Banner Messages for the 03/03/08 ER&S and 03/07/08 R&S Reports

Size: px
Start display at page:

Download "Banner Messages for the 03/03/08 ER&S and 03/07/08 R&S Reports"

Transcription

1 Banner Messages for the 03/03/08 ER&S and 03/07/08 R&S Reports This file contains abbreviated messages meant to provide timely notifications that affect all provider groups (physicians, dentists, and so forth). Additional current and historic information affecting the Medicaid, Medicaid Managed Care, and Children with Special Health Care Needs (CSHCN) Services Program provider community may be found in the earlier postings of these files in the TMHP banner library at as well as in the bi-monthly editions of the Texas Medicaid Bulletin and the quarterly CSHCN Services Program Provider Bulletin, which update the Texas Medicaid Provider Procedures Manual and CSHCN Services Program Provider Manual, respectively. Copyright Acknowledgements Use of the American Medical Association s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication with the following disclosure: Current Procedural Terminology (CPT) is copyright 2007 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regulation System/Department of Defense Regulation System (FARS/DFARS) restrictions apply to government use. The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: CDT 2007/2008 [including procedure codes, definitions (descriptions), and other data] is copyrighted by the American Dental Association. (c) 2006 American Dental Association. All Rights Reserved. Applicable Federal Acquisition Regulation System/Department of Defense Acquisition Regulation System (FARS/DFARS) restrictions apply. Microsoft Corporation requires the following notice in publications containing trademarked product names: Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. Total Messages (46) 1 (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** This is an update to a banner message about private duty nursing (PDN) services (procedure code C-T1000) that first appeared on the February 22, 2008, Remittance and Status (R&S) report. Effective for dates of service on or after March 1, 2008, the reimbursement rate for procedure code C-T1000 when billed by a home health agency with modifier TD has changed from $8.25 to $11.28 per 15 minutes. Procedure code C-T1000 with modifier TE will continue to be reimbursed at $8.25 per 15 minutes. Procedure code C-T1000 requires prior authorization. Prior authorization requests must include the required hours for only procedure code C-T1000 and must be submitted by fax to the Texas Health Steps- Comprehensive Care Program (THSteps-CCP) Prior Authorization Department at or in writing to the following address: Texas Medicaid & Healthcare Partnership, Attn: Comprehensive Care Program, PO Box , Austin, TX Modifiers and rates are not required when requesting prior authorization for PDN services. Claims should be submitted to TMHP with procedure code C-T1000 and the appropriate TD or TE modifier. Claims submitted with procedure code C-T1000 but without modifier TD or TE will be denied. 1 of 14

2 Details of these changes will be published in the May/June 2008 Texas Medicaid Bulletin, No For more information, call the TMHP Contact Center at (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** As indicated in banner messages on the December 15, 2006, and January 28, 2007, Remittance and Status (R&S) reports, effective for dates of service on or after February 1, 2007, inpatient hospital claims for State of Texas Access Reform (STAR)+PLUS clients will be processed by TMHP and reimbursed as fee-for-service claims. This information was also included in the Health and Human Services Commission (HHSC) STAR+PLUS Hospital Provider Training on the HHSC website at The spell-of-illness limitation applies to clients in the STAR+PLUS Program. A spell-of-illness is defined as 30 days of inpatient hospital care, which may accrue intermittently or consecutively. After 30 days of inpatient care is provided, reimbursement for additional inpatient care is not considered until the client has been out of an acute care facility for 60 consecutive days. This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section 1.4, "Texas Medicaid Program Limitations and Exclusions," on page 1-20, and Section 7.3.2, "STAR+PLUS Program Benefits," on page Freestanding psychiatric facility claims and inpatient claims with a behavioral health primary diagnosis submitted for clients who are enrolled in a STAR+PLUS plan will be processed by the STAR+PLUS HMOs. 3 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** Reminder: Effective for dates of service on or after April 1, 2008, the following services will be benefits of the Texas Medicaid Program: Brachytherapy services. Chemotherapy services. Electromyography (EMG) and nerve conduction studies (NCS). Implantable infusion pumps. Iron studies. Lung volume reduction surgery (LVRS) (including the preoperative pulmonary rehabilitation service for preparation for LVRS and post-discharge pulmonary surgery services after LVRS). Radiation therapy services. Stereotactic radiosurgery services. Therapeutic radiopharmaceuticals. Wearable cardiac defibrillator (WCD) (procedure codes , L-K0606, or 9-K0606). Details of these changes are available on the TMHP website at and will be published in the May/June 2008 Texas Medicaid Bulletin, No (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** The 2008 Texas Medicaid Fee Schedules are now available on the TMHP website at 2 of 14

3 Fee schedules can be downloaded from the website as either portable document format (PDF) files or Microsoft Excel spreadsheets. Providers can request a free paper copy of a fee schedule by calling the TMHP Contact Center at (03/07/08 through 03/28/08) *****Attention All Medicaid Providers***** Rates have been assigned for procedure codes 1-C9236, 1-J1300, and 1-J9261. Details of the rates are available on the TMHP website at and will be published in the July/August 2008 Texas Medicaid Bulletin, No (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** Effective March 1, 2008, the following enhancements will be made to the online provider lookup tool: The provider update page will include collapsible boxes, frames, and borders, which will make it easier to use. On the expanded results page, a green checkmark will appear next to plans in which the provider is a primary care provider. The Health Plan drop-down menu will show STAR and STAR+PLUS separately. 7 (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** This is an update to an article posted on the TMHP website on January 9, 2008, entitled, "Medicaid Medical Nutrition Counseling Services Benefit to Change." Additional benefit information has been added to the article. The updated article is available on the TMHP website at and will also be available in the May/June 2008 Texas Medicaid Bulletin, No (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** Many Integrated Care Management (ICM) clients are eligible for both Medicaid and Medicare. Medicare enrollment does not affect eligibility for ICM. For clients who are enrolled in both Medicaid and Medicare, ICM is responsible only for long-term services and supports. Primary acute-care and pharmacy services for this population are covered by and should be billed to Medicare. Enrollment in ICM will not change the way a client receives Medicare services. Additional information is available on the TMHP website at and will be published in the July/August Texas Medicaid Bulletin, No (02/29/08 through 03/21/08) *****Attention All Medicaid Providers***** This is an update to a banner message that appeared on the January 18, 2008, Remittance and Status (R&S) report about vaccines/toxoids and procedure code 1-J1670. The banner message stated that effective for dates of service on or after March 1, 2008, the benefit criteria for vaccines/toxoids and procedure code 1-J1670 will change for the Texas Medicaid Program. The implementation of these benefit changes has been postponed, and the Health and Human Services Commission (HHSC) is currently reviewing the policy. Providers should monitor future banner messages and the Texas Medicaid Bulletin for information about benefit changes related to vaccines/toxoids and procedure code 1-J of 14

