease
525.13	Loss of teeth due to caries
525.19	Other loss of teeth
530.12	Acute esophagitis
564.00	Unspecified constipation
564.01	Slow transit constipation
564.02	Outlet dysfunction constipation
564.09	Other constipation
602.3	Dysplasia of prostate
608.82	Hematospermia
608.87	Retrograde ejaculation
692.76	Sunburn of second degree
692.77	Sunburn of third degree
718.70	Developmental dislocation of joint, site unspecified
718.71	Developmental dislocation of joint, shoulder region
718.72	Developmental dislocation of joint, upper arm
718.73	Developmental dislocation of joint, forearm
718.74	Developmental dislocation of joint, hand
718.75	Developmental dislocation of joint, pelvic region and thigh
718.76	Developmental dislocation of joint, lower leg
718.77	Developmental dislocation joint, ankle and foot
718.78	Developmental dislocation of joint, other specified sites
718.79	Developmental dislocation of joint, multiple sites
733.93	Stress fracture of tibia or fibula
733.94	Stress fracture of the metatarsals
733.95	Stress fracture of other bone
772.10	Intraventricular hemorrhage, unspecified grade
772.11	Intraventricular hemorrhage, Grade I
772.12	Intraventricular hemorrhage, Grade II
772.13	Intraventricular hemorrhage, Grade III
772.14	Intraventricular hemorrhage, Grade IV
779.7	Perventricular leukomalacia
793.80	Unspecified abnormal mammogram
793.81	Mammographic microcalcification
793.89	Other abnormal findings on radiological examination breast
840.7	Superior glenoid labrum lesions (SLAP)
997.71	Vascular complications of mesenteric artery
997.72	Vascular complications of renal artery
997.79	Vascular complications of other vessels
V10.53	Personal history of malignant neoplasm, renal pelvis
V45.84	Dental restoration status
V49.82	Dental sealant status
V83.01	Asymptomatic hemophilia A carrier
V83.02	Symptomatic hemophilia A carrier

Codes Requiring Further Subdivision

The following diagnosis codes have been further subdivided with new codes found in the above table. Therefore, effective with date of service October 1, 2001, these codes should not be used.
 

Code	Description
256.3	Other ovarian failure
464.0	Acute laryngitis
521.0	Dental caries
525.1	Loss of teeth due to accident, extraction, or local periodontal disease
564.0	Constipation
772.1	Intraventricular hemorrhage
793.8	Nonspecific abnormal findings on radiological and other examinations of body structure, breast

Revised Diagnosis Code Titles
 

Code	Current Description	Revised Description
411.81	Coronary occlusion without myocardial infarction	Acute coronary occlusion without myocardial infarction
493.00	Extrinsic asthma without mention of status asthmaticus	Extrinsic asthma without mention of status asthmaticus or acute exacerbation or unspecified
493.10	Intrinsic asthma without mention of status asthmaticus	Intrinsic asthma without mention of status asthmaticus or acute exacerbation or unspecified
493.20	Chronic obstructive asthma without mention of status asthmaticus	Chronic obstructive asthma without mention of status asthmaticus or acute exacerbation or unspecified
493.90	Asthma, unspecified without mention of status asthmaticus	Asthma, unspecified without mention of status asthmaticus or acute exacerbation or unspecified
V70.7	Examination for normal comparison or control in clinical research	Examination of participant in clinical trial

Ann H. Kimbrell, R.N., Institutional Services
DMA, 919-857-4022

Attention: Personal Care Services Providers and Home Health Agencies

Questions and Answers Regarding Personal Care Services (in Private Residences)

1. Is there a limit on the amount of time that the aide can spend on "incidental services" such as meal preparation and housekeeping?


