Alaska Medical Assistance Newsletter

Transcription

1 Alaska Medical Assistance Newsletter A Monthly Newsletter for Alaska Medical Assistance Providers March 2012 Xerox 1835 S. Bragaw St., Suite 200 Anchorage, AK Web Address Phone Numbers (toll-free) Fraud and Abuse Hotline or (toll-free) Recipient Services , option , option 2 (toll-free) Provider Inquiry , option , option 1, 1 (toll-free) New Provider Enrollment Portal Fax Numbers PA PA: Travel, MRI, PA Mental Health SUR EPS Finance Training Attachments/RTD or Enrollment Provider Inquiry In this issue ACS is Now Xerox... 1 VacTrAK Helps Ensure Timely and Appropriate Immunizations... 1 Translation and Interpretation Services... 2 New Precertification Requirements For Upcoming Holiday... 2 Spring Training for Providers... 3 WebEx Training... 3 RBRVS-Based Fee Schedules Now Available.. 3 Health Care Corner... 3 Update Coming to Preferred Drug List... 3 New Federal Medicaid Website Available... 3 Alaska Medicaid Introduces RSS Feeds... 4 Claim Rejection Error Corrected... 4 Ask Medicaid... 5 Diagnosis Code Now Required on Claims for All Provider Types... 5 ACS is Now Xerox Affiliated Computer Services Transitions to Xerox Brand Two years ago Xerox acquired Affiliated Computer Services (ACS), Alaska Medicaid's fiscal agent. On Wednesday, January 25, 2012, Xerox officially retired the ACS name from most of Xerox s service businesses including Government Healthcare Solutions. All communication will now bear the Xerox name and logo. This change does not require any action by you, the provider. Please continue to use the same addresses for mailing your claims or correspondences; the same phone numbers for inquiries and faxes; and the same website, for information on Alaska Medicaid billing and training. If you have any questions regarding this transition, please call Provider Inquiry at , option 1, or , options 1, 1 (in-state toll free). VacTrAK Helps Ensure Timely and Appropriate Immunizations A Letter to Providers from Drs. Ward Hurlburt, State Director of Public Health, and Joe McLaughlin, State Epidemiologist Dear Colleague: The purpose of this letter is to encourage your practice to enroll in VacTrAK, Alaska s immunization information system (IIS). The state of Alaska is seeking to increase provider enrollment in this system, which will help ensure that children in our state receive timely and appropriate immunizations. According to the US Centers for Disease Control and Prevention, in 2010, Alaska ranked 42 nd in the nation among the states with respect to immunization coverage rates for infants and young children. We can and should do much better! A tool such as VacTrAK has been an important resource for increasing immunization coverage rates in other states like Wisconsin and Mississippi that lead the national coverage ranking list. Another benefit to patients is that statewide IISs help ensure timely immunization for children if families move or change providers. According to the US Centers for Disease Control and Prevention, over 20% of US children see more than one healthcare provider by their second birthday. In addition to benefiting your patients, there are numerous benefits to you in utilizing VacTrAK. The following is a list of some of these benefits: Obtaining consolidated patient immunization records Viewing automatically generated vaccine forecasts (Continued on p 2) 1

2 (Continued from p 1) Generating reminder/recall notices Managing vaccine inventory and meeting state requirements for VFC enrolled providers Improving accuracy of immunization records Reducing paperwork Producing official immunization records Accessing provider-specific immunization completion rates at any time Currently, there are over 130 Alaska organizations/facilities participating in VacTrAK, representing hundreds of individual health care providers across the state. As of February 16, 2012 there were 508,320 persons listed in VacTrAK that had two or more vaccines on-record. Enrollment is easy, quick, and free just go to our website to download the enrollment application at: For more information please call the Alaska Immunization Program at If your practice is not already enrolled in VacTrAK, we need your help. The more effectively we can pull together as a statewide public health/health care provider team, the greater our impact will be on raising the health status bar in Alaska! Sincerely, Ward B. Hurlburt, MD, MPH Director Division of Public Health and Chief Medical Officer, DHSS Translation and Interpretation Services Federal Mandates for Providers Title VI of the Civil Rights Act of 1964 and federal regulations implementing Title VI prohibit exclusion of individuals on the grounds of race, color, or national origin from participation in programs that receive federal funding. As recipients of federal funding through Medicaid payments which are, in part, federally funded, enrolled providers may not employ practices that have a discriminatory impact on individuals. Medicaid-enrolled providers are obligated to provide access to health care services, including language interpreting services, when needed, for patients who have Limited English Proficiency (LEP). The U.S. Department of Health and Human Services has published a document that includes a four-factor analysis that guides providers through the process of determining the extent of their obligation to offer LEP services, and development of a plan to meet the needs of the LEP population. This document, Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, is available in Volume 68, Number 153 of the Federal Register, published Friday, August 8, 2003, and available at New Precertification Requirements For 2012 The 2012 Alaska Medicaid Select Diagnoses and Procedures Precertification List is now available on the Qualis Health website at (under Healthcare Professionals select Alaska Medicaid Division of Health Care Services, then under Announcements click on Select Diagnoses/Procedures Precertification List). You may go directly to the 2012 precertification list at /files/ak-medicaid-precert-list.pdf. Please review the new 2012 list as changes have occurred. Upcoming Holiday State of Alaska Closure The state s offices will be closed in honor of Seward s Day on March 26, Joe McLaughlin, MD, MPH State Epidemiologist and Chief Section of Epidemiology, DHSS 2