4 10 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** Effective March 1, 2008, the Texas Medicaid Program will increase the reimbursement rate for the following transport portable X-ray services: Procedure code 4-R0070 will have a reimbursement rate of $ Procedure code 4-R0075 with modifier UN will have a reimbursement rate of $ Procedure code 4-R0075 with modifier UP will have a reimbursement rate of $ Procedure code 4-R0075 with modifier UQ will have a reimbursement rate of $ Procedure code 4-R0075 with modifier UR will have a reimbursement rate of $ Procedure code 4-R0075 with modifier US will have a reimbursement rate of $ Procedure code 4-R0075 must be submitted with modifier UN, UP, UQ, UR, or US. If procedure code 4-R0075 is submitted without the appropriate modifier, the claim will be denied. 11 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** Effective April 1, 2008, the Health and Human Services Commission (HHSC) will launch STAR Health, a new health-care program to improve services and better coordinate care for children in foster care. HHSC has contracted with Superior HealthPlan to provide services for this program. More information about STAR Health is located on the TMHP website at and will be published in the May/June 2008 Texas Medicaid Bulletin, No (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** TMHP has identified an issue with claims submitted with hematopoietic injections procedure codes 1-J0881, 1-J0882, 1-J0885, and 1-J0886. Details of this issue are located on the TMHP website at 13 (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** This is a correction to a banner message that first appeared on the December 7, 2007, Remittance & Status (R&S) report. The banner message indicated that if more than one component is performed, a complete blood count (CBC) procedure code must be billed (procedure code , , or ). Procedure code is incorrect. The correct procedure code is The corrected statement is as follows: If more than one component is performed, a CBC procedure code must be billed (procedure code , , or ). The complete, corrected article will be available in the March/April 2008 Texas Medicaid Bulletin, No (02/22/08 through 03/14/08) *****Attention All Medicaid Providers***** On January 30, 2008, reimbursement rates for the procedure codes listed below were assigned at a public rate hearing. Effective for dates of service on or after March 1, 2008, the rates for the following laser eye surgery procedure codes will change for the Texas Medicaid Program: 4 of 14

5 Procedure code will have a reimbursement rate of $ (9.08 relative value units (RVUs), $ conversion factor). Procedure code F will be reimbursed under ambulatory surgical center (ASC) Group 4. Procedure code will have a reimbursement rate of $ (12.31 RVUs, $ conversion factor). Procedure code F will be reimbursed under ASC Group 4. Procedure code F will be reimbursed under ASC Group 2. Procedure code F will be reimbursed under ASC Group (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The augmentative communication device (ACD) systems policy information is not current in the 2008 Texas Medicaid Provider Procedures Manual, section , "Augmentative Communication Device (ACD) System" on page The current policy and benefit information for ACDs covered under home health services is located in the 2007 Texas Medicaid Provider Procedures Manual, section , Augmentative Communication Device (ACD) System on page The Health and Human Services Commission (HHSC) is reviewing the current policy for ACDs. Any revisions to the ACD policy and benefit information will be published in the May/June 2008 Texas Medicaid Bulletin, No (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The Health and Human Services Commission (HHSC) has identified an error impacting some claims for the Women's Health Program (WHP). Some WHP clients whose year-long certification period expired on December 31, 2007, received new identification cards showing eligibility for January 2008 in error. The affected clients eligibility will be updated to include the month of January Claims may have been denied in error with explanation of benefits (EOB) Unable to assign program/benefit plan." They may continue to be denied until TMHP s eligibility verification systems have been updated to reflect client eligibility for the month of January Claims affected by this error will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. 17 (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** On March 1, 2008, TMHP will implement enhancements to the online prior authorization submission functionality on the TMHP website. Details of the enhancements are available on the TMHP website at and will be published in the May/June 2008 Texas Medicaid Bulletin, No (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The instructions for the TMHP Standardized MRAN templates found in the 2008 Texas Medicaid Provider Procedure Manual, Sections and have been revised. The revised instructions include information 5 of 14

6 about the requirement for typed or computer-generated templates. The revised instructions are available on the TMHP website at and will be published in the May/June 2008 Texas Medicaid Bulletin, No (02/15/08 through 03/07/08) *****Attention All Medicaid Providers***** The Centers for Disease Control and Prevention (CDC) has released the 2008 Recommended Childhood and Adolescent Immunization Schedule that indicates the recommended age for routine administration of currently licensed childhood vaccines. The 2008 Recommended Childhood and Adolescent Immunization Schedule is approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). Providers who offer immunization services should obtain and refer to the schedule or schedules that affect their client populations. The 2008 schedule may be downloaded from the CDC website at: For more information about the 2008 Recommended Childhood and Adolescent Immunization Schedules, call the Department of State Health Services (DSHS) Immunization Branch at (02/15/2008 through 03/07/2008) *****Attention All Medicaid Providers***** This is a correction and an update to an article published in the November/December 2006 Texas Medicaid Bulletin, No. 199, entitled, Changes in Billing Procedures for State School Services. The article stated that effective September 1, 2006, providers can no longer bill TMHP for off-campus acute care services provided to Medicaid-eligible state school residents, except for inpatient hospital care for individuals that are eligible for Supplemental Security Income (SSI) Medicaid. The effective date indicated in the article is incorrect. The correct date is January 1, Additionally, beginning April 1, 2008, claims for off-campus acute care services provided to Medicaid-eligible state school residents (excluding inpatient hospital care for individuals that are eligible for SSI Medicaid) submitted to TMHP with dates of service on or after January 1, 2006, will be recouped and payments adjusted accordingly. The complete, corrected article is available on the TMHP website as and will also be available in the 2008 May/June Texas Medicaid Bulletin, No (02/22/08 through 03/14/08) *****Attention All Medicaid Dental Providers***** This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section , "Restorative Services," on page The reimbursement rate for procedure code D2390 when performed on primary anterior teeth is shown as $ The correct reimbursement for procedure code D2390 on primary anterior teeth is $ The reimbursement limitation for resin restorations is shown as $ when performed on primary teeth. The correct amount is $ The corrected paragraph is as follows: All fees for resin restorations on primary teeth are limited to $156.06, which is the fee for a stainless steel crown (exception: procedure code D2335). All fees for resin restorations on permanent teeth are limited to a total of $ for posterior teeth and $ for anterior teeth. Resin restoration includes composites or glass ionomer. 6 of 14

7 22 (02/15/08 through 03/07/08) *****Attention All Medicaid Dental Providers***** This is a correction to an article published on the TMHP website at on December 10, 2007, entitled Additional Oral Maxillofacial Procedure Codes To Be Benefits. The procedure code table referenced in the article did not include all the procedure codes that are payable to oral maxillofacial surgeons. The corrected article is available on the TMHP website at and will be published in the March/April 2008 Texas Medicaid Bulletin, No (02/22/08 through 03/14/08) *****Attention All Medicaid Inpatient Hospital Providers***** This is an update to the November 2007 ICD-9-CM Special Bulletin, No The table entitled, "2008 New MS-DRGs," on page 13, included assigned DRG relative weights, mean lengths of stay (LOS), and day thresholds for new Medicare Severity-Diagnosis Related Group (MS-DRG) codes. HHSC has since updated the reimbursement information for 390 of the codes. Effective March 1, 2008, for dates of admission on or after October 1, 2007, 390 of the DRG relative weights have been revised. Day thresholds and mean lengths of stay remain unchanged. Claims submitted before March 1, 2008, with dates of admission on or after October 1, 2007, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. The updated information for affected MS-DRG codes and additional payment information effective for inpatient hospital admissions on or after October 1, 2007, is available in the TMHP website at The updates will also be available in the May/June 2008 Texas Medicaid Bulletin, No (02/29/08 through 03/21/08) *****Attention All Medicaid and PCCM Providers***** This is a correction to a banner message that was published on December 3, 2007, about an article entitled "Provider Name No Longer Listed on PCCM Medicaid ID Form." The message stated that details of the changes were available on the TMHP website at and in the March/April 2008 Texas Medicaid Bulletin, No The bulletin number was incorrect. The correct bulletin number is 214. For more information call the PCCM Provider Helpline at or the TMHP Contact Center at (02/22/08 through 03/14/08) *****Attention All Medicaid and PCCM Providers***** This is an update to a banner message that first appeared on the January 25, 2008, Remittance and Status (R&S) report, and a website article that was posted on January 21, 2008, entitled "High Cost Durable Medical Equipment." The process has changed for recouping claims for which the DME Certification and Receipt Form has not been submitted to TMHP. Effective for dates of service on or after March 1, 2008, the revised DME Certification and Receipt Form must be submitted to TMHP for claims for durable medical equipment (DME) that meets or exceeds a billed amount of $2, The form must be submitted when multiple items that meet or exceed a total billed amount of $2, are billed for the same date of service. The form is required in addition to obtaining prior authorization, when applicable. 7 of 14

