Montana Medicaid Provider Information
WHAT'S NEW ON THE SITE THIS WEEK
Weekly
Payment Cycles in September
Beginning September 3, through September
24, full payment cycles will be run weekly. Providers who typically receive
payment every two weeks will receive weekly payment during September.
This change will allow providers to be paid more frequently and hopefully
reduce the number of payment issues. The Department will review the situation
again in early October to determine whether to continue.
ACS
Staff Available at Fall Events
Attention, providers! ACS staff will be coming to a city near you. Throughout
September and October there are many conferences,
conventions, and trainings in which ACS will have staff attending.
Please visit the ACS vendor booths to meet our staff and to discuss questions
or concerns your office may have.
There are also scheduled provider training sessions to be presented by ACS and State staff. The schedule for the trainings can be viewed in further detail under Upcoming Events. We look forward to meeting with you in the upcoming months and providing assistance to better serve you.
MATH Web Portal Maintenance
The Montana Access to Health (MATH)
web portal will be unavailable Wednesday, September 3, from 7 p.m. to
12 a.m. MST for scheduled maintenance.
Holiday ESOR Schedule
Due to the Labor Day holiday, Electronic
Statements of Remittance (ESORs) will be posted to the website on Tuesday
afternoon, September 2, or Wednesday morning, September 3.
Federal Government May Request
Medical Records
Beginning October 1, 2008, Montana’s Healthcare Plans will be required
to participate in the federal Payment Error Rate Measurement (PERM) program.
This national program will measure improper payment in Medicaid and CHIP
because these two programs were identified as being at risk for significant
erroneous payments. Providers will be asked to send copies of selected claims
to a CMS contractor for review. Click here
for more information.
Adjustment for Claims Using
Multiple Conversion Factors
An issue was identified related to the implementation of the multiple conversion
factors. Some claims for dates of service between May 1 and June 30, 2008,
that were adjudicated between June 30 and July 6, were paid at $0.00.
Claims affected:
- Dates of service: May 1, 2008, to June 30, 2008
- Dates of payment: July 1, 2008, to present
- Provider types 06, 07, 08, 10, 17, 21, 22, 42, 45 and 58 — RBRVS providers for Allied and Mental Health
We have corrected the problem and are currently working on an estimate of the impact and an adjustment to correct the situation. This adjustment is planned for Wednesday, July 9.
Transferring Credit Balances
Now that claims are being processed with either National Provider Identifier
(NPI) or atypical provider identifier (API), any activity on your previous
legacy provider number may result in that number moving into a credit
balance. Your legacy number may move in and out of a credit balance depending
on adjustments completed to claims originally billed with the legacy number.
ACS has started moving the credit balance amounts from your legacy number to the NPI/API and will continue to do so until all currently enrolled providers are no longer in a credit balance. This process will take a significant amount of time due to the number of providers involved. If you wish to have your credit balance moved more quickly, please contact Provider Relations and ask to have your credit balance moved to your NPI/API. You will need to indicate the legacy number from which you wish the credit moved and the NPI and taxonomy or API to which you wish the credit moved. These transactions are conducted as gross adjustments and cannot be attributed to any individual client.
When the credit is satisfied, those claims that appeared in the credit balance section of your remittance advice will move into the paid section and can be posted at that time.
Mass Adjustment Issue
On remittance advices dated June 16, 2008, providers may
have seen a credit amount for the denied professional crossover claims that
appeared on previous remittance advices with a reimbursement amount for
the denied claim. There was no reimbursement for the original claim although
a payment amount appeared on the remittance advice. However, when a mass
adjustment was completed to correct a pricing error, the denied claims were
inadvertently included, the amount indicated as a payment on the denied
claims was credited, and the repayment side of the adjustment was denied.
Gross repayment adjustments will be completed in the near future to repay
the inappropriate credit amounts.
Provider File Updates
Providers who have already completed their reenrollment
with Montana's Healthcare Programs in conjunction with the implementation
of NPI do not need to complete a new enrollment if their information changes.
If a reenrolled provider needs to update their provider file (i.e., change
of practice location, billing address, tax information, etc.), they should
mail the new information to Provider Relations, P.O. Box 4936, Helena, MT
59604 or fax to (406) 442-4402, Attention: Provider File Updates. Health
care providers who have not yet reenrolled with their NPI, or atypical providers
for a new proprietary ID, should so so immediately.
Mass Adjustment for Physician-Administered
Drugs Requiring NDC
Effective April 1, 2008, the National Drug Code (NDC) is
required to be billed in addition to the procedure code for certain physician-administered
drugs. A mass adjustment will be completed soon for claims with dates of
service back to April 1, 2008, containing procedure codes for these drugs.
