In This Issue
All Providers:
Carolina ACCESS Primary Care Providers:
Community Alternatives Program Case Managers:
Dental Providers:
Home Health Agencies:
Hospice Providers:
Hospital Providers:
Mental Health Providers:
Personal Care Services Providers:
Physicians:
The Division of Medical Assistance (DMA) and EDS will be closed on Monday,
May 28, 2001 in observance of Memorial Day.
EDS, 1-800-688-6696 or 919-851-8888
The following questions were asked during the Home Health provider workshops conducted in February 2001. This article is part of a continuing effort to educate providers regarding the new Medicaid guidelines for providing services in the patient's home.
In February 2001, new Medicaid identification (MID) cards for Supplemental Security Income (SSI) recipients were printed on laser paper. In a continuing effort to increase efficiency and improve security, effective June 2001, these new MID cards will also be issued to most other Medicaid recipients. The new design will allow more flexibility in getting information to recipients. Also, the cards will be printed using the postal bar code, which is expected to improve delivery of the cards statewide. The cards will be printed on 8½ x 11 inch watermarked paper. The paper is a lighter weight, making it more pliable, and will be perforated allowing the recipient the ability to detach the card. However, the card is still valid if not detached. Medicaid recipients will receive notice in May 2001 and June 2001 regarding the new cards.
There is no change in the way recipients will use the cards. On occasion,
Medicaid recipients may receive cards printed on the heavier stock paper. These
cards are still valid.
Vanessa Broadhurst, Medicaid Eligibility Unit
DMA, 919-857-4019
Physicians (medical doctors, osteopaths, podiatrists, chiropractors, ophthalmologists,
optometrists, and dentists) report all changes in provider status to their regional
Blue Cross Blue Shield (BCBS) office. Physicians DO NOT USE the Notification
of Change Form on page 31 of the January 2001 Medicaid Special Bulletin I, Provider
Enrollment Guidelines. The exceptions on the back of the form (page 32) advise
physicians (medical doctors, osteopaths, podiatrists, chiropractors, ophthalmologists,
optometrists, and dentists) to report all changes to BCBS. To report a change,
please contact your local BCBS representative at one of the numbers listed
below:
| Charlotte, NC | 1-704-561-2740 |
| Greensboro, NC | 1-336-316-5374 |
| Greenville, NC | 1-252-758-4745 |
| Hickory, NC | 1-877-889-0002 |
| Raleigh, NC | 1-919-461-5246 |
| Wilmington, NC | 1-877-889-0001 |
| Out-of-State (Enrolled providers within 40 miles of North Carolina) |
1-919-765-2471 |
Meme Creech, Provider Services Unit
DMA, 919-857-4017
Please note the following information related to the coverage of PPV23 (CPT code 90732, pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for subcutaneous or intramuscular use). This information regarding the guidelines for coverage is meant to replace the article printed in the January 2001 general Medicaid bulletin.
The Vaccines for Children program (VFC) provides this vaccine at no charge to children through 18 years of age according to the recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC). Medicaid will not reimburse for the vaccine for children through 18 years of age. To access the ACIP on the Internet, key in www.cdc.gov/nip.
The N.C. Medicaid program will reimburse for the vaccine and the administration fee, as noted in the billing guidelines for PPV23 listed in the following chart, for high-risk groups of adults 19 years of age and over according to the ACIP recommendations.
Billing Guidelines for PPV23
| Age/Type of Service | Health Departments | Private Providers |
|---|---|---|
| Under 19 years of age with Health Check screening (vaccine is free) |
|
|
| Under 19 years of age without Health Check screening (vaccine is free) |
|
|
| Between 19 and 21 years of age with Health Check screening |
|
|
| Between 19 and 21 years of age without Health Check screening |
|
|
| 21 years of age and over |
|
|
| 21 years of age and over without an exam or office visit |
|
|
* The ICD-9-CM coding book requires that the diagnosis code V03.8 be
expanded to a fifth digit For this reason, the diagnoses listed for this vaccine
should either be V03.82 or V05.8.
EDS, 1-800-688-6696 or 919-851-8888
Effective August 1, 2000, the Division of Medical Assistance (DMA) has expanded the "incident to service" policy to include Licensed Clinical Social Workers (LCSW) and Clinical Nurse Specialists (CNS) who are masters level registered nurses with psychiatric certification in providing mental health/substance abuse services. The LCSW and CNS must be an employee of the supervising physician, physician group practice, or of the legal entity that employs the physician who provides direct personal supervision. (Refer to the August 2000 general Medicaid bulletin.)