8 If the DME Certification and Receipt Form is not submitted to TMHP, the claim payment will be reviewed and will be eligible for recoupment. Incomplete forms will be returned to the provider for correction and resubmission. TMHP will also contact clients that received DME for verification of services rendered. If the delivery of the equipment can not be verified by the client, the claim payment will be eligible for recoupment. The revised DME Certification and Receipt Form is available on the TMHP website at and will be published in the May/June 2008 Texas Medicaid Bulletin, No The revised form may be submitted by fax to or submitted with the paper claim form. 26 (02/22/08 through 03/14/08) *****Attention All Medicaid and THSteps-CCP Providers***** This is an update to an article posted on the TMHP website on January 9, 2008, entitled, "Bariatric Surgery Benefits Now Available." The article stated that effective for dates of service on or after March 1, 2008, some bariatric surgical procedures are benefits of the Texas Medicaid Program. Bariatric surgery benefits will not be implemented on March 1, Providers will be informed in a future banner message when benefits for bariatric surgery become available. 27 (03/07/08 through 03/28/08) *****Attention All Inpatient Hospital Providers***** This is an update to an article posted on the TMHP website on February 18, 2008, entitled, "DRG Relative Weights Have Been Revised." Texas Medicaid Program health maintenance organizations (HMOs) are not required to reprocess claims retroactively for dates of admission on or after October 1, Texas Medicaid Program HMOs must use the revised weights for claims beginning on March 1, For the complete list of DRG relative weights, mean lengths of stay, and day thresholds, providers may refer to the article on the TMHP website entitled, "DRG Relative Weights Have Been Revised." 28 (03/07/08 through 03/28/08) *****Attention All MHMR Providers***** Effective April 26, 2008, for dates of service on or after January 1, 2005, TMHP will no longer reimburse claims submitted by Department of State Health Services (DSHS)- and Department of Aging and Disabilities Services (DADS)-certified providers for mental health rehabilitation, case management, and mental retardation services provided to clients in three client type programs. The funding to the centers received from DSHS and DADS agencies should be considered payment in full for these client categories. Claims for these individuals should no longer be submitted to TMHP. Centers are still responsible for providing appropriate services to clients without disruption. The type programs are: Type Program 9, Base Plan 32-Foster care clients who do not receive benefits through Temporary Assistance to Needy Families (TANF), medical assistance only, no federal match. Type Program 10, Base Plan 32-State-paid foster care clients, no federal match. Type Program 51, All Base Plans-State-paid Medical Assistance-Only (MAO) clients. 29 (02/29/08 through 03/21/08) *****Attention All THSteps-CCP Providers***** Effective immediately, providers must submit the THSteps-CCP Prior Authorization Request Form if they request a medically necessary service that is not addressed in the 2008 Texas Medicaid Provider Procedures 8 of 14

9 Manual for a client birth through 20 years of age. The THSteps-CCP Prior Authorization Request Form must be submitted to the Texas Medicaid & Healthcare Partnership, Attn: Comprehensive Care Program, PO Box , Austin, Texas It can also be faxed to (02/22/08 through 03/14/08) *****Attention All Providers***** The Automated Inquiry System (AIS) will be enhanced March 20, The enhancements include the ability for providers to obtain a ticket number within the interactive voice response (IVR). The enhancements also include shortened menu prompt scripts to reduce the length of time a provider spends within the IVR. The enhancements to the AIS will improve the provider experience by improving self service within the IVR. For more information, call the TMHP Contact Center at or the TMHP-CSHCN Services Program Contact Center at (02/22/08 through 03/14/08) *****Attention All Providers***** Providers will soon be able to enroll in the Texas Medicaid Program and Children with Special Health Care Needs (CSHCN) Services Program and apply for Primary Care Case Management (PCCM) credentialing on the TMHP website at Providers will have the following options: initial enrollment, reenrollment, credentialing, recredentialing, and provider information maintenance. The effective date will be published in a future banner message. Details are available on the TMHP website at For more information, call the TMHP Contact Center at or the TMHP-CSHCN Services Program Contact Center at (02/15/08 through 03/07/08) *****Attention All Providers***** The state of Texas contingency period for National Provider Identifier (NPI) compliance has changed and will not end on February 29, HHSC and TMHP have extended the NPI contingency period through May 23, Providers must attest their NPIs and related data to TMHP by May 23, Related data includes a taxonomy code, a benefit code (if applicable), and a physical address with a ZIP Code+4. NPIs can be attested on the TMHP website at Effective May 24, 2008, full NPI compliance will be implemented, and the contingency period will end. Providers that have not attested their NPIs and related data or that do not use their attested NPI and related data on all claims and other transactions (e.g., authorizations, eligibility verifications, and claim status inquiries) will experience the following: Rejection or denial of paper and electronic claims and other transactions. Returned authorization requests. Closed primary care provider panel reports (beginning April 1, 2008). The end of the contingency period will affect software and electronic data interchange (EDI): TDHconnect does not support the NPI, so claims and other transactions submitted using TDHconnect will be rejected. TDHconnect has been replaced by TexMedConnect, which is available on the TMHP website at Third-party billers and software vendors must complete the mandatory EDI testing of NPI transactions or their transactions will be rejected. 9 of 14

10 Complete details are available on the TMHP website at and will be published in the 2008 March/April Texas Medicaid Bulletin, No. 214, and the 2008 May CSHCN Services Program Bulletin, No. 66. For more information, call the TMHP Contact Center at or the TMHP-CSHCN Services Program Contact Center at (03/07/08 through 03/28/08) *****Attention All THSteps Dental Providers***** TMHP has revised the THSteps Dental Mandatory Prior Authorization Request Form found in the 2008 Texas Medicaid Provider Procedures Manual. The updated form will be available on the TMHP website at on March 7, 2008, and will be published in the 2008 May/June Texas Medicaid Bulletin, No The updated form will also be available through the TMHP fax-back option through the Automated Inquiry System (AIS) at Effective May 1, 2008, TMHP will only accept the revised form. Prior authorization requests submitted on the old form will not be processed, and the provider will be notified to resubmit the request on the revised form. 34 (03/07/08 through 03/28/08) *****Attention All Medicaid and CSHCN Services Program Providers***** Respiratory syncytial virus (RSV) prophylaxis (procedure code ) is a benefit to eligible clients of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) and Children with Special Health Care Needs (CSHCN) Services Program when medically necessary. RSV prophylaxis can be provided through monthly injections of palivizumab (Synagis). Monthly injections of palivizumab are only medically necessary when the client will be exposed to widespread RSV activity in the community. In consultation with qualified experts, the Texas Medicaid Program and the CSHCN Services Program have been monitoring RSV activity across the state. Current surveillance trends document that RSV activity is rapidly waning. Based on these trends, RSV prophylaxis for this season will not be necessary in most areas of the state after March 31, Providers should communicate with their local hospitals or other qualified laboratories for information about RSV trends in their community so they can tailor palivizumab administration accordingly. Effective for dates of service on or after April 1, 2008, palivizumab is no longer medically necessary and will not be reimbursed without prior authorization. For more information, call the TMHP Contact Center at or the TMHP-CSHCN Services Program Contact Center at (02/29/08 through 03/21/08) *****Attention All Medicaid and CSHCN Services Program Providers***** This is a correction to the 2008 HCPCS Special Bulletin, No The bulletin incorrectly listed procedure code 1-S9152 as not covered by the Texas Medicaid Program or the Children with Special Health Care Needs (CSHCN) Services Program. Details about procedure code 1-S9152 are located on the 2008 HCPCS webpage of the TMHP website at and will be published in the May/June 2008 Texas Medicaid Bulletin, No. 215 and the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP Contact Center at or the TMHP-CSHCN Services Program Contact Center at of 14

