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In This Issue . . .

Attention: All Providers

Holiday Observance

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

Attention: Long-Term Care Providers

Quality Control Eligibility Reviews of Medicaid Recipients in Long-Term Care

During the QC review process, the QC Analyst (QCA) reviews the county department of social service's case records as well as conducts a face-to-face interview with the recipient, when possible, and the recipient's responsible representative(s). The QCA also interviews the facility's business manager regarding the following issues as part of the recipient eligibility determination.

• Date of entry into the facility or hospital
• Date of last utilization review
• Recipient's level of care
• Name of the responsible representative
• Number of leave days during the certification period
• Verification of the patient account
• Sources of recipient's income
• Payee for the recipient's income
• Non-covered medical expenses
• Amount of patient monthly liability reported to EDS (fiscal agent)

• Rebecca Carroll
• Drucilla Connor
• Nina Greeson
• Beth Justice
• Sheryl Leatherberry
• Brenda Hall
• Lynn Lane
• Wanda Meadows
• Danny Squires
• Carol Waldrop

Debbie Chamblee, Program Integrity
Elizabeth Goss, Program Integrity
DMA, 919-733-3590

Attention: Physicians, Nurse Practitioners, Nurse Midwives, Health Departments, Federally Qualified Health Centers, and Rural Health Clinics

Mirena (Levonorgestrel-Releasing Intrauterine System, Code J7302) Coverage Criteria

Providers must bill with code J7302 on the HCFA-1500 claim form. Providers are reminded that if an Evaluation and Management code is billed, the visit will count as one of the 24 legislative visits allowed per year. The legislative limitation on visits does not apply to individuals under the age of 21. CPT codes 58300, insertion of intrauterine device (IUD), and 58301, removal of intrauterine device (IUD), remain covered services.

Billing on the HCFA-1500 Claim Form:

• Enter ICD-9-CM diagnosis code V25.1 in block 21.
• Enter the date of service in block 24A.
• Enter the place of service in block 24B.
• Bill code J7302 in block 24D.
• Enter the total charges in block 24F.
• Enter the unit given in block 24G.
• Enter an "F" in block 24H or append the family planning modifier "FP."

Federal Qualified Health Centers and Rural Health Clinics must enter their six-digit provider number with the alpha "C" for physician services. If a face-to-face encounter with a physician or physician extender occurs on the same date of service as the IUD insertion, a core visit may be billed on a separate claim using the clinic's or center's six-digit provider number and the alpha "A."

Providers must bill their usual and customary charge. The maximum reimbursement rate for Mirena is $395.00.
 

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

Attention: Carolina ACCESS Primary Care Providers

Carolina ACCESS Provider Surveys

Your office may be contacted by telephone or letter during the months of March through May to complete one of the surveys. Provider participation is necessary to make the surveys a useful tool. Your cooperation in returning a prompt and accurate response is appreciated.
 

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

Attention: Mental Health Services Providers

Prior Approval and Medicare

When Medicare is not the primary payer for services rendered by Area Mental Health Programs or their employees who are not eligible to bill Medicare, authorization must be obtained from ValueOptions in accordance with Medicaid requirements.
 

Carol Robertson, Behavioral Health Services
DMA, 919-857-4020

Attention: All Providers

Health Insurance Portability and Accountability Act Compliance Training

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

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

Cancellation of the Personal Care Services Seminars and Requests for Individual Visits

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

Attention: All Providers

Basic Medicaid Seminar Schedule

Due to limited seating, preregistration is required and limited to two staff members per office. Unregistered providers are welcome to attend when reserved space is adequate to accommodate. Please select the most convenient site and return the completed Basic Medicaid 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 to the sites
 

Tuesday, April 2, 2002 Catawba Valley Technical College Auditorium Highway 64-70 Hickory, NC	Tuesday, April 9, 2002 Martin Community  Auditorium Kehakee Park Road Williamston, NC
Tuesday, April 16, 2002 Coast Line Convention Center  501 Nutt Street  Wilmington, NC	Tuesday, April 23, 2002 WakeMed  Andrews Conference Center  3000 New Bern Avenue Raleigh, NC

Directions to the Basic Medicaid Seminars

HICKORY, NORTH CAROLINA
CATAWBA VALLEY TECHNICAL COLLEGE

Take I-40 to exit 125. Travel approximately .5 mile to Highway 70 East. The college is located approximately 1.5 mile on the right. Ample parking is available. The entrance to the Auditorium is between Student Services and the Maintenance Center. Follow the sidewalk (toward satellite dish) and turn right to Auditorium entrance.
 
 

WILLIAMSTON, NORTH CAROLINA
MARTIN COMMUNITY COLLEGE

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

WILMINGTON, NORTH CAROLINA
COAST LINE CONVENTION CENTER

Take I-40 east to Wilmington. Take the Highway 17 exit. Turn left onto Market Street. Travel approximately 4 or 5 miles to Water Street. Turn right onto Water Street. The Coast Line Inn is located one block from the Hilton on Nutt Street behind the Railroad Museum.
 
 

RALEIGH, NORTH CAROLINA
WAKEMED ANDREWS CONFERENCE CENTER

Driving and Parking Directions

Take the I-440 Raleigh Beltline to exit 13A, New Bern Avenue.

Paid parking ($3.00 maximum per day) is available on the top two levels of parking deck P3. To reach the parking deck, turn left at the fourth stoplight on New Bern Avenue, and then turn left at the first stop sign. Parking for oversized vehicles is available in the overflow lot for parking deck P3. Handicapped accessible parking is available in parking lot P4, directly in front of the conference center.

To enter the Andrews Conference Center, follow the sidewalk toward New Bern Avenue past the Medical Office Building to entrance E2 of the William F. Andrews Center for Medical Education.

Illegally parked vehicles will be towed. Parking is not permitted at East Square Medical Plaza, Wake County Human Services or in parking lot P4 (except for handicapped accessible parking).
 

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

A copy of an order for a preliminary injunction related to Home Health Services and Personal Care Services (in private residences) is available on the Division of Medical Assistance's website.

Checkwrite Schedule
 

March 5, 2002	April 9, 2002	May 7, 2002
March 12, 2002	April 16, 2002	May 14, 2002
March 19, 2002	April 25, 2002	May 21, 2002
March 28, 2002		May 30, 2002

Electronic Cut-Off Schedule
 

March 1, 2002	April 5, 2002	May 3, 2002
March 8, 2002	April 12, 2002	May 10, 2002
March 15, 2002	April 19, 2002	May 17, 2002
March 22, 2002		May 24, 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.
 

Providers are responsible for informing their billing agency of information in this bulletin.

Bold, italicized material is excerpted from the American Medical Association Current Procedural Terminal CPT Codes. Descriptions and other data only are copyrighted 2001 American Medical Association. All rights reserved.

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