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MI Department of Community Health Medical Services Administration Tamara J. Warren- Provider Liaison
Medicaid Updates November 1, 2004 HIPAA 837 v 4010 A 1 n New optional procedures for paper claims processing n Online Medicaid Manuals n Medicaid Billing Help Sessions n New Biller Training n
New options for paper claims n n Nordic Technologies and Netwerkes will begin processing paper claims for high volume paper providers. Any provider who submits a substantial amount of paper claims can participate. Both Netwerkes and Nordic will convert paper claims into HIPAA electronic formats. This is an optional process for providers which is free of charge.
Paper Claims processing n n Currently Medicaid does not offer a claims statusing on either paper or electronic claims. Paper claims can take up to 4 months to process. Providers are encouraged to bill electronically whenever possible. Electronic claims are processed within 714 business days.
Medicaid Resources MDCH website www. michigan. gov/mdch n Provider Inquiry Line 1 -800 -292 -2550 n Provider Support e-mail address [email protected] gov n
Common Billing Errors on the HCFA 1500 Claim Format
Modifier Usage The Billing and Reimbursement Chapter, section 7 provides information on Modifier usage for claims submitted to Medicaid n Special services such as Vision and DME, also reference modifier usage on the MA database available at the MDCH website. n
Sterilization Consent Forms n n Consent forms may be downloaded at the MDCH website Forms may be faxed to 517 -241 -7856 or the actual form may be mailed in with the claim If the consent form has been faxed enter “consent on file” in Item 19 (remarks) NOTE: Claims will pend with the 104 edit for review of the filed consent form.
Coordination of Benefits Codes (Paper Claims) The appropriate COB code should be listed for each service line n Billing and Reimbursement Chapter, references the covered COB codes for billing paper claims. n
Medicare Part B (WPS) crossover claims n n n Medicaid began accepting Medicare crossover claims 8 -1 -2004. Providers must enter the Medicaid Provider ID number on the claim to Medicare. Providers must report this information on their electronic claim submission to Medicare for the crossover process to take place.
Crossover Claims. Electronic Format n n n The Medicaid provider ID must be reported in addition to the Medicare provider ID by repeating Loop ID 2010 AA REF 01 and REF 02 on a crossover claim: Loop ID 2010 AA REF 01: Enter “ 1 D” for Medicaid. Loop ID 2010 AA REF 02: Enter the 9 -digit Medicaid provider ID (2 -digit provider type followed by the 7 -digit number)
Medicaid Remittance Advice Information
Request for the 835 n n n Providers must complete the form at the MDCH website (Electronic Billing) entitled Electronic Remittance Advice Request form. Providers are encouraged to sign up early to become familiar with the 835 format, before proprietary files become unavailable. Requests take approximately one week to process.
Records Retrieval n n Providers must submit requests for Remittance Advice information to Fax 517 -335 -5562. Requests must be submitted on company letterhead and include the following information: Paycycle/date Provider Type and Medicaid ID Number Provider Phone number and Fax Number Name of the person requesting the Fax NOTE: If the information requested requires numerous pages it will be mailed to the address on the letterhead. Minimal Fees may apply.
Medicaid Provider FAQ Medicaid Billing Frequently Asked Questions
Provider Questions n n How do I report other insurance information that has been terminated? You may also report the terminated insurance information on the HCFA 1500 by using COB code 8 (item 24 J) and entering in remarks Item 19 the policy number and date insurance was canceled. [email protected] gov Fax 517 -335 -8868
Medicare Buy In Unit n Contact Information n Phone 517 -335 -5488 n Fax 517 -335 -0478
Provider Input Session Medicaid welcomes suggestions for improvement from the provider community.