11 36 (02/29/08 through 03/21/08) *****Attention All Medicaid and CSHCN Services Program Providers***** TMHP has identified an issue impacting claims submitted with dates of service on or after October 16, 2003, through February 8, 2008, and procedure code or Claims submitted with procedure code or and a quantity greater than one were inappropriately denied. Procedure codes and are limited to four units per rolling year for the same provider. One unit is equivalent to 15 minutes. Impacted claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. For more information, call the TMHP Contact Center at or the TMHP-CSHCN Services Program Contact Center at (02/29/08 through 03/21/08) *****Attention All Medicaid and CSHCN Services Program Providers***** TMHP has identified an issue impacting claims submitted with procedure code , , , , or For dates of service on or before December 31, 2006, these procedure codes were only valid for initial inpatient consultations and were limited to once every 30 days. Effective for dates of service on or after January 1, 2007, providers may bill these procedure codes for both new and established patient inpatient consultations. Claims submitted with dates of service on or after January 1, 2007, may have been denied in error. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Providers may refer to the 2008 Texas Medicaid Provider Procedures Manual, Section 36, or the 2008 Children with Special Health Care Needs Provider Manual, Chapter 24, for additional information on consultations and physician evaluation and management benefits. For more information, call the TMHP Contact Center at or the CSHCN Services Program Contact Center at (2/15/08 through 3/7/08) *****Attention All Medicaid and CSHCN Services Program Providers***** On April 1, 2008, TMHP will implement first quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions effective for dates of service on or after April 1, Deleted procedure codes will no longer be benefits of the Texas Medicaid Program, Medicaid Managed Care Program, and Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes will be available on the TMHP website at under the 2008 HCPCS webpage beginning April 1, 2008, and will also be included in the May/June 2008 Texas Medicaid Bulletin, No. 215 and the May 2008 CSHCN Provider Bulletin, No. 66. For more information, visit the TMHP website or call the TMHP Contact Center at or the TMHP-CSHCN Contact Center at (02/22/08 through 3/14/08) *****Attention All Medicaid and CSHCN Services Program Dental Providers***** This is an update to the 2007 HCPCS Special Bulletin, No. 200, and also to the 2008 Texas Medicaid Provider Procedures Manual, Section , "Diagnostic Services," on page The bulletin originally stated that effective for dates of service on or after January 1, 2007, procedure code D0145 is a benefit of the Texas 11 of 14

12 Medicaid Program and the Children with Special Health Care Needs (CSHCN) Services Program for dental providers. The updated information is as follows: Effective for dates of service on or after January 1, 2007, through February 29, 2008, procedure code D0145 is a benefit of the Texas Medicaid Program and the CSHCN Services Program and must complete the rate hearing process for an appropriate reimbursement rate to be established. Once the reimbursement rate is adopted, all claims submitted for reimbursement between January 1, 2007, and February 29, 2008, with procedure code D0145, will be reprocessed and payments adjusted accordingly. No further action on the part of the provider is necessary. Effective March 1, 2008, benefit requirements will change for procedure code W-D0145. Providers will be informed of these changes in a separate banner message. The information concerning procedure code D0145 in the 2008 CSHCN Services Program Provider Manual is correct and does not require an update. For more information, call the TMHP Contact Center at , or the TMHP-CSHCN Contact Center at (02/22/08 through 03/14/08) *****Attention All THSteps and CSHCN Services Program Dental Providers***** First Dental Home is a new initiative designed to help Texas Health Steps (THSteps) and Children with Special Health Care Needs (CSHCN) Services Program clients 6 months through 35 months of age to establish a dental home. Earlier oral evaluation allows earlier identification of dental needs and the start of needed preventive and therapeutic dental services. Dentists will be required to complete training and be certified to participate in the First Dental Home initiative. Effective for dates of service on or after March 1, 2008, dentists must be certified as First Dental Home providers in order to receive reimbursement for procedure code D0145. Procedure codes D0120, D0150, D1120, D1203, or D1206 will not be reimbursed if procedure code D0145 is billed with the same date of service by any provider. Certification as a First Dental Home provider will be added to the advanced search criteria of the online provider lookup on the TMHP website at This change will enable users to find a dentist who is certified to provide this oral evaluation and counseling. The Texas Department of State Health Services (DSHS) will begin training and certifying currently-enrolled pediatric dental providers on or after March 1, Training for general dentists will begin on or after May 1, For more information about training, contact Dr. Linda Altenhoff at Linda.altenhoff@dshs.state.tx.us or , Ext (02/22/08 through 03/14/08) *****Attention All CSHCN Services Program Providers***** TMHP has completed the National Provider Identifier (NPI) attestation for CSHCN Services Program providers who have completed the NPI attestation of their Texas Medicaid Program Texas Provider Identifier (TPI.) The NPI attestation was completed using the CSHCN Services Program TPI and the NPI, taxonomy code, and physical address provided during the NPI attestation with the Texas Medicaid Program. Providers are encouraged to review the information on the attestation page of the TMHP website at If the information reflected in the NPI attestation is incorrect, providers must update the information on the attestation page. Access to the attestation page is granted through current administrative permissions. Only account administrators are able to attest and update online. 12 of 14

13 Transactions on the TMHP website, including claims filing and eligibility verifications, require the NPI and benefit code of those providers for whom the attestation has been completed. After attestation, the CSHCN Services Program and Texas Medicaid Program TPIs will no longer be accepted for transactions on the TMHP website. CSHCN Services Program transactions must include a benefit code. A benefit code is an additional data element that TMHP uses to identify state programs. "CSN" is used to identify the CSHCN Services Program. This benefit code is required on all claims and authorizations and will appear on paper checks when applicable. NPI information is available on the TMHP website under the NPI announcements page. For more information, call the TMHP CSHCN Services Program Contact Center at (03/07/08 through 03/28/08) *****Attention All CSHCN Services Program Providers***** This is a correction to the 2008 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No The bulletin incorrectly indicated benefits and limitations for certain codes for the Children with Special Health Care Needs (CSHCN) Services Program. Details of these corrections are available on the 2008 HCPCS webpage at The information will also be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP-CSHCN Services Program Contact Center at (02/22/2008 through 03/14/2008) *****Attention All CSHCN Services Program Providers***** This is a correction to an article posted on the TMHP website at on December 10, 2007, entitled "Additional Oral Maxillofacial Procedure Codes to be CSHCN Services Benefits". The procedure code table attached to in the article did not include all the procedure codes that are payable to oral maxillofacial surgeons. The complete, corrected article is available on the TMHP website at and will be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 61. For more information, call the TMHP-CSHCN Services Program Contact Center at (02/15/08 through 03/07/08) *****Attention All CSHCN Services Program Providers***** Effective for dates of service on or after April 1, 2008, benefit criteria for chemotherapy services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes are available on the TMHP website at and will be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP Contact Center at (2/15/08 through 3/7/08) *****Attention All CSHCN Services Program Providers***** Effective for dates of service on or after April 1, 2008, electrodiagnostic testing (electromyography [EMG] and nerve conduction studies [NCS]) services are benefits of the Children with Special Health Care Needs (CSHCN) Services Program. EMG and NCS services are limited to four occurrences/visits per calendar year when submitted for reimbursement by the same provider. Prior authorization will not be considered beyond the four occurrences. Additional nerve conduction studies per occurrence may be considered for prior authorization with documentation of medical necessity. EMG and NCS procedure codes are diagnosis restricted. Additional details of these new benefits are available on the TMHP website at and will also be published in the May 2008 CSHCN Services Program Provider Bulletin, No of 14