The adjustment will take back monies for the following types of claims:
- Those that required but did not include the appropriate NDC
- Those in which the NDC units or the units qualifier are not present
- Those in which the NDC or units qualifier are invalid
When the adjustment date has been scheduled, a notice will appear here on www.mtmedicaid.org.
Please see the provider notice dated April 10, 2008, for additional information related to the NDC requirement.
NPI Reenrollment and Billing National Drug Code Billing Instructions NPI and Taxonomy Electronic Claim Instructions NPI and Taxonomy Paper Claim Instructions |
NPI Required for Eligibility
Verification
Providers must
use their NPI when inquiring about client eligibility using FAXBack, the
Automated Voice Response System (AVRS), or the web portal. If you are not
yet enrolled with your NPI, please call Provider Relations at 1-800-624-3958.
AVRS/FaxBack Functionality Enhanced
AVRS/FaxBack has been enhanced to allow providers with multiple enrollments
and different fax numbers for one NPI to verify eligibility. Providers can
also complete eligibility inquiries on the MATH
web portal. If you have any questions, please contact ACS Provider Relations
at 1-800-624-3958.
Institutional Providers Must Use NPI to Check
Eligibility on the Web Portal After January 1, 2008
All old institutional provider numbers will no longer be valid to check
eligibility. These numbers can still be used to check claim status. If providers
do not see their NPI numbers in their drop-down box on the web portal, they
will need to e-mail the submitter number and NPI numbers to MTPRHelpdesk@acs-inc.com.
Attention New Providers
If you are enrolling for the first time in Montana’s
Healthcare Programs, which include Medicaid, Children’s Health Insurance
Program (CHIP) and Mental Health Services Plan (MHSP), please note the following.
This enrollment will not be effective to use for billing until October 1, 2007. Services provided prior to October 1 can be billed after October 1. When completing the web enrollment, the effective date of your enrollment is the date you indicate on the enrollment that you first provided services to a Montana's Healthcare Program client.
If you must bill for services prior to October 1, complete and submit the web enrollment and contact Provider Relations at 1-800-624-3958.
Online Reenrollment for NPI Now Available
On-line
reenrollment is now available through Montana Access to Health.
NPI Paper Reenrollment Form Now Available
The new paper form is available for current providers to begin the reenrollment
process to capture NPI numbers and update information within the provider
system. This reenrollment form can be downloaded at Existing
Provider Reenrollment for Participation On or After October 1, 2007.
Provider Reenrollment for NPI
Effective February 1, 2007, providers
began the reenrollment process by downloading the revised paper enrollment
forms, completing them and mailing them to ACS. Reenrollment utilizing
the web became available March 1, 2007. Institutional providers must ensure
that reenrollment is completed prior to January 1, 2008, and professional
providers prior to March 1, 2008, to continue to be reimbursed by Medicaid.
Medicare Part D Prescription Drug Benefit News
Introduction to Medicare Part D Drug BenefitsNeed help with picking the right Part D plan for you or your client?
- State Health Insurance Assistance Program (SHIP) 1-800-551-3191 or visit their Website at http://www.dphhs.mt.gov/sltc/services/aging/ship.shtml
- 1-800-MEDICARE (1-800-633-4227) or Medicare.gov
Stand-Alone Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries in Montana
The WellPoint Point of Sale system for dual-eligible Medicare and Medicaid eligible individuals:
- Point of Sale Facilitated Enrollment of Dual Beneficiaries for Pharmacists
- Point of Sale Facilitated Enrollment of Dual Beneficiaries Tip Sheet
Learn About the Medicare Prescription Drug Plan:
- Medicare Prescription Drug Coverage Personal Information Worksheet for People with Medicare and Medicaid
- Choosing a Medicare Drug Plan for People with Medicare and Medicaid
- People with Medicare and Medicaid: Medicare will enroll you in a plan automatically. How do you find out which plan?
- Request for Prescription Information or Change. This is a standard form for exceptions or prior authorizations.
Medicaid Program Information Handbook insert. Learn more about Medicaid coverage of prescription drugs for clients who are dual eligible for both Medicare and Medicaid.
Pharmacy
Tamper-Resistant
Prescription Pad Vendors
Get the Most Recent Montana
Medicaid Preferred Drug Information!
Visit the Pharmacy Provider page for a list of preferred drugs and upcoming
Montana Medicaid and Medicaid Mental Health Drug Use Review Board/Formulary
Committee Meetings. (Updated 07/01/08)
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit www.bigskyrx.mt.gov.
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(such as how to verify client eligibility, Medicaid covered services, important
contacts, and more), select Website Tips
or Medicaid Information from the menu on the left.
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