3 Spring Training for Providers April Training Dates in Seward and Nome It s not just for baseball teams. On-site education will be offered in two locations for providers. April 3 through 5 will see classes offered in Seward, and in Nome the dates are April 10 through 12. These courses will prepare you and your staff to accurately bill for services reimbursed by Medicaid, Denali KidCare, and CAMA. Classes will include introductory courses such as Recipient Eligibility, Claims Management, Prior Authorizations, Guidelines for Record Keeping, Tribal courses, a Tribal Specific Workshop, and Advanced Provider Workshops. Register online at To view the complete 2012 Provider Training Calendar, please visit the Xerox website at From the main menu select Training then Schedule. To register for a training class, select Training then Registration. For more information about provider training, please contact the Xerox Training Department at or (in-state, toll free). WebEx Training Get Connected! No training sessions in your area? Prefer not to travel to attend training? If you have internet access and phone service, WebEx may be your solution. Xerox is offering WebEx training April 17 through 19, WebEx training sessions offer the same material and are presented by the same trainers as our on-site training sessions. Participants enjoy the same opportunity for Q&A with the trainer and interactivity with their fellow attendees as they would at on-site training. In addition, you can attend from the comfort and convenience of your own office! Check the Xerox website at under Training >Schedule to view a list of topics that will be presented at these WebEx sessions, and register today. RBRVS-Based Fee Schedules Now Available Effective January 1, 2012 Resource Based Relative Value Scale- fee schedules for services provided on and after December 1, 2011 are now available at (select Providers > Lookups > Fee Schedule, accept the CPT copyright agreement, then select the appropriate provider type fee schedule). If you are unable to access your fee schedule online, you may request a copy by calling the Xerox Provider Inquiry Unit at or (tollfree in Alaska). You may also request the fee schedule in writing by fax to or , or by mail to Xerox, Provider Inquiry Unit PO Box Anchorage, AK Written requests should include the provider name, mailing address, NPI or Medicaid ID, number of copies requested, and preferred medium (paper or CD). Health Care Corner A study released by the Alaska Section of Epidemiology said that 9,000 Alaskans were hospitalized due to falls from The highest rates were among seniors, especially Natives and those in the northern part of the state. There are many simple preventative measures to reduce the chances of a fall. For more information, see the fall injuryprevention page at nalsafety/falls/index.html Update Coming to Preferred Drug List A new Alaska Medicaid Preferred Drug List will be effective on March 8, The revised Preferred Drug List is currently available online at Please contact Chad Hope, Pharm.D. at with any questions. New Federal Medicaid Website Available Medicaid.gov Goes Live The Center for Medicaid and CHIP Services (CMCS) is pleased to announce the initial launch of the first Federal government website devoted to the policies - and the people - of Medicaid and the Children s Health Insurance Program (CHIP). This website is the culmination of efforts at the Center for Medicaid and CHIP Services to revitalize and reorient the information the Federal government makes available about these programs. (Continued on p 4) 3