14 For more information, call the TMHP-CSHCN Services Program Contact Center at (03/07/08 through 03/28/08) *****Attention All CSHCN Services Program DME Providers***** Effective February 27, 2008, for dates of service on or after December 1, 2006, the rates changed for some durable medical equipment (DME) procedure codes. Effective February 22, 2008, for dates of service on or after October 1, 2006, the rates changed for procedure codes J/L-K0010 and J/L-K0011. Claim reprocessing information and a complete list of procedure codes with updated reimbursement rates is available on the TMHP website at and will be published in the May 2008 CSHCN Services Program Provider Bulletin, No. 66. For more information, call the TMHP-CSHCN Services Program Contact Center at of 14

Banner Message for the 01/30/06 ER&S and the 02/03/06 R&S Reports

Banner Message for the 01/30/06 ER&S and the 02/03/06 R&S Reports Banner Message for the 01/30/06 ER&S and the 02/03/06 R&S Reports This file contains abbreviated messages meant to provide timely notifications that affect all provider groups (physicians, dentists, and

More information

T exas Medicaid Bulletin

T exas Medicaid Bulletin T exas Medicaid Bulletin Bimonthly update to the Texas Medicaid Provider Procedures Manual November/December 2008 No. 219 Medicare Paper Claims Providers that receive paper Medicare Remittance Advice Notices

More information

T exas Medicaid Bulletin

T exas Medicaid Bulletin T exas Medicaid Bulletin Bimonthly update to the Texas Medicaid Provider Procedures Manual July/August 2009 No. 224 Mammography Certification Issued by DSHS On September 1, 2008, the Department of State

More information

TMHP Telephone and Address Guide

TMHP Telephone and Address Guide TMHP Telephone and Address Guide TMHP Telephone and Fax Communication...................................... x Primary Care Case Management (PCCM) Telephone Communication................... x Prior Authorization

More information

HCPCS Special Bulletin

HCPCS Special Bulletin HCPCS Special Bulletin 2018 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin JANUARY 2018 NO. 13 2018 HCPCS Implementation On January 1, 2018, the Texas Medicaid & Healthcare Partnership

More information

PRELIMINARY INFORMATION TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

PRELIMINARY INFORMATION TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 PRELIMINARY INFORMATION TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 AUGUST 2018 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 AUGUST 2018 PRELIMINARY INFORMATION Table of Contents Welcome: Texas

More information

T exas Medicaid Bulletin

T exas Medicaid Bulletin T exas Medicaid Bulletin Bimonthly update to the Texas Medicaid Provider Procedures Manual May/June 2009 No. 223 Claims Filing Deadline Waived for Providers in Ike Evacuation Areas This is a clarification

More information

HOME HEALTH (SKILLED NURSING) CARE CSHCN SERVICES PROGRAM PROVIDER MANUAL

HOME HEALTH (SKILLED NURSING) CARE CSHCN SERVICES PROGRAM PROVIDER MANUAL HOME HEALTH (SKILLED NURSING) CARE CSHCN SERVICES PROGRAM PROVIDER MANUAL JANUARY 2018 CSHCN PROVIDER PROCEDURES MANUAL JANUARY 2018 HOME HEALTH (SKILLED NURSING) CARE Table of Contents 22.1 Enrollment......................................................................

More information

Hospital Credentialing Application

Hospital Credentialing Application Hospital Credentialing Application Thank you for your interest in Superior HealthPlan. Please use this checklist to ensure you have all necessary contract and credentialing items to avoid processing delays.

More information

Approved Banner Messages For Total Messages (260) Banner Messages for Copyright Acknowledgements

Approved Banner Messages For Total Messages (260) Banner Messages for Copyright Acknowledgements Banner Messages for 2006 This file contains abbreviated messages meant to provide timely notifications that affect all provider groups (physicians, dentists, and so forth). Additional current and historic

More information

HOSPITAL CSHCN SERVICES PROGRAM PROVIDER MANUAL

HOSPITAL CSHCN SERVICES PROGRAM PROVIDER MANUAL HOSPITAL CSHCN SERVICES PROGRAM PROVIDER MANUAL JUNE 2018 CSHCN PROVIDER PROCEDURES MANUAL JUNE 2018 HOSPITAL Table of Contents 24.1 Enrollment......................................................................

More information

SECTION 2: TEXAS MEDICAID REIMBURSEMENT

SECTION 2: TEXAS MEDICAID REIMBURSEMENT SECTION 2: TEXAS MEDICAID REIMBURSEMENT 2.1 Payment Information............................................................. 2-2 2.2 Reimbursement Methodology....................................................

More information

PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS CSHCN SERVICES PROGRAM PROVIDER MANUAL

PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS CSHCN SERVICES PROGRAM PROVIDER MANUAL PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS CSHCN SERVICES PROGRAM PROVIDER MANUAL SEPTEMBER 2018 CSHCN PROVIDER PROCEDURES MANUAL SEPTEMBER 2018 PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS Table of Contents

More information

CMS-1500 Billing and Reimbursement. HP Provider Relations/October 2013

CMS-1500 Billing and Reimbursement. HP Provider Relations/October 2013 CMS-1500 Billing and Reimbursement HP Provider Relations/October 2013 Agenda Common Denials for CMS-1500 CMS-1500 Claims Billing Types of CMS-1500 Claims Paper Claim Billing Fee Schedule Crossover Claims

More information

9.1.1 Medicaid Managed Care Enrollment Prior Authorization Emergency Ambulance Services

9.1.1 Medicaid Managed Care Enrollment Prior Authorization Emergency Ambulance Services Section 9Ambulance 9 9.1 Enrollment........................................................ 9-2 9.1.1 Medicaid Managed Care Enrollment................................. 9-2 9.2 Reimbursement....................................................

More information

AMBULATORY SURGICAL CENTERS PROVIDER MANUAL Chapter Twenty-nine of the Medicaid Services Manual

AMBULATORY SURGICAL CENTERS PROVIDER MANUAL Chapter Twenty-nine of the Medicaid Services Manual AMBULATORY SURGICAL CENTERS PROVIDER MANUAL Chapter Twenty-nine of the Medicaid Services Manual Issued November 1, 2010 Claims/authorizations for dates of service on or after October 1, 2015 must use the

More information

Quick Reference Card

Quick Reference Card Amerigroup District of Columbia, Inc. Quick Reference Card Precertification/notification requirements Important contact numbers n Revenue codes https://providers.amerigroup.com/dc DCPEC-0176-17 Important

More information

Chapter. CPT only copyright 2010 American Medical Association. All rights reserved. 23Hospital

Chapter. CPT only copyright 2010 American Medical Association. All rights reserved. 23Hospital 23Hospital Chapter 23 23.1 Enrollment..................................................................... 23-2 23.1.1 Continuity of Hospital Eligibility Through Change of Ownership............ 23-2 23.1.2

More information

2008 Nursing Facility and Hospice Quick Reference Guide

2008 Nursing Facility and Hospice Quick Reference Guide 2008 Nursing Facility and Hospice Quick Reference Guide Copyright Acknowledgments Use of the American Medical Association s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication

More information

SECTION 2: TEXAS MEDICAID FEE-FOR-SERVICE REIMBURSEMENT TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

SECTION 2: TEXAS MEDICAID FEE-FOR-SERVICE REIMBURSEMENT TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 SECTION 2: TEXAS MEDICAID FEE-FOR-SERVICE REIMBURSEMENT TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2017 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2017 SECTION 2: TEXAS

More information

Optima Health Provider Manual

Optima Health Provider Manual Optima Health Provider Manual Supplemental Information For Ohio Facilities and Ancillaries This supplement of the Optima Health Ohio Provider Manual provides information of specific interest to Participating

More information

Subject: 2007 Indiana Health Coverage Programs Provider Seminar

Subject: 2007 Indiana Health Coverage Programs Provider Seminar INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 2 2 S E P T E M B E R 4, 2 0 0 7 To: All Providers Subject: 2007 Indiana Health Coverage Programs Provider Seminar Overview

