Montana Medicaid Provider Information
WHAT'S NEW ON THE SITE THIS WEEK
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.
Noridian Merger to Affect
COBA Trading Partners
CMS is alerting providers that Noridian Administrative Services (NAS)
is in the process of merging six Medicare claims processing environments,
including Montana, effective May 1, 2008.
Noridian will impose dark days on May 1 and 2, during which the contractor will not transmit crossover files to the COB Contractor (COBC). Monday, May 5, will be Noridian's first claims cycle date, and, at that time, Noridian will resume transmission of crossover files to the COBC.
Read the entire notice here.
May 7 Is “Legacy Free” Day
– An Opportunity to Check Your NPI Readiness!
CMS, in collaboration with the Healthcare Information
and Management Systems Society (HIMSS), has requested clearinghouses that
submit claims to FFS Medicare to participate in a one-day NPI preparation
exercise. Specifically, on Wednesday, May 7, 2008, participating clearinghouses
should submit Medicare claims with NPI-only in all provider identifier
fields for which a provider uses NPI/legacy pairs. On May 8, participating
clearinghouses will revert back to sending Medicare NPI/legacy pairs as
received from the providers.
Through its monthly NPI messages, CMS has been requesting providers to begin testing NPI-only by sending a group of claims with NPI alone in primary provider fields. This “exercise” will result in feedback from your Medicare contractor on your readiness as it pertains to your National Provider Identifiers.
On May 7, 2008, participating clearinghouses will send Medicare claims with NPI-only in provider fields which originally contain NPI/legacy pairs from the provider. In other words, clearinghouses will strip the legacy identifiers when they are submitted as part of an NPI/legacy pair. Of course, fields already containing NPI-only will be sent to Medicare, as usual, and secondary provider identifier fields containing legacy-only will be sent to Medicare, as usual.
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.
NPI Reenrollment and Billing National Drug Code Billing Instructions NPI and Taxonomy Electronic Claim
Instructions NPI and Taxonomy Paper Claim Instructions |
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.
Billing Montana Healthcare Programs
Medicare recently announced that they will continue to allow providers
to bill using their legacy number only. Medicare is also allowing providers
to bill using their NPI number only or both their NPI and legacy number.
Due to Medicare’s decision, Montana Healthcare Programs will also
allow providers to bill Medicaid using their NPI (for healthcare providers);
NPI and current Montana Healthcare Program number(s) or their current
Montana Healthcare Programs number(s). When Medicare mandates NPI-only
billing for healthcare providers, Montana’s Healthcare Programs
will also require the NPI. For atypical providers, they may use their
new Montana Healthcare Program number.
There is a possibility that you may receive more than one payment from Montana’s Healthcare Programs if you bill Medicare differently than you bill Montana’s Healthcare Programs.
- If you bill Medicare using your NPI and Montana’s Healthcare Programs with your current provider number, your crossover payment will be under your NPI and payment for non-Medicare claims will be under your current number.
- If you bill Montana’s Healthcare Programs using your NPI and Medicare with your current Medicare legacy number, your crossover payment will be under your current Montana Healthcare Program number and your non-crossover claims will be under your NPI.
For claims received on or after October 1, 2007, the Department of Public Health and Human Services encourages providers who have an NPI or have been issued a new atypical provider number to use these numbers to bill. If you have received your NPI and are not yet reenrolled in Montana’s Healthcare Programs, you are encouraged to do so immediately. Reenrollment is available online at www.mtmedicaid.org. For those providers who do not yet have an NPI, you may apply online at https://nppes.cms.hhs.gov.
If you have questions or need assistance with reenrollment, contact ACS Provider Relations at 1-800-624-3958.
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.
Instructions for Billing on Paper During
the NPI Contingency Period
Providers billing Montana's Healthcare Programs on either the new
CMS-1500 or UB-04 must follow these
specific instructions until the end of the contingency period.
Billing During the NPI Contingency Period
A National Provider Identifier (NPI) contingency plan has been
put in place, changing the NPI implementation date for Montana’s
Healthcare Programs operated by ACS. This contingency plan affects how
providers must complete claims submitted between now and the end of the
contingency period. Click
here for more information.
Online Reenrollment for NPI Now Available
On-line
reenrollment is now available through Montana Access to Health.
As of March 2, only providers without Internet access will be allowed
to complete a paper application
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.
Only providers that do not have access to the Internet may use the paper
enrollment option after March 1, 2007.
Medicare Part D Prescription Drug Benefit
News
Medicare
Part D Prescription Drug Benefit News
Request for
Prescription Information or Change. This is a standard form for
exceptions or prior authorizations.
The Wellpoint system for dual-eligible individuals:
- Point of Sale Facilitated Enrollment of Dual Beneficiaries
- Q & A
- Point of Sale Facilitated Enrollment: Update on NACDS Issues, Wellpoint/CMS
Stand-Alone
Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries
in Montana
Help Your Clients 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?
- 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 04/21/08)
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit www.bigskyrx.mt.gov.
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