Effective June 1, 2001, this policy is further expanded to allow licensed psychological associates (LPAs) to bill for services "incident to" if they are supervised and employed by Ph.D. psychologists or, as is currently the case, physicians.
This "incident to service" extension only applies to services for recipients
under 21 years of age.
Carol Robertson, Behavioral Health Services Unit
DMA, 919-857-4025
As a result of the enhancement to the Medicaid Management Information System (MMIS), effective March 26, 2001, the following changes were made to the Prior Approval (PA) numbering system and the PA number requirements for claims. There is no change in prior approval requirements or criteria. Those services that previously required prior approval continue to require prior approval.
1. Beginning March 26, 2001, the number
issued for a prior approval action will be a
thirteen-digit
Service Review Number (SRN). The terminology "Service Review
Number" and "SRN"
replaces the previous terminology of "Prior Approval
number" and "PA
number." The SRN consists of four digits for the year, three
digits for the
Julian date, and six digits for the hour, minute, and second
(YYYYJJJHHMMSS).
For example, 2001015132545 would be interpreted as:
| 2001 | 015 | 13 | 25 | 45 |
|---|---|---|---|---|
| YEAR 2001 | JANUARY 15TH | ONE O'CLOCK IN THE AFTERNOON | TWENTY-FIVE MINUTES AFTER THE HOUR | FORTY-FIVE SECONDS AFTER THE MINUTE |
3. All claims submitted on and after March
26, 2001, regardless of date of service or type
of service, do
not require a PA number or a SRN number on the claim.
For more information, refer to the article entitled Renovation
of the MMIS System - Identification Tracking Measurement Enhancement (ITME)
Project printed in the January 2001 general Medicaid bulletin. A copy
of the bulletin can be accessed through the Internet at the Division of Medical
Assistance's website at www.dhhs.state.nc.us/dma.
EDS, 1-800-688-6696 or 919-851-8888
The most frequently requested Medicaid forms are now
available online at:
Residential Care providers Levels II through IV with four beds or more who are direct enrolled with Medicaid may bill using the UB-92 claim form following the billing instructions in the November 2000 Special Bulletin II, Mental Health and Substance Abuse Guidelines. However, until July 1, 2001, providers with four beds or more may continue to bill through the Area Mental Health Program (AMHP) if they so desire. The AMHP must use their provider number and will receive the Medicaid payment. After July 1, 2001, Level II through IV Residential Care providers with four beds or more must be directly enrolled with Medicaid and bill with their own provider number. Residential Care providers may contract with a billing agent if not planning to bill themselves. The billing agent would use the Residential Care Medicaid provider's number on all claims.
All admissions after January 1, 2001 to direct enrolled Residential Care providers must be prior approved by Value Options. Levels II and Levels III must obtain ongoing authorization after 120 days; Level IV must obtain ongoing authorization after 30 days. AMHPs must initially authorize all admissions.
Independently enrolled Licensed Psychologists, Licensed Clinical Social Workers, Clinical Nurse Specialists, and Nurse Practitioners serving children under 21 years of age may bill Medicaid using their provider numbers for dates of service beginning February 1, 2001 if they have obtained referral numbers and are appropriately enrolled. However, these providers may also choose to remain under contract with an AMHP with the AMHP billing Medicaid for their services. Providers under contract with AMHPs do not have to obtain prior authorization from Value Options after the 26th visit.
Please note that EDS will not be able to accept claims from recently enrolled
Licensed Psychologists, Licensed Clinical Social Workers, Clinical Nurse Specialists,
and Nurse Practitioners until May 1, 2001. However, this does not prohibit
these providers from providing services beginning with their effective enrollment
date, which can be as early as February 1, 200l. Billing cannot occur unless
the referral numbers have been obtained prior to rendering the service.
Carolyn Wiser, Medical Policy Section
Reba Hamm, Medical Policy Section
DMA, 919-857-4020
In February 2000, the Division of Medical Assistance (DMA) Managed Care Section conducted a Provider Satisfaction Survey using a random sample of participating Carolina ACCESS (CA) primary care providers (PCPs). The information provided on the survey was beneficial to our efforts to provide a quality managed care program for Medicaid. DMA Managed Care appreciates the time providers spent completing the survey.