More information

Chapter. CPT only copyright 2009 American Medical Association. All rights reserved. 31Radiation Therapy Services

Chapter. CPT only copyright 2009 American Medical Association. All rights reserved. 31Radiation Therapy Services Chapter 31Radiation Therapy Services 31 31.1 Enrollment...................................................... 31-2 31.2 Benefits, Limitations, and Authorization Requirements...................... 31-2

More information

BCBSNC Best Practices

BCBSNC Best Practices BCBSNC Best Practices Thank you for attending today! We value your commitment of caring for our members your patients and our shared goals for their improved health An independent licensee of the Blue

More information

Medicaid Managed Care Program (STAR) and Children s Health Insurance Program (CHIP) Provider Transition Orientation December 1, 2015

Medicaid Managed Care Program (STAR) and Children s Health Insurance Program (CHIP) Provider Transition Orientation December 1, 2015 Medicaid Managed Care Program (STAR) and Children s Health Insurance Program (CHIP) Provider Transition Orientation December 1, 2015 PWP-9002-15 A Division of Health Care Service Corporation, a Mutual

More information

LifeWise Reference Manual LifeWise Health Plan of Oregon

LifeWise Reference Manual LifeWise Health Plan of Oregon 11 UB-04 Billing Description This chapter contains participation, claims and billing information for providers who bill on a UB-04 (CMS 1450) claim form. This chapter supplements information contained

More information

Connecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers

Connecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Training Topics Hospice Agenda HIPAA 5010 Hospice Form

More information

Hospital Refresher Workshop. Presented by The Department of Social Services & HP Enterprise Services

Hospital Refresher Workshop. Presented by The Department of Social Services & HP Enterprise Services Hospital Refresher Workshop Presented by The Department of Social Services & HP Enterprise Services 1 Training Topics Provider Bulletins Outpatient Claim Billing Changes Explanation of Benefit Codes Web

More information

ADVANCED PRACTICE REGISTERED NURSE (APRN [NP/CNS]) CSHCN SERVICES PROGRAM PROVIDER MANUAL

ADVANCED PRACTICE REGISTERED NURSE (APRN [NP/CNS]) CSHCN SERVICES PROGRAM PROVIDER MANUAL ADVANCED PRACTICE REGISTERED NURSE (APRN [NP/CNS]) CSHCN SERVICES PROGRAM PROVIDER MANUAL FEBRUARY 2018 CSHCN PROVIDER PROCEDURES MANUAL FEBRUARY 2018 ADVANCED PRACTICE REGISTERED NURSE (APRN [NP/CNS])

More information

Subject: Indiana Health Coverage Programs 2003 Seminar

Subject: Indiana Health Coverage Programs 2003 Seminar P R O V I D E R B U L L E T I N B T 2 0 0 3 4 8 J U L Y 1 5, 2 0 0 3 To: All Providers Subject: Overview The Office of Medicaid Policy and Planning (OMPP), the Children s Health Insurance Program (CHIP),

More information

Section. 35Psychologist

Section. 35Psychologist Section 35Psychologist 35 35.1 Enrollment...................................................... 35-2 35.1.1 STAR and STAR+PLUS Program Enrollment.......................... 35-2 35.2 Reimbursement..................................................

More information

Section. CPT only copyright 2005 American Medical Association. All rights reserved. 2Texas Medicaid Reimbursement

Section. CPT only copyright 2005 American Medical Association. All rights reserved. 2Texas Medicaid Reimbursement Section 2Texas Medicaid Reimbursement 2 2.1 Reimbursement.................................................... 2-2 2.1.1 Electronic Funds Transfer........................................ 2-2 2.1.1.1 Using

More information

Day Activity Health Services (DAHS)

Day Activity Health Services (DAHS) Day Activity Health Services (DAHS) Training Last Updated June 2015 SHP_2015891 Who is Superior HealthPlan? A subsidiary of Centene Corporation located in St. Louis, MO. Has held a contract with HHSC since

More information

Superior HealthPlan STAR+PLUS

Superior HealthPlan STAR+PLUS Superior HealthPlan STAR+PLUS Provider Training (non-nursing Facility Residents) SHP_2015883 Who is Superior HealthPlan? Superior HealthPlan is a subsidiary of Centene Corporation located in St. Louis,

More information

Connecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers

Connecticut Medical Assistance Program Refresher for Hospice Providers. Presented by The Department of Social Services & HP for Billing Providers Connecticut Medical Assistance Program Refresher for Hospice Providers Presented by The Department of Social Services & HP for Billing Providers 1 Hospice Agenda Overview Forms Fee Schedule/Reimbursement

More information

Chapter. CPT only copyright 2008 American Medical Association. All rights reserved. 30Radiation Therapy Services

Chapter. CPT only copyright 2008 American Medical Association. All rights reserved. 30Radiation Therapy Services Chapter 30Radiation Therapy Services 30 30.1 Enrollment...................................................... 30-2 30.2 Benefits, Limitations, and Authorization Requirements...................... 30-2

More information

SECTION 4: CLIENT ELIGIBILITY TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

SECTION 4: CLIENT ELIGIBILITY TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 SECTION 4: CLIENT ELIGIBILITY TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 FEBRUARY 2018 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 FEBRUARY 2018 SECTION 4: CLIENT ELIGIBILITY Table of Contents

More information

Section. 2Texas Medicaid Reimbursement

Section. 2Texas Medicaid Reimbursement Section 2Texas Medicaid Reimbursement 2 2.1 Reimbursement.................................................... 2-2 2.1.1 Electronic Funds Transfer........................................ 2-2 2.1.1.1 Using

More information

AMBULATORY SURGERY FACILITY GENERAL INFORMATION

AMBULATORY SURGERY FACILITY GENERAL INFORMATION AMBULATORY SURGERY FACILITY GENERAL INFORMATION I. BCBSM s Ambulatory Surgery Facility Programs Traditional BCBSM s Traditional Ambulatory Surgery Facility Program includes all facilities that are licensed

More information

Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement

Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review: 12/2017 Next Review:

More information

CHAPTER 3: EXECUTIVE SUMMARY

CHAPTER 3: EXECUTIVE SUMMARY INDIANA PROVIDER MANUAL EXECUTIVE SUMMARY Indiana Family and Social Services Administration (FSSA) contracts with Anthem Insurance Companies, Inc. (dba Anthem Blue Cross and Blue Shield) for the provision

More information

CSHCN Provider Bulletin

CSHCN Provider Bulletin February 2004 No. 49 CSHCN Provider Bulletin The Children with Special Health Care Needs Program Welcome to the Texas Medicaid & Healthcare Partnership CONTENTS e Texas Medicaid & Healthcare Partnership

More information

Louisiana Department of Health and Hospitals Bureau of Health Services Financing

Louisiana Department of Health and Hospitals Bureau of Health Services Financing Louisiana Department of Health and Hospitals Bureau of Health Services Financing Affordable Care Act Enhanced Reimbursement of Primary Care Services Informational Bulletin December 19, 2012 Revised April

More information

TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL

TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL NOVEMBER 2017 CSHCN PROVIDER PROCEDURES MANUAL NOVEMBER 2017 TELECOMMUNICATION SERVICES Table of Contents 38.1 Enrollment......................................................................

