Department of Medical Assistance Services

Medicaid and SchoolsOctober 2, 2013

www.dmas.virginia.gov

Medicaid Web Portal

• A new enhance Web Portal will allow providers to transact all Medicaid business via one central location

• The web portal will provide access to:– Member Eligibility Status– Claim Status– Payment History– Remittance Advices– Service Authorizations– Direct Data Entry (DDE)

Medicaid Web Portal Registration

• To take advantage of the Portal and its functions, users must be a part of the security structure

• Detailed information regarding the overall web registration process and navigation can be found at:

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/Webregistration

Web Registration SupportCall Center

• Questions regarding new user registration, existing user access letter, or temporay passwords– 1-866-352-0496– Available after June 8, 2010– 8 am – 5 pm Monday thru Friday– No holidays

• Virginia.Websupport@acs-inc.com

Provider Call Center

Claims, covered services, billing inquiries:

800-552-8627 804-786-6273

8:30am – 4:30pm (Monday-Friday)11:00am – 4:30pm (Wednesday)

Provider Enrollment

NPI enrollment, EFT sign up, or change of address:

Provider Enrollment UnitP. O. Box 26803

Richmond, VA 23261888-829-5373804-270-5105

804-270-7027 – Fax

Electronic Billing

Electronic Claims Coordinator

E-mail: virginia.edisupport@acs-inc.com

Phone: (888) 352-0766

Fax: (888) 335-8460

Billing

Claims DDE

• Claims DDE function is currently associated with the following types of claims:– Professional Claims (CMS-1500)– Institutional Claims (CMS-1450 {UB-04})– Medicare Crossover Claims

• You must be approved under the new role Authorized Staff-Claims to access DDE claims functions

• Users will have the option to create separate claim forms for submission or save each claim as a separate template for future submissions

10

Accessing the Claims DDEhttps://www.virginiamedicaid.dmas.virginia.gov

• Upon successful login, you will be directed to the secure Provider Welcome Page• Navigational tabs will direct you to Claims DDE and Automated Response System functions

11

Claims Menu-Access

12

Claims Main Page

• DDE functions can be accessed here

• Create Crossover Part B Claim

• Create Crossover Part B Template

13

Create New Professional ClaimCMS-1500

14

Void/Replacement Claim

15

Submitter Information

• Submitter ID- this field defaults to the User ID used to login into the portal

16

Patient and Insured Information

17

Physician or Supplier Information

This is notrequired

CLIA#

18

Service Line ItemClick on ‘Add Service Line Item’Button to add additional Line items

After entering informationYou must Save, Reset, or Cancel

Note: Taxonomy Code isentered here if applicable

19

Saved Service Line Items

After entering information you must Save, Delete, or Cancel

Click on Service Line Item to view

20

Service Location and Attachments

21

Service Facility Location Information

22

Billing Provider Information

• This section details information about the provider requesting payment for services rendered.

• Billing Provider Information section has both required and optional/situational fields

23

Claim Submitted Page

TIMELY FILING• Medical Assistance Program regulations

require the prompt submission of all claims• VA Medicaid is mandated by federal

regulations to require the initial submission of all claims (including accident cases) within 12 months from the date of service

• Providers are encouraged to submit claims within 30 days from the date of service or date of discharge

TIMELY FILING• Submission is defined as actual, physical

receipt of a claim by DMAS• Documentation of timely filing must be

submitted with all claim submissions for dates of service over 12 months from service date

TIMELY FILING EXCEPTION• DMAS is now requiring providers show due

diligence that they are actively pursuing claim payment-– Documentation of contacting DMAS via claim

submission or phone contact at least every six months

• Claims submitted without this required documentation will be considered untimely and denied

• Denied claims must be submitted and processed within 13 months from the initial date of denial where the initial claim was filed within the 12 month limit

NO TIMELY FILING EXCEPTION

• Accident Cases• Other Primary Insurance

28

Create a Professional Template CMS 1500

29

• Templates are a mechanism for the user to establish a baseline claim that can be reused as needed.

