In This Issue Medicaid Program Integrity Unit ................................................................................................. 1 Do Your Patients Need to Lose or Gain Weight? ........................................................................... 1 20th Annual Idaho Health Care Conference 2013 ......................................................................... 2 Conference Locations: .............................................................................................................. 2 Claims Processing and Diagnosis Codes ...................................................................................... 3 Children’s Redesign Transition ................................................................................................... 3 Idaho Health Information Technology Forum: .............................................................................. 4 The CMS EHR Incentive Programs for Eligible Professionals ........................................................... 4 May Changes for Long Term Care Providers................................................................................. 5 Provider Training Opportunities in March ....................................................................................22 Prior Authorization Contact Information .....................................................................................23 Transportation ........................................................................................................................23 DHW Resource and Contact Information ....................................................................................24 Insurance Verification ..............................................................................................................24 Molina Provider and Participant Services Contact Information .......................................................25 Molina Provider Services Fax Numbers .......................................................................................25 Provider Relations Consultant (PRC) Information.........................................................................26 Information Releases MA13-02 Preferred Agents for Drug Classes Reviewed at Pharmacy and Therapepeutics Committee Meetings on October 19 and November 16, 2012 ......................................................................... 6 MA13-03 Federally Funded Incentive Payment for Certain Primary Care Services in 2013 and 2014 ..15 An Informational Newsletter for Idaho Medicaid Providers From the Idaho Department of Health and Welfare, March 2013 Division of Medicaid
Transcript
In This Issue
Medicaid Program Integrity Unit ................................................................................................. 1 Do Your Patients Need to Lose or Gain Weight? ........................................................................... 1 20th Annual Idaho Health Care Conference 2013 ......................................................................... 2 Conference Locations: .............................................................................................................. 2 Claims Processing and Diagnosis Codes ...................................................................................... 3 Children’s Redesign Transition ................................................................................................... 3 Idaho Health Information Technology Forum: .............................................................................. 4 The CMS EHR Incentive Programs for Eligible Professionals ........................................................... 4 May Changes for Long Term Care Providers ................................................................................. 5 Provider Training Opportunities in March ....................................................................................22 Prior Authorization Contact Information .....................................................................................23 Transportation ........................................................................................................................23 DHW Resource and Contact Information ....................................................................................24 Insurance Verification ..............................................................................................................24 Molina Provider and Participant Services Contact Information .......................................................25 Molina Provider Services Fax Numbers .......................................................................................25 Provider Relations Consultant (PRC) Information .........................................................................26
Information Releases MA13-02 Preferred Agents for Drug Classes Reviewed at Pharmacy and Therapepeutics Committee Meetings on October 19 and November 16, 2012 ......................................................................... 6 MA13-03 Federally Funded Incentive Payment for Certain Primary Care Services in 2013 and 2014 ..15
An Informational Newsletter for Idaho Medicaid Providers
From the Idaho Department of Health and Welfare, March 2013
Division of Medicaid
MedicAide March 2013 Page 1 of 27
Medicaid Program Integrity Unit Charges for Preschool, School, Summer Camp, Special Olympics, and Sports Physicals
Providers are instructed by Medicaid to use wellness exam codes when billing Medicaid for preschool, school, summer camp, Special Olympics and sports exams/physicals. During recent audits, the Medicaid Program Integrity Unit identified providers that charged Medicaid their usual and customary wellness exam fees instead of billing the reduced fee the providers usually charge non-Medicaid patients. Please be advised, charges to Medicaid should not be greater than the amount charged to the general public for the same service. Providers who charge Medicaid more than they charge non-Medicaid patients for the same service will be required to refund Medicaid the difference and may be subject to civil monetary penalties.
Do Your Patients Need to Lose or Gain Weight?
The Preventive Health Assistance (PHA) benefit may be able to help pay for a weight management program. PHA provides assistance to Medicaid patients who meet the Centers for Disease Control definition of being obese or underweight.
To qualify for this benefit, Medicaid patients must:
• be over the age of 5 • have a Body Mass Index (BMI) in the obese or
underweight range, and • want to improve health through weight management.
If you have a patient you think may qualify, please give them a PHA brochure or refer them to the PHA Unit at 1-877-364-1843.
If you would like to request a supply of PHA brochures or if you would like more information on PHA benefits, please call the PHA Unit at 1-877-364-1843 (toll-free).