More information

Renal Dialysis. Chapter

Renal Dialysis. Chapter Renal Dialysis Chapter.1 Enrollment..................................................................... -2.2 Client Eligibility................................................................. -2.3 Benefits,

More information

PROVIDER BULLETIN. Vendor Drug Program (VDP) Website Revised. CSHCN Services Program No. 77 IN THIS EDITION

PROVIDER BULLETIN. Vendor Drug Program (VDP) Website Revised. CSHCN Services Program No. 77 IN THIS EDITION Pub. No. 07 12276 CSHCN Services Program No. 77 PROVIDER BULLETIN Children with Special Health Care Needs Services Program February 2011 IN THIS EDITION General Interest 1 Vendor Drug Program (VDP) Website

More information

2009 Long Term Care User Manual. for Paper Submitters

2009 Long Term Care User Manual. for Paper Submitters 2009 Long Term Care User Manual for Paper Submitters Dear Long Term Care Provider, Welcome to the 2009 Long Term Care User Manual for Paper Submitters. This user manual is published for Long Term Care

More information

7.1.1 STAR and STAR+PLUS Program Enrollment Prior Authorization Emergency Ambulance Services Medicaid Limitations and Exclusions

7.1.1 STAR and STAR+PLUS Program Enrollment Prior Authorization Emergency Ambulance Services Medicaid Limitations and Exclusions Section 7Ambulance 7 7.1 Enrollment........................................................ 7-2 7.1.1 STAR and STAR+PLUS Program Enrollment............................ 7-2 7.2 Reimbursement....................................................

More information

FEDERALLY QUALIFIED HEALTH CENTERS (FQHC)

FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) AND RURAL HEALTH CLINICS (RHC) CSHCN SERVICES PROGRAM PROVIDER MANUAL AUGUST 2018 CSHCN PROVIDER PROCEDURES MANUAL AUGUST 2018 FEDERALLY QUALIFIED HEALTH CENTERS

More information

Today s News Brought to You by

Today s News Brought to You by , LLC 9702 Bissonnet, Suite 2200W Houston, TX 77036 PRESORTED FIRST-CLASS MAIL U.S. POSTAGE PAID MINNEAPOLIS, MN PERMIT NO. 32126 in focus Evercare of Texas Winter 2008/2009 Volume 8, Issue 1 Please help

More information

TCS FAQ s. How will the implementation of national standard code sets reduce burden on the health care industry?

TCS FAQ s. How will the implementation of national standard code sets reduce burden on the health care industry? TCS FAQ s What is a code set? Under HIPAA, a code set is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.

More information

Home Health & HP Provider Relations

Home Health & HP Provider Relations Home Health & Hospice HP Provider Relations October 2010 Agenda Session Objectives Home Health Benefit Coverage Billing Overhead Multiple Visits Most Common Denials Hospice Benefit Coverage Election/Revocation/Discharge

More information

OUTPATIENT BEHAVIORAL HEALTH CSHCN SERVICES PROGRAM PROVIDER MANUAL

OUTPATIENT BEHAVIORAL HEALTH CSHCN SERVICES PROGRAM PROVIDER MANUAL OUTPATIENT BEHAVIORAL HEALTH CSHCN SERVICES PROGRAM PROVIDER MANUAL APRIL 2018 CSHCN PROVIDER PROCEDURES MANUAL APRIL 2018 OUTPATIENT BEHAVIORAL HEALTH Table of Contents 29.1 Enrollment......................................................................

More information

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Home Health Nursing and Private Duty Nursing Services Handbook

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Home Health Nursing and Private Duty Nursing Services Handbook Texas Medicaid Provider Procedures Manual Provider Handbooks January 2018 Home Health Nursing and Private Duty Nursing Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims

More information

Welcome Providers. Thursday, November 11, Page 1

Welcome Providers. Thursday, November 11, Page 1 Welcome Providers Thursday, November 11, 2010 Page 1 What is a 3 Share Plan? The 3 Share Plan is an affordable health plan for small businesses. Cost is shared among employers, their employees, and one

More information

BCBSNC Provider Application for Participation

BCBSNC Provider Application for Participation BCBSNC Provider Application for Participation This application is to be used if you wish to become a participating provider facility with BCBSNC. This application is not a contract. Please follow the applicable

More information

Chapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups

Chapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Chapter 13 Section 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Issue Date:

More information

Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement

Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of

More information

Behavioral Health Provider Training: BHSO updates

Behavioral Health Provider Training: BHSO updates Behavioral Health Provider Training: BHSO updates Agenda Diagnosis Code 799 Laboratory Work CPT Code Q3014- Telehealth BHSO Claims submission Process Targeted Case Management Diagnosis Codes Diagnosis

More information

T exas Medicaid Bulletin

T exas Medicaid Bulletin T exas Medicaid Bulletin Bimonthly update to the Texas Medicaid Provider Procedures Manual March/April 2010 No. 228 FDA Authorized Peramivir EAU On October 23, 2009, the U.S. Food and Drug Administration

More information

Outpatient Hospital Facilities

Outpatient Hospital Facilities Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology

More information

Passport Advantage Provider Manual Section 5.0 Utilization Management

Passport Advantage Provider Manual Section 5.0 Utilization Management Passport Advantage Provider Manual Section 5.0 Utilization Management Table of Contents 5.1 Utilization Management 5.2 Review Criteria 5.3 Prior Authorization Requirements 5.4 Organization Determinations

More information

Connecticut Medical Assistance Program. Hospice Refresher Workshop

Connecticut Medical Assistance Program. Hospice Refresher Workshop Connecticut Medical Assistance Program Hospice Refresher Workshop Training Topics What s New in 2015? Electronic Messaging Claim Adjustments Messages Archived Proposed Changes in Hospice Rates Fiscal Year

More information

New provider orientation. IAPEC December 2015

New provider orientation. IAPEC December 2015 New provider orientation IAPEC-0109-15 December 2015 Welcome 2 Agenda Introduction to Amerigroup Provider resources Preservice processes Member benefits and services Claims and billing Provider responsibilities

More information

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy Subject: Place of Service NY Policy: 0018 Effective: 12/01/2015 02/21/2016 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria

More information

Important Billing Guidelines

Important Billing Guidelines Important Billing Guidelines The guidelines contained herein are meant to assist GHP Family Participating Providers in billing appropriately for medically necessary services rendered to GHP Family Members.

More information

VIRGINIA WORKERS COMPENSATION MEDICAL FEE SCHEDULES GROUND RULES JUNE 5, 2017

VIRGINIA WORKERS COMPENSATION MEDICAL FEE SCHEDULES GROUND RULES JUNE 5, 2017 VIRGINIA WORKERS COMPENSATION MEDICAL FEE SCHEDULES GROUND RULES JUNE 5, 2017 Contents Introduction... 3 Definitions... 4 General Information... 11 Application of the Medical Fee Schedules... 11 Exclusions

More information

All Providers. Provider Network Operations. Date: March 24, 2000

All Providers. Provider Network Operations. Date: March 24, 2000 To: From: All Providers Provider Network Operations Date: March 24, 2000 Please Note: This newsletter contains information pertaining to Arkansas Blue Cross Blue Shield, a mutual insurance company, it

More information

Non-Chemotherapy Injection and Infusion Services Policy, Professional

Non-Chemotherapy Injection and Infusion Services Policy, Professional Non-Chemotherapy Injection and Infusion Services Policy, Professional Policy Number Annual Approval Date 3/14/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy

More information

Optima Health Provider Manual

Optima Health Provider Manual Optima Health Provider Manual Supplemental Information For Facilities and Ancillaries This supplement of the Optima Health Provider Manual provides information of specific interest to Optima Health contracted

More information

All Indiana Health Coverage Programs Providers. Package C Claim Submission and Coverage Information

All Indiana Health Coverage Programs Providers. Package C Claim Submission and Coverage Information P R O V I D E R B U L L E T I N B T 2 0 0 0 0 6 J A N U A R Y 2 0, 2 0 0 0 To: Subject: All Indiana Health Coverage Programs Providers Package C Claim Submission and Coverage Information Overview The purpose

More information

IN THIS EDITION. Resubmitting Corrected Claims. Bimonthly update to the Texas Medicaid Provider Procedures Manual