4 Continued from p 3) As part of CMCS commitment to transparency and information sharing, brings to the forefront the items that states, the health policy community and other stakeholders have said they care about most, including: federal policy guidance, lists of pending and approved waivers, highlights of our Affordable Care Act implementation efforts, State-specific program information and data, and improved search capabilities. Additionally, the CMS.gov website has been modified and improved. Here s what you ll find on the new CMS and Medicaid sites: A significantly improved search engine that gets you to the information you re looking for, fast. More in-depth information about what CMS is doing to implement the Affordable Care Act and other new initiatives, and details about how you can apply for new programs. Up-to-date, real-time updates that reflect important developments and initiatives happening with CMS programs. Medicaid program information that s readily available, easy to find, and easy to use - and CMCS will be continually looking for ways to enhance your experience on this site. Easy-to-access links to which will continue to be the primary site for consumer information. Current Medicare and Medicaid information people rely on now will continue to be available as CMS is launching an archive version of each CMS website so that historic information can remain online without adding clutter to our primary sites. Alaska Medicaid Introduces RSS Feeds Innovating and Improving Communication with Medicaid Providers We are proud to announce the Alaska Medicaid RSS Feed for HIPAA 5010 updates. Now, providers can get up-to-date announcements instantly using their favorite feed reader, , or even mobile phone. Updates in the feed could include everything from policy changes, important Medicaid-related news, and provider training opportunities. The benefit to providers is two-fold: it eliminates the need to constantly check our webpage for updates and streamlines our communication with you; simply subscribe to our feed to stay informed. What is RSS? Really Simple Syndication, commonly abbreviated as RSS, is a standardized format for delivering new or updated content from a website. RSS quickly delivers news and updates straight to a user s inbox or news reader. Many news-related sites, weblogs and other online publishers syndicate their content as an RSS Feed. Subscribing to the HIPAA 5010 RSS will ensure your office is in the loop on recent policy changes, updates, or training opportunities we have added RSS also protects your privacy; we do not collect your personal information, and you need not create an account with us to read the Alaska Medicaid RSS Feed. Xerox does not track the RSS Feeds you read and those you do not. Finding a Media to read RSS If you have never subscribed to an RSS feed before, you will need to use a feed reader or aggregator. Many programs, including Microsoft Outlook, allow you to receive RSS feeds right in your inbox. A number of feed readers can be found at the following links: Feed readers for your computer: e/internet/clients/web tp/windows_free.html Feed readers for your mobile phone: To use Microsoft Outlook to read RSS, follow the instructions found here: us/outlook-help/subscribe-to-an-rss-feed- HA aspx Other popular web-based sites such as Yahoo!, Google, and MSN also offer feed readers, so consult your support for instructions. Alaska Medicaid does not endorse or guarantee any particular RSS feed reader or aggregator. Claim Rejection Error Corrected Claims for Speech Language Treatment Affected Providers who submitted electronic claims with CPT code between 1/1/2012 and 1/31/2012 received a negative 999 rejection message containing the explanation of EXPECTED VALUE OF ZERO FOR PQRI PROCEDURE CODES. On 1/31/2012, Alaska Medicaid corrected the electronic claims processing system to remove this error. Any claims containing CPT code submitted between 1/1/2012 and 1/31/2012 that received a negative 999 rejection message must be resubmitted. Please check your remittance advice to ensure all resubmitted claims were received and processed properly. 4

5 Ask Medicaid Q: All of our recent claims have been rejected because we didn t use a physical address on our claims. We have always used our PO Box on claims that is where we receive our clinic s mail. Is this a new requirement? How do we get paid for these claims? A: Effective January 1, 2012 and in accordance with HIPAA 5010 requirements, all providers must enter a physical address for the billing (servicing) address when submitting claims electronically. Claims submitted without a physical billing address will be rejected. Submitting the physical address will not affect where you receive your claims payments and RA. They will continue to be mailed to the Pay-To address in your provider file.resubmit your claim with a physical address, and don t forget to include your ZIP+4, which is also required. For more information, please refer to the January 6, 2012 announcement, New Billing Provider Address Requirements for HIPAA 5010 Transactions, available at (on the menu bar select HIPAA 5010, then 5010 Companion Guides). Questions? Contact Xerox at (option 1 for Provider Inquiry, option 3 for the Electronic Media Coordinator), or in-state toll-free at (option 1, 1 for Provider Inquiry, Option 1, 4 for the Electronic Media Coordinator). Diagnosis Code Now Required on Claims for All Provider Types Effective January 1, 2012 All HIPAA-compliant electronic claims submitted on and after January 1, 2012 must conform to the new federal HIPAA 5010 standards. One of the changes impacting providers is that electronic Medicaid claims will not be paid if submitted without a diagnosis code. Some provider types may not have access to a Medicaid recipient s medical records. To ensure HIPAA 5010 compliance for those provider types, default diagnosis codes have been assigned for use on certain Medicaid claims. For Payerpath users of these provider types, enter the code in field 21 and omit the decimal. The default diagnosis codes (ICD-9) for each of these provider types are as follows: Provider Type Provider Description ICD-9 Code ICD-9 Description 83 Taxi V63.0 Residence remote from hospital or other health care facility 88 Pre-maternal Home V22.2 Pregnancy state, incidental 88 Hotel/Motel with Restaurant V63.0 Residence remote from hospital or other health care facility 89 Hotel/Motel without Restaurant V63.0 Residence remote from hospital or other health care facility 46 Home and Community Based Agency (HCB) Other general symptoms 47 Residential Supported Living Arrangements V60.6 Person living in residential institution 48 Environmental Modifications V60.1 Inadequate housing 95 Personal Care Agency Other unknown and unspecified cause Table 1: Default Diagnosis Codes (ICD-9) by Provider Type A mandatory diagnosis code is just one of the changes resulting from HIPAA Additional information is available at Select the HIPAA 5010 tab. If, after reviewing these resources you still have questions, knowledgeable HIPAA 5010 support is available by at AKHIPAASupport@acs-inc.com or by telephone at or (toll-free). 5