Georgia Medicaid Update - Georgia Association of Medical

Transcription

Durable Medical Equipment
Version 1.0
Objectives
Obtain a clearer understanding of the recent changes to
the Policy and Procedures of the Durable Medical
Equipment Program.
How complete the submit your claims with on the CMS1500 v08/05 claim form.
How to submit your claims using the GHP Web Portal.
How to submit your claims using WINASAP2003.
How to register and attend the Provider Refresher
Trainings that are available.
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Scope of Services – Chapter 900

Coverage for Durable Medical Equipment
Coverage for Medical Supplies
Coverage for Accessories
Non-covered Services
Purchasing Guidelines
Rental Guidelines
Repairs and Maintenance
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Scope of Services – Chapter 900 (cont’d)
Replacing Purchased Equipment
Disposal of Equipment
Newborn Eligibility Verification
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Policy Updates
E1399: In accordance with Section 806.9-HCPCS code
E1399 (Durable Medical Equipment Miscellaneous) was
designated to request prior approval for “Catastrophic
DME needs”.
In compliance with the Department’s standard business
practice regarding the use of unlisted/unspecified
HCPCS/CPT codes, E1399 is no longer valid to request
prior approval or bill for routine DME Services/SuppliesWhere there is an existing unique HCPCS code.
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Policy Updates (Continued)
Accreditation: The deadline for all DME
Providers/Suppliers to become accredited has been
extended to September 2009.
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Prior Approval – Chapter 800

Services which Require PAs
Procedures for Obtaining PAs
Provider’s Review of an Approved Request
Billing for Prior Authorized Services
Special Considerations
Equipment Rentals
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Appendix C
Instructions for completing the Prior Authorization
Request Form
Prior Authorization Request Form (DMA-610)
New CMS-1500 claim form
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Appendix D & E
Durable Medical Equipment – Categorized listing of
purchase codes (Appendix D)
Durable Medical Equipment – Categorized listing of rental
codes (Appendix E)
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Appendix F & G
Covered medical supplies listing – categorized listing of
purchase codes (Appendix F)
Certification of Medical Necessity Forms (Appendix G)
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Appendix L & M
Georgia Health Partnership(GHP) information (Appendix L)
Georgia Healthy Families(Appendix M)
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Medicaid Provider Manuals
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Medicaid Provider Manuals (Continued)
View Full List
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Provider Manuals (Continued)
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National Provider Identifiers (NPI)
Every Provider should have registered for a NPI Number
by this time.
Complete the Georgia National Provider Identifier Form.
You can access it on the ACS Web site:

– Go to www.ghp.georgia.gov.
– Click the “Provider Information” tab.
– Click on View Full List in the “Documents and Forms”
box.
Attach a copy of the NPI Letter.
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National Provider Identifiers (NPI) (cont’d)
Mail your form to:
Provider Enrollment
P.O. Box 4000
McRae, GA. 31055
Fax (866) 309-0935
Need more information on NPIs?
Go to https://nppes.cms.hhs.gov or call 800-465-3203.
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New CMS-1500 Form
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New CMS-1500 Sections 1 to 13
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17a. Referral #
17b. NPI
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New CMS-1500 Section 24
24a. NDC or DME Serial #
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New CMS-1500 Section 24
The serial number of all purchased wheelchairs, lifts,
fracture frames for complete traction and the foot spring
serial number of hospital beds must be entered in the
shaded area only of field 24(a) on the claim form (HCFA
1500).
For rental of this equipment, enter the serial number in the
shaded area only of field 24(a) on the claim form (HCFA
1500) on the tenth month when the equipment is
considered purchased by DCH.
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New CMS-1500 Section 24 (cont’d)
Claims submitted without these serial numbers will be
rejected by the system.
Procedure: in the shaded area only of field 24(a) enter the
VP qualifier followed by the Serial Number. There is no
space between the qualifier and the serial number,
example VPXXXXXXXXXXXX… - Section 805.1
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33a. NPI
33b. Medicaid ID
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CMS-1500 on the GHP Web Portal
You must be a
registered user.
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CMS-1500 on the GHP Web Portal (cont’d)
Claims
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CMS-1500 Professional
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Click 3.
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Add Addition
Detail to Line
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Drugs and Prescription Data
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Adding the NDC Number
Add
Add to Claim
and Return to
Claim Entry
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Add Line
Item
Add Line Item
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Services
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Adding the DME Serial Number
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2
1
3
1.
2.
3.
Select Unit
Enter DME Serial Number
Add to Claim and Return to Claim Entry
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Add Line Add Line Item
Item
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After adding all of the line items, please proceed with the
following:
– Review claim for accuracy
– Submit
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WINASAP 2003
Download Version 5.12.
www.acs-gcro.com
Existing users must backup current files.
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CMS-1500 on WINASAP 2003

Main Page
Provider List
Provider Data Page
Professional Claim Data
Claim Line Item
Drug Information
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WINASAP 2003 Taxonomy Code Entry
From the Tools menu,
select Taxonomy
Codes.
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WINASAP 2003 Taxonomy Code Entry
Click to check the box
of the codes you want
to save.
Click to save
code (s).
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WINASAP 2003 NPI Entry
Enter NPI #
Select HCFA National
Provider ID.
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WINASAP 2003 NPI Entry
Select the
Taxonomy Code
from the dropdown
box.
Click Save.
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WINASAP 2003 Medicaid Provider # Entry
Secondary Identification
Identification Type
Select Medicaid
Provider Number.
Click Save.
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WINASAP 2003 — Professional Claim Data
Next Page
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WINASAP 2003 Medicaid Provider # Entry
Claim Data
Enter the correct
taxonomy code.
Click OK.
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WINASAP 2003 — Drug Information
Drug information
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WINASAP 2003 — Drug Information (cont’d)
Drug
Information
Box
Click OK.
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Important Things to Remember…
Only the New Version of the CMS-1500 will be accepted
after May 31,2007.
Submit your National Provider Identifier (NPI) number by
May 23, 2008.
Review the Account Information under “My Workspace” to
ensure all information is accurate and current, paying
special attention to the demographic information.
Check your banner messages (frequently) and provider
manuals (quarterly) for updates.
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Summary
Please do not send any invoices to DCH for approval.
Please do not send any manual claims to DCH for review.
If your claims are denied you must submit a DMA 520
within 90 days from the initial Remittance Advice Denial
for review.
All PA requests should be submitted to GMCF DME Prior
Approval Unit for consideration of approval.
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Refresher Provider Trainings
View
Training
Materials
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Refresher Trainings (Continued)
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Online Provider Training
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Provider Representative-Led Training
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Provider Representative-Led Training(Cont)
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Provider Representative-Led Training (Cont)
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Questions?
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