Responses to some of the questions indicate a need to review several contractual requirements. The requirements for participation as a CA PCP include the following:
Laurie Giles, Managed Care Section
DMA, 919-857-4022
In April 2001, the Division of Medical Assistance (DMA) Third Party Recovery
Section began onsite reviews of the credit balance reporting system at hospital
facilities with a pilot program that involved six hospitals. Representatives
of Public Consulting Group, Inc. (PCG) contacted and visited these facilities.
Currently, DMA and PCG are reviewing the information obtained to begin this
process with the hospital providers throughout the state.
Marilyn Vail, Third Party Recovery
DMA, 919-733-6294
Effective with dates of service May 1, 2001, edits have been removed that limit
the billing of CPT code 90862 (pharmacologic management, including prescription,
use and review of medication with no more than minimal medical psychotherapy)
to once every 30 days. Beginning May 1, 2001, this code will not have any limitations
nor will it be subject to prior approval. It will not count in the 26 unmanaged
visits for the under 21 population but does count in the 24 annual visits for
adults.
Carolyn Wiser, Medical Policy Section
Reba Hamm, Medical Policy Section
DMA, 919-857-4020
If you are currently filing claims electronically
And change vendors or billing services
Please call EDS at 1-800-688-6696 (option "1")
It is not necessary to complete a new ECS agreement
The April 2001 general Medicaid bulletin included an article titled Endoscopy CPT Base Codes and Their Related Procedures. The following procedure codes represent the complete listing of related endoscopy codes for group 25. Please note, the codes shown in bold have been added to list of related codes.
Scopy Base and Related Code Group
| Group | Base Code | Related Codes |
|---|---|---|
|
25
|
52000
|
52007, 52010, 52204, 52214, 52250, 52260, 52265, 52270, 52275-52277, 52281- 52283, 52285, 52290, 52300, 52301, 52305, 52310, 52315, 52317-52318 |
EDS, 1-800-688-6696 or 919-851-8888
Effective March 26, 2001, the number issued to confirm the reporting of hospice participation will be a thirteen-digit Service Review Number (SRN), which will include the date and time of the issuance. The number is four digits for the year, three digits for the julian date, and six digits for the hour, minute, and second (YYYYJJJHHMMSS). The terminology "Service Review Number" and "SRN" replaces the previous terminology of "confirmation number."
If a confirmation number was given prior to March 26, 2001, the original confirmation number is valid through the duration of the hospice benefit period. Providers do not have to request a SRN for participation previously reported.
This change is part of the overall renovation of the claims payment system,
the Medicaid Management Information System (MMIS). Refer to the article entitled
Renovation of the MMIS System - Identification
Tracking Measurement Enhancement (ITME) Project printed in the January
2001 general Medicaid bulletin. A copy of the bulletin can be accessed through
the Internet at the Division of Medical Assistance's website at www.dhhs.state.nc.us/dma.
EDS, 1-800-688-6696 or 919-851-8888
Seminars for dental providers are scheduled in June 2001. This seminar will focus on the information from the N.C. Medicaid Dental Services Manual, completion of the 1999 ADA claim form, procedure codes, the most common denials, and general Medicaid issues. Medicaid billing personnel, supervisors, and office managers are encouraged to attend.
Note: Bring your 2000 Dental Services Manual. Additional manuals will be available for purchase at a cost of $10.00.
Due to limited seating, preregistration is required. Unregistered providers 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.
Return the Dental Seminar Registration form to:
Provider ServicesDirections to the sites
EDS
P.O. Box 300009
Raleigh, NC 27622
| Tuesday, June 5, 2001
Catawba Valley Technical College Highway 64-70 Hickory, NC Auditorium |
Tuesday, June 12, 2001
Ramada Inn Plaza 3050 University Parkway Winston-Salem, NC |
| Tuesday, June 19, 2001
Coast Line Convention Center 501 Nutt Street Wilmington, NC |
Monday, June 25, 2001
WakeMed Andrews Conference Center (formerly the MEI Conference Center) 3000 New Bern Avenue Raleigh, NC |
CATAWBA VALLEY TECHNICAL COLLEGE
Take I-40 to exit 125 and go approximately ½ mile to Highway 70. Travel
east on Highway 70. The college is approximately 1½ mile on the right.
Ample parking is available. Entrance to Auditorium is between the Student Services
and the Maintenance Center. Follow sidewalk (toward satellite dish) and turn
right to Auditorium entrance.
WINSTON-SALEM, NORTH CAROLINA
RAMADA INN PLAZA
I-40 Business to Cherry Street exit. Continue on Cherry Street for approximately
2 to 3 miles. Turn left at the IHOP Restaurant. The Ramada Inn Plaza is located
on the right.