No, but remember that PCS is based on the client's need for personal care, not home management, and the purpose of each visit must be to meet the client's personal care needs. Guidelines do not address the amount of time that can be spent on incidental services. The incidental services covered under PCS are housekeeping and home management tasks essential, though secondary, to the personal care needs of the patient. The time allotted on the PCS plan of care for all the personal care and home management tasks to be accomplished during a visit must be reasonable and necessary to complete the tasks. The plan of care must document the specific tasks and the total time needed to complete all of the tasks on a given day. Daily records must be kept to support the services provided. Appropriate revisions to the plan of care must be made to reflect any permanent change in amount of time or task.
 

2. Is meal preparation considered an "incidental service" or a "personal care" service? It is listed under "Personal Care" in section 30 of the DMA 3000 but under "Home Management" on page 6-3 of the N.C. Medicaid Community Care Manual.


Preparation of "simple meals" is considered an "incidental" housekeeping and home management task, as indicated on page 6-3 of the N.C. Medicaid Community Care Manual. The meal preparation could qualify as a Level III Personal Care task if the physician orders a specific diet requiring careful menu planning or specialized preparation. Aides performing menu planning and preparation of more complex diets must meet the N.C. Board of Nursing's competency requirements and be registered as a Nurse Aide I or II in the N.C. Nurse Aide Registry with the Division of Facility Services (DFS).
 

3. What does "medically stable" mean?


"Medically stable" means that the patient's medical condition is at maintenance level and without constant changes that would require monitoring and evaluation. Keep in mind that PCS is a paraprofessional service and does not include skilled medical care.
 

4. Is bathing or assistance with bathing a requirement to get PCS services?


Medicaid guidelines do not indicate the need for a specific personal care task as a requirement for services. PCS guidelines indicate that the patient must need at least one of the In-Home Aide Level II or III Personal Care tasks listed on pages 6-2 and 6-3 of the N.C. Medicaid Community Care Manual, due to a medical condition, to be appropriate for the program. Keep in mind that PCS must be the most cost-effective and appropriate form of care and should not replace other care available.
 

5. Please review levels of care that require a certified versus a non-certified aide.


The qualifications of the aide needed are determined by the tasks identified and in accordance with rules set forth by the N.C. Board of Nursing. The tasks included under PCS correspond to personal care tasks in the "In-Home Aide Level II and Level III Personal Care" of the DHHS In-Home Aide Service Plan. Aides performing Level III Personal Care tasks must meet the N.C. Board of Nursing's competency requirements and be registered as a Nurse Aide I or II in the N.C. Nurse Aide Registry with DFS. Level II Personal Care tasks can be performed by an aide meeting in-home aide qualifications in the Home Care Licensure Rules. A full explanation of these requirements is covered on pages 6-2 and 6-3 of the N.C. Medicaid Community Care Manual.
 

6. Please provide clarification and updated guidelines for dually eligibleMedicare/Medicaid patients getting skilled services under the Medicare Prospective Payment System (PPS).

The response to this question is deleted from the electronic version of the bulletin due to a legal action.

 

7. As a PCS provider, what do I need to know about an "open episode" and how does it affect my provision of PCS?

The response to this question is deleted from the electronic version of the bulletin due to a legal action.

 

8. Will the PCS plan of care need to match the Home Health plan of care if services are resumed after Medicare-covered skilled service ends? Will Medicaid question the amount of time spent by the PCS aide verses the Home Health aide?
   
   The response to this question is deleted from the electronic version of the bulletin due to a legal action.