• They can :– be used to eliminate the need for having to rekey

static data with every submission (i.e. billing provider information).

– be established for common submissions (i.e. infant well care, immunizations, etc)

– be stored for reuse

30

• To establish a template for a professional claim, select Create Professional Template from the Claims drop down menu.

• You will be transferred to the Create New Professional Template page for template creation

31

Template Name

32

• All the fields utilized in the Create Professional Template will be the same as the fields in the Create Professional Claim Except for the buttons below

• From this template page you can

– save the template by clicking on ‘Save Template’ button

– reset all the entered fields by clicking on the ‘Reset’ button or;

– navigate to the ‘Create New Professional Template’ page by clicking on the ‘Cancel’ button.

33

• When saving the template, the system only validates the format of the data entered.

• After clicking 'Save Template' button, the system displays a successful save message by directing you to the ’Save Template‘ portlet.

34

Save Template

• From this Save Template page you can– navigate to the ’Claims Main Page’ in order to

access other claims options by clicking on the 'Claims Main Page’ button or;

– create a new professional template by clicking on the 'Create Another Template' button.

35

View/Manage/DeleteTemplates

36

View/Edit/Delete Template

• Once a selection is made, you will be transferred to the request page

37

View/Edit/Delete Request Page

38

View/Edit/Delete Template –Search Results

39

• Results that match the search criteria entered, will be displayed in the ‘Search Results’ section

• Clicking on the individual search result record will direct you to the response page containing detailed information for the selected template

• Except for the buttons above, all of the fields in the Template Response page will be the same as the fields in Create Professional Claim

40

• After clicking on the ‘Delete Template’ button, the system deletes the template and displays a successful deletion message by directing you to the ‘Template Deleted’ portlet shown above

41

DDE Tips

• Recommend using 6.0 or higher Internet Explorer

• Web-based cursor must be placed in correct location

• Templates limited to 100• Be as specific as possible when naming

templates-they are to be shared• Data entry only-no edits• When adjustments and/or voids of claims are

required, you must wait until the next business day to submit this information

42

DDE Tips

• Print or save confirmation-Claim Submitted Page

• You will not receive prompts to submit required Supplemental Data

• Don’t worry about capitalization, punctuation, or symbols (except for TPL Supplemental Data)

• 3 year limit for adjustments and voids• Claims for Medallion II members enrolled in

Managed Care Organizations will continue to be submitted to the MCOs according to their guidelines

THANK YOU

http://dmasva.dmas.virginia.gov

POSITIVES & NEGATIVES of

School Based Claiming

Theresa BrownSpotsylvania County Schools

POSITIVES

Can Now Bill Electronically!!!!!!!! It’s as Easy as 1, 2, 3……………

POSITIVES

Templates can be set up & personalized to make billing easier. Enter Common info for faster billing.

POSITIVES

Remittance Statements Viewable On-Line Weekly.

Just Click and Print.

POSITIVES

Claims Paid Weekly!!!!Electronically Deposited!!!!

POSITIVESSchool Districts can now bill for Sped

Transportation Services!!!!Every day a student receives a serviceand rides on a specially adapted bus.

POSITIVES

Transportation Claims bring in additional revenue for School

Districts. Whoo Hoo………

NEGATIVESDelinquent Progress Notes or Transportation Logs Result in No Revenue coming in…….

NEGATIVES

It’s a Domino Affect……If one falls down they all fall down.

It’s About Time

Turning Progress Notes in on Time & in a Timely Fashion makes billing

easier &……………….

It’s about $

The more we bill……. the more revenue will be flowing in for

students and schools.

PAY DAYSo………..If you want your School

District’s Revenue to Increase don’t let the first domino fall and you will be sure to have more money in the bank.

THE ENDIf you follow these helpful hints money

in the bank for your district doesn’t have to be a dream any longer.