IN THIS EDITION. Resubmitting Corrected Claims. Bimonthly update to the Texas Medicaid Provider Procedures Manual T EXAS MEDICAID BULLETIN Bimonthly update to the Texas Medicaid Provider Procedures Manual MAY/JUNE 2006 NO. 195 Resubmitting Corrected Claims This is a clarification of the 2006 Texas Medicaid Provider

More information

Medi-Pak Advantage: Reimbursement Methodology

Medi-Pak Advantage: Reimbursement Methodology Medi-Pak Advantage: Reimbursement Methodology The information located on the following pages is intended to summarize the reimbursement methodologies for Medi-Pak Advantage: Medi-Pak Advantage reimburses

More information

SHP_ Respite Care

SHP_ Respite Care SHP_2015891 Respite Care Who is Superior HealthPlan? A subsidiary of Centene Corporation located in St. Louis, MO. Has held a contract with HHSC since December 1999. Provides programs in various counties

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

Long Term Care (LTC) Claims Forwarding Webinar for Nursing Facility Users Frequently Asked Questions (FAQ)

Long Term Care (LTC) Claims Forwarding Webinar for Nursing Facility Users Frequently Asked Questions (FAQ) Long Term Care (LTC) Claims Forwarding Webinar for Nursing Facility Users Frequently Asked Questions (FAQ) 1. What assistance is available if providers have additional questions regarding claims billing

More information

Global Surgery Package

Global Surgery Package Private Property of Florida Blue. This payment policy is Copyright 2017 Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

Provider Orientation. Amerigroup

Provider Orientation. Amerigroup Provider Orientation Amerigroup Amerigroup members in the Medicaid Rural Service Area and the STAR Kids program are served by Amerigroup Insurance Company; all other Amerigroup members in Texas are served

More information

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Telecommunication Services Handbook

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Telecommunication Services Handbook Texas Medicaid Provider Procedures Manual Provider Handbooks December 2017 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid

More information

Review Process. Introduction. Reference materials. InterQual Procedures Criteria

Review Process. Introduction. Reference materials. InterQual Procedures Criteria InterQual Procedures Criteria Review Process Introduction As part of the InterQual Care Planning family of products, InterQual Procedures Criteria provide healthcare organizations with evidence-based clinical

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

Department of Assistive and Rehabilitative Services Early Childhood Intervention Services Medicaid Billing Guidelines Effective: October 1, 2011

Department of Assistive and Rehabilitative Services Early Childhood Intervention Services Medicaid Billing Guidelines Effective: October 1, 2011 Department of Assistive and Rehabilitative Services Early Childhood Intervention Services Medicaid Billing Guidelines Effective: October 1, 2011 The purpose of this guide is to provide Early Childhood

More information

Dell Children s Health Plan Texas Health Steps program provider presentation

Dell Children s Health Plan Texas Health Steps program provider presentation Dell Children s Health Plan Texas Health Steps program provider presentation TSPEC-0231-17 May 2017 Overview The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) service is Medicaid s comprehensive

More information

SHP_ Personal Attendant Services (PAS) & Home Health (HH)

SHP_ Personal Attendant Services (PAS) & Home Health (HH) SHP_2015891 Personal Attendant Services (PAS) & Home Health (HH) Who is Superior HealthPlan? A subsidiary of Centene Corporation located in St. Louis, MO. Has held a contract with HHSC since December 1999.

More information

2018 Northern California HMO Provider Manual Kaiser Foundation Health Plan, Inc.

2018 Northern California HMO Provider Manual Kaiser Foundation Health Plan, Inc. 2018 Northern California HMO Provider Manual Kaiser Foundation Health Plan, Inc. Welcome from Kaiser Permanente It is our pleasure to welcome you as a contracted provider (Provider) participating under

More information

CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) CSHCN SERVICES PROGRAM PROVIDER MANUAL

CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) CSHCN SERVICES PROGRAM PROVIDER MANUAL CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) CSHCN SERVICES PROGRAM PROVIDER MANUAL JANUARY 2018 CSHCN PROVIDER PROCEDURES MANUAL JANUARY 2018 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) Table of Contents

More information

Provider Policies and Procedures Manual

Provider Policies and Procedures Manual Provider Policies and Procedures Manual SFY 2004 TABLE OF CONTENTS INTRODUCTION...i QUICK REFERENCE...iii TERMS AND DEFINITIONS...iv CHAPTERS I. Covered Services II. III. IV. Provider Responsibilities

More information

Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018

Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018 Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018 Revision Log See Important Reminder at the end of this policy for important regulatory

More information

VANTAGE HEALTH PLAN FACILITY CREDENTIALING APPLICATION

VANTAGE HEALTH PLAN FACILITY CREDENTIALING APPLICATION VANTAGE HEALTH PLAN FACILITY CREDENTIALING APPLICATION GENERAL INFORMATION Primary Practice Facility Location The type of application being submitted: Please choose facility type (check all that apply):

More information

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY Global Surgery Policy Number GLS03272013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 04/09/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

RENAL DIALYSIS CSHCN SERVICES PROGRAM PROVIDER MANUAL

RENAL DIALYSIS CSHCN SERVICES PROGRAM PROVIDER MANUAL RENAL DIALYSIS CSHCN SERVICES PROGRAM PROVIDER MANUAL JANUARY 2018 CSHCN PROVIDER PROCEDURES MANUAL JANUARY 2018 RENAL DIALYSIS Table of Contents 35.1 Enrollment......................................................................

More information

GUIDE TO BILLING HEALTH HOME CLAIMS

GUIDE TO BILLING HEALTH HOME CLAIMS GUIDE TO BILLING HEALTH HOME CLAIMS 1 GUIDE TO BILLING HEALTH HOME CLAIMS DEFINITIONS...1 BILLING TIPS...2 EDI TRANSACTIONS GUIDE...5 ATTACHMENT A SERVICE GRID...6 ATTACHMENT B FEE SCHEDULE...8 EXHIBIT

More information

Provider Handbooks. Telecommunication Services Handbook

Provider Handbooks. Telecommunication Services Handbook Provider Handbooks December 2016 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health

More information

Medical Fee Schedule (MFS) Frequently Asked Questions (FAQs) General FAQs

Medical Fee Schedule (MFS) Frequently Asked Questions (FAQs) General FAQs Medical Fee Schedule (MFS) Frequently Asked Questions (FAQs) General FAQs 1. What is the Medical Fee Schedule (MFS)? The MFS is the schedule of maximum fees payable for scheduled medical services rendered

More information

This policy describes the appropriate use of new patient evaluation and management (E/M) codes.

This policy describes the appropriate use of new patient evaluation and management (E/M) codes. Private Property of Florida Blue. This payment policy is Copyright 2017, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

Jurisdiction Nebraska. Retirement Date N/A

Jurisdiction Nebraska. Retirement Date N/A If you wish to save the PDF, please ensure that you change the file extension to.pdf (from.ashx). Local Coverage Determination (LCD): Independent Diagnostic Testing Facilities (IDTFs) (L31626) Contractor

More information

Provider Handbooks. Ambulance Services Handbook

Provider Handbooks. Ambulance Services Handbook Provider Handbooks December 2014 Ambulance Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human

More information

Reimbursement Policy. BadgerCare Plus. Subject: Consultations

Reimbursement Policy. BadgerCare Plus. Subject: Consultations Subject: Reimbursement Policy Effective Date: Committee Approval Obtained: Section: Evaluation and 04/20/18 04/20/18 Management *****The most current version of our reimbursement policies can be found

More information

Community Mental Health Centers PROVIDER TRAINING

Community Mental Health Centers PROVIDER TRAINING Community Mental Health Centers PROVIDER TRAINING June 18, 2008 & June 23, 2008 Revised July 22, 2008 LOUISIANA MEDICAID PROGRAM DEPARTMENT OF HEALTH AND HOSPITALS BUREAU OF HEALTH SERVICES FINANCING TABLE

More information