COAST LINE CONVENTION CENTER
Take I-40 East into Wilmington to Highway 17 - just off I-40. 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.
WAKEMED ANDREWS CONFERENCE CENTER (FORMERLY MEI CONFERENCE CENTER)
Driving and Parking Directions
Take the I-440 Raleigh Beltline to New Bern Avenue, exit 13A (New Bern Avenue,
Downtown). Travel toward WakeMed. Turn left onto Sunnybrook Road.
Parking is available at the former CCB Bank parking lot, a short walk to the conference facility. The entrance to the Conference Center is at the top of the stairs to Wake Med's Medical Education Institute.
Parking is also available on the top two levels of Parking Deck P3. To reach this deck, exit the I-440 Beltline, exit 13A. Proceed to the Emergency entrance of the hospital (on the left). Follow the access road up the hill to the gate for Parking Deck P3. After parking in P3, walk down the hill past the Medical Office Building and past the side of the Medical Education Institute. Turn right at the front entrance of the building and follow the sidewalk to the Conference Center entrance.
Illegally parked vehicles will be towed. Parking is not permitted at East Square Medical Plaza, Wake County Human Services, the P4 parking lot or in front of the Conference Center.
Seminars for Basic Medicaid are scheduled for June 2001. The seminars are intended for providers who are new to N.C. Medicaid program. Topics to be discussed will include, but are not limited to, provider enrollment requirements, billing instructions, eligibility issues, and Managed Care, including Carolina ACCESS and HMOs. Persons inexperienced in billing N.C. Medicaid are encouraged to attend.
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 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.
Return Basic Medicaid Seminar Registration form to:
Provider Services
EDS
P.O. Box 300009
Raleigh, N.C. 27622
| Wednesday, June 6, 2001
A-B Technical College 340 Victoria Road Asheville, NC Laurel Auditorium |
Tuesday, June 12, 2001
Coast Line Convention Center 501 Nutt Street Wilmington, NC |
| Monday, June 18, 2001
WakeMed Andrews Conference Center (formerly the MEI Conference Center) 3000 New Bern Avenue Raleigh, NC |
Wednesday, June 20, 2001
Ramada Inn Plaza 3050 University Parkway Winston-Salem, NC |
A-B TECHNICAL COLLEGE
Directions to the College
Take 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. Turn right between the Holly Building and the Simpson
Building. The Laurel Building/Auditorium is located on the right, behind the
Holly Building.
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.
RAMADA INN PLAZA
Take I-40 Business to Cherry Street exit. Continue on Cherry Street for approximately
2 to 3 miles. Turn left at the IHOP Restaurant. The Ramada Inn Plaza is located
on the right.
WAKEMED ANDREWS CONFERENCE CENTER (FORMERLY MEI CONFERENCE CENTER)
Driving and Parking Directions
Take the I-440 Raleigh Beltline to New Bern Avenue, exit 13A (New Bern Avenue,
Downtown). Travel toward WakeMed. Turn left onto Sunnybrook Road.
Parking is available at the former CCB Bank parking lot, a short walk to the conference facility. The entrance to the Conference Center is at the top of the stairs to WakeMed's Medical Education Institute.
Parking is also available on the top two levels of Parking Deck P3. To reach this deck, exit the I-440 Beltline at exit 13A. Proceed to the Emergency entrance of the hospital (on the left). Follow the access road up the hill to the gate for Parking Deck P3. After parking in P3, walk down the hill past the Medical Office Building and past the side of the Medical Education Institute. Turn right at the front entrance of the building and follow the sidewalk to the Conference Center entrance.
Illegally parked vehicles will be towed. Parking is not permitted
at East Square Medical Plaza, Wake County Human Services, the P4 parking lot
or in front of the Conference Center.
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May 8, 2001
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June 12, 2001
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July 10, 2001
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May 15, 2001
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June 19, 2001
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July 17, 2001
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May 22, 2001
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June 28, 2001
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July 26, 2001
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May 31, 2001
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May 4, 2001
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June 8, 2001
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July 6, 2001
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May 11, 2001
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June 15, 2001
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July 13, 2001
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May 18, 2001
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June 22, 2001
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July 20, 2001
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May 25, 2001
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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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| Paul R. Perruzzi, Director | Christopher T. Deelsnyder, CE | ||
| Division of Medical Assitance | Administrative Process Management | ||
| Department of Health and Human Services | EDS | ||
| Back | Home | |