Adelle Kingsberry, Hospice/PCS Program Consultant
DMA, 919-857-4021

Attention: Carolina ACCESS Primary Care Providers

Carolina ACCESS Primary Care Provider Manual Available Online

Regional Managed Care Consultants
 

Jerry Law 252-321-1806	Rosemary Long 919-477-3362	Lisa Gibson 919-319-0301	Julia McCollum 919-857-4219	Daryl Frazier 919-857-4233	Lisa Catron 828-683-8812
Beaufort	Bladen	Alamance	Chatham	Cabarrus	Alexander
Bertie	Brunswick	Anson	Durham	Gaston	Alleghany
Camden	Carteret	Caswell	Franklin	Iredell	Ashe
Chowan	Columbus	Davie	Granville	Lincoln	Avery
Currituck	Craven	Davidson	Orange	Mecklenburg	Buncombe
Dare	Cumberland	Forsyth	Vance	Union	Burke
Edgecombe	Duplin	Guilford	Wake		Caldwell
Gates	Greene	Lee			Catawba
Halifax	Harnett	Montgomery			Cherokee
Hertford	Hoke	Moore			Clay
Hyde	Johnston	Person			Cleveland
Martin	Jones	Randolph			Graham
Nash	Lenoir	Richmond			Haywood
Northhampton	New Hanover	Rockingham			Henderson
Pasquotank	Onslow	Rowan			Jackson
Perquimans	Pamlico	Stanley			Macon
Pitt	Pender	Stokes			Madison
Terrell	Robeson	Surry			McDowell
Warren	Sampson	Yadkin			Mitchell
Washington	Scotland				Polk
	Wayne				Rutherford
	Wilson				Swain
					Transylvania
					Watauga
					Wilkes
					Yancey

Laurie Giles, Managed Care Section
DMA, 919-857-4022

Attention: All Providers

Index to General and Special Medicaid Bulletins for 2001

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

Attention: All Providers

Electronic Funds Transfer Form - Fax Number Change for Submittals

EDS offers EFT as an alternative to paper check issuance. Providers are required to complete and submit an EFT form to initiate the automatic deposit process. Providers must also complete and submit a new EFT form if they change banks or bank accounts.

A deposit slip or voided check confirming the account number and bank transit number must be attached to the EFT form. Completed forms may be mailed to EDS at the address listed below or they may be faxed to the EDS Financial Unit.

EDS
Attention: Financial Unit
P.O. Box 300011
Raleigh, NC 27622

Note: There is an interim time period of two checkwrites during which providers will receive a paper check before automatic deposit begins or resumes to a new bank account. The top left corner of the last page of the provider's Remittance and Status Report will indicate EFT number rather than check number when automatic deposit begins or resumes.

Electronic Funds Transfer form
 

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

Attention: All Providers

Corrected 1099 Requests - Action Required by March 1, 2002

If the tax name or tax identification number on the annual 1099 MISC you receive is incorrect, a correction to the 1099 MISC must be requested. This ensures that accurate tax information is on file with Medicaid and sent to the IRS annually. When the IRS receives incorrect information on your 1099 MISC, it may require backup withholding in the amount of 30.5 percent of future Medicaid payments. The IRS could require EDS to initiate and continue this withholding to obtain correct tax data.

A correction to the original 1099 MISC must be submitted to EDS by March 1, 2002 and must be accompanied by the following documentation:

• a copy of the original 1099 MISC

• a signed and completed IRS W-9 form  clearly indicating the correct tax identification number and tax name. (Additional instructions for completing the W-9 form can be obtained at http://www.irs.gov under the link "Forms and Pubs.")

Or

Mail both documents to:
EDS
P.O. Box 300011
Raleigh, NC 27622
Attention: Corrected 1099 Request - Financial

A copy of the corrected 1099 MISC will be mailed to you for your records. All corrected 1099 MISC requests will be reported to the IRS. In some cases, additional information may be required to ensure that the tax information on file with Medicaid is accurate. Providers will be notified by mail of any additional action that may be required to complete the correction to their tax information.
 

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

Attention: Home Health, Personal Care Services, and Private Duty Nursing Providers

Written Confirmation of Verbal Orders

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

Attention: Personal Care Services Providers (excluding Adult Care Homes)

Personal Care Services Seminars

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

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

January 15, 2002	February 12, 2002	March 5, 2002
January 23, 2002	February 19, 2002	March 12, 2002
January 30, 2002	February 27, 2002	March 19, 2002
		March 28, 2002

January 11, 2002	February 8, 2002	March 1, 2002
January 18, 2002	February 15, 2002	March 8, 2002
January 25, 2002	February 22, 2002	March 15, 2002
		March 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.

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