MedicAide March 2013 Page 2 of 27
20th Annual Idaho Health Care Conference 2013 Blue Cross of Idaho, First Choice Health, Molina Medicaid Solutions/Idaho Department of Health and Welfare, Noridian Administrative Services, LLC (NAS) - Medicare Part B, PacificSource/IPN, Regence BlueShield of Idaho, State Insurance Fund, and United Military & Veterans Services, invite you to attend the 2013 Idaho Health Care Conference.
Participants are encouraged to visit with the exhibitors during breaks and lunch. Registration is free for all Idaho healthcare providers. Please continue to check announcements for pending registration information.
Conference Locations:
Boise Monday April 22, 2013
The Riverside Hotel, 2900 Chinden Blvd.
Lewiston Tuesday, May 7, 2013
Red Lion, 621 21st Street
Coeur D’Alene Wednesday, May 8, 2013
Best Western CDA, 506 W. Appleway Avenue
Idaho Falls Tuesday, May 14, 2013
ISU Idaho Falls Campus, 1776 Science Ctr. Dr.
Pocatello Wednesday, May 15, 2013
Clarion Inn, 1399 Bench Road
Burley Thursday, May 16, 2013
Best Western Burley Inn, 800 N. Overland Avenue
MedicAide March 2013 Page 3 of 27
Claims Processing and Diagnosis Codes
Effective October 1, 2014, medical coding in U.S. health care settings will change from ICD-9-CM to ICD-10. The transition will require business and systems changes throughout the health care industry. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims. If you are not ready, your claims will not be paid. Preparing now can help you avoid potential reimbursement issues. Important, please note:
• ICD-9 codes will not be accepted for services provided on or after October 1, 2014.
• ICD-10 codes will not be accepted for services prior to October 1, 2014. Additionally, you must begin using the ICD-10-PCS (procedure codes) for all hospital claims for inpatient procedures on claims with dates of discharge that occur on or after October 1, 2014.
For complete information on these Federal requirements see Medicare Learning Network publication SE1239 at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1239.pdf.
Children’s Redesign Transition
This notice is to inform providers and families who have not yet transitioned to the children’s redesign services that they are at high risk of experiencing a gap in services for their child if they do not contact the Department immediately. The final rules to discontinue children’s developmental therapy, intensive behavioral intervention (IBI), and developmental disabilities service coordination have been approved by the 2013 Idaho Legislature and the Center for Medicare and Medicaid Services (CMS). This means these services for children will end on June 30, 2013. There are still over 2,000 families who have not transitioned, as well as provider agencies that have not started delivering the new services. It is important to take the steps now to begin the new program or services will no longer be available to you on July 1, 2013. Families Need To Know:
• Families must contact their local Department of Health and Welfare’s Division of Family and Community Services (FACS) office to schedule an appointment as soon as possible.
• Families with a scheduled appointment will be the first priority.
• The eligibility and planning process takes up to 90 days, but may take longer given the volume of children enrolling at once.
Please visit the Children’ Redesign Website at www.redesignforchildren.medicaid.idaho.gov for instructions on applying for the redesign services.
Idaho Health Information Technology Forum: The CMS EHR Incentive Programs for Eligible
Professionals Please join us in person, via video teleconference, or via webinar to take advantage of these benefits:
• Receive updates from Medicaid about the EHR Adopt, Implement, Upgrade (AIU) program and the upcoming attestation process for stage 1 meaningful use.
• Hear up-to-date information from Medicare about stage 1 and stage 2 meaningful use. • Learn helpful tips about participating in the AIU program and achieving meaningful use.
When?
Wednesday, March 20, 2013 9:00 A.M.–12:00 P.M., MT Idaho Medicaid Central Office
3232 Elder Street ◦ Boise, ID 83705
Who Should Attend?
Providers, healthcare organization representatives, and others who are interested in participating in the CMS Incentive Programs for Eligible Professionals can attend either in person, at a Medicaid video teleconference location (see below for sites) or via webinar. Registration is required for all three venues: in-person conference, video teleconference or webinar. In-person attendance will be limited to 100 participants. To Register: Click here to register. There is no fee to attend this event. Space is limited. Please register online. A confirmation letter outlining attendance and event information will be emailed to you upon registration.
Video Teleconference Locations
Coeur d’Alene Moody Building 2195 Ironwood Court Coeur d’Alene, ID 83814-2655 Main Conference Room – Moody Center Capacity 18 Lewiston Lewiston State Office Building 1118 F Street
Lewiston, ