URGENT REMINDER: Dual-Use Periods Are Ending for ADA and CMS-1500 Claim Forms; New Forms Must Be Used [Web Announcement 729]
Ordering, Prescribing and Referring Provider Enrollment Requirement to be Implemented August 18, 2014 [Web Announcement 774]
Attention Pharmacies: Update Regarding Implementation of Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners [Web Announcement 799]
July, August and September 2014 Provider Training [Web Announcement 761]
Nevada Medicaid and Nevada Check Up News (Second Quarter 2014 Provider Newsletter) [Read]
Provider Web Portal Quick Reference Guide (Updated April 16, 2012)
Web Announcement 805
New Speech Evaluation Codes Billable by Provider Type 60 (School Based); Denied Claims for the New Codes Reprocessed
Effective with dates of service on and after January 1, 2014, the following speech evaluation codes are billable by provider type (PT) 60 (School Based): CPT codes 92521, 92522, 92523 and 92524. Modifier GN is required for billing.
CPT code 92506 was terminated effective December 31, 2013, and is no longer a Nevada Medicaid covered code for PT 60.
Claims submitted by PT 60 for CPT codes 92521, 92522, 09523 and 92524 with dates of service on or after January 1, 2014, and processed before May 27, 2014, that denied have been automatically reprocessed. The adjudication of the reprocessed claims appeared on remittance advices dated August 15, 2014.
Web Announcement 804
Provider Type 14: Review Supervision Standards for Medical Supervision
Provider type 14 (Behavioral Health Outpatient Treatment) providers are referred to Medicaid Services Manual (MSM) Chapter 400 Section 403.2A for review of the Supervision Standards for Medical Supervision. Medical supervision includes ongoing evaluation and monitoring of the quality and effectiveness of the services provided. Please also note that medical supervisors must operate within the scope of their licensure and expertise and attest to having at least two years experience in a mental health setting with competency to oversee and evaluate a comprehensive mental health treatment program. Verification is provided upon enrollment in Nevada Medicaid as a medical supervisor.
Further, medical supervision for the Behavioral Health Community Networks (BHCN) must be updated within five (5) days of any changes being made by completing the Provider Information Change form (FA-33) per the Medicaid Services Manual, Chapter 100.
Web Announcement 803
Reminders for Checking Eligibility on the Provider Web Portal
The following reminders will assist providers when checking recipient eligibility on the Provider Web Portal.
- When checking eligibility, enter the recipient information and click “Submit.” After clicking the “Submit” button, the eligibility displays in the Eligibility Verification Information section in the lower part of the Eligibility Verification Request screen. You can then click on the coverage and other insurance links in the Eligibility Verification Information section to view additional information.
- If you need to check eligibility for a second recipient, navigate back to the Eligibility Verification Request screen if you clicked on the coverage or other insurance links. Click the “Reset” button to clear the previously submitted recipient information. Then, complete the recipient information fields and click the “Submit” button to display the eligibility information for the new recipient.
Web Announcement 802
Streamlined Claim Appeal Request Process Implemented
A streamlined process has been implemented for providers to submit claim appeals. A provider claim appeal request now requires less information and fewer documents from the provider, and claim appeals may be submitted via email.
Effective immediately, the required documents providers must submit to request a claim appeal are:
- A letter addressing the specific reason for the appeal, which includes the provider name and National Provider Identifier (NPI) or Atypical Provider Identifier (API), the ICN of the claim, and the name and telephone number of the person to be contacted regarding the appeal. Providers may use form FA-90 Formal Claim Appeal Request as the cover letter.
- Documentation to thoroughly support the appeal request.
- A completed, original signed paper claim that may be used for processing should the appeal be approved.
Claim appeals may be submitted via mail to HP Enterprise Services, Attn.: Claim Appeals, P.O. Box 30042, Reno NV 89502-30472 or via email to ProviderClaimAppeals@hp.com. To submit via email, scan the letter or form FA-90, all supporting documents, and the completed signed original claim, and attach all items to one email. Please send the documents using secure email and write “Claim Appeal” in the subject line. Please note: If the claim appeal is submitted via email, all future correspondence regarding the appeal will be done via email.
Web Announcement 801
Save the Date: 2014 Annual Medicaid Conference Scheduled for October
Nevada Medicaid and Nevada Check Up providers are urged to attend the 2014 Annual Medicaid Conference scheduled for the following dates and locations:
- Wednesday, October 8, 2014, in Reno/Sparks: JA Nugget Casino Resort, 1100 Nugget Ave., Sparks (in the Rose Ballroom)
- Thursday, October 16, 2014, in Las Vegas: Palace Station Hotel and Casino at 2411 W. Sahara Ave., Las Vegas
This year there are half-day morning and afternoon sessions at each location. The same content will be included in each session. When providers register, they will be asked to choose either the morning or afternoon session.
Last year’s event, which focused on the effects of health care reform and Medicaid Expansion on Nevada Medicaid and Nevada Check Up, was well-attended by providers.
The 2014 Conference will include updates regarding Long Term Care Services, Presumptive Eligibility, Managed Care, the new Health Care Guidance Program, Electronic Health Records, Behavioral Health Services and Medicaid Fraud.
Register soon for this year’s Medicaid Conference at the following website: http://starcite.smarteventscloud.com/hp/Annual_Medicaid_Conference_2014.
Web Announcement 800
Ordering, Prescribing and Referring Providers Not Allowed to Register for Access to Provider Web Portal
Providers who are enrolled in Nevada Medicaid as an Ordering, Prescribing or Referring (OPR) provider may not register for access to the Provider Web Portal. The following error message will be displayed if an OPR provider tries to register for access to the Provider Web Portal.
-1001: Personal identity information not recognized or provider is inactive or OPR provider.
Web Announcement 799
Attention Pharmacies: Update Regarding Implementation of Claims Adjudication Process to Validate Ordering, Prescribing and Referring (OPR) Practitioners
In order for Medicaid to reimburse for services or medical supplies that require a provider’s order, prescription or referral, the Affordable Care Act (42 CFR Parts 405, 447, 455, 457 and 498) requires that the ordering, prescribing or referring provider be enrolled in Medicaid. Compliance with this requirement necessitates future changes to Nevada Medicaid claims and provider enrollment processes. The Division of Health Care Financing and Policy (DHCFP) will implement this new requirement on October 29, 2014
How will this affect you?
The practitioner writing a prescription for a Medicaid Fee-for-Service recipient needs to be enrolled as a full Medicaid service provider or an OPR-only provider by October 29, 2014.
To comply with these provisions, Nevada Medicaid, with the implementation of the OPR claims adjudication process, will verify both the presence of a valid practitioner National Provider Identifier (NPI) and the practitioner’s enrollment in Nevada Medicaid as either a full Medicaid service provider or an OPR-only provider. Pharmacy claims will post a soft edit 45 days prior to October 29, 2014, informing the billing provider if the NPI for the prescriber is not present or if the prescriber is not enrolled in Nevada Medicaid. Effective on and after October 29, 2014, if the prescriber does not have prescriptive authority or if the prescriber is not enrolled as a full Nevada Medicaid service provider or an OPR-only provider, then the edit will result in a claim denial. There will be a 30-day override period starting October 29, when the pharmacist may choose to override a denied claim for OPR. If a claim hits the soft edit, pharmacies should notify the recipient to contact their prescriber because after implementation their claims will deny.
Regarding the use of NPIs: Every prescriber must include their personal NPI on each prescription. Every pharmacy must accurately submit this prescriber NPI with each prescription claim. If a provider intentionally submits a claim with a prescriber NPI which they know to be inaccurate, they are committing a fraudulent act, and may be subject to administrative, civil and/or criminal actions.
For more information about the changes to billing and the new OPR provider enrollment category, call the Catamaran Technical Call Center at (866) 244-8554.
Web Announcement 798
Speech Pathologists May Bill CPT Code 92520 Effective September 1, 2014
Effective with claims submitted on or after September 1, 2014, provider type 34 (Therapy) specialty 29 (Speech Pathologist) may bill CPT code 92520 (Laryngeal function studies, i.e., aerodynamic testing and acoustic testing). Prior authorization is required. Modifier GN is required for prior authorization and billing.
Web Announcement 797
Urgent Announcement Regarding CMS-1500 (02-12) Paper Claims Submitted with Incorrect Diagnosis Pointers
CMS-1500 (02-12) paper claims submitted with incorrect diagnosis pointers that were processed October 28, 2013, through June 10, 2014, have been reprocessed. Providers saw both a debit (DR) and a credit (CR) for each of the affected reprocessed claims on remittance advices dated August 15, 2014.
Reminder: Valid ICD-9 diagnosis codes and/or principal diagnosis codes are required on all paper and electronic CMS-1500 (02-12) claims. On paper claims, diagnosis pointers are required in Field 24E when diagnosis codes are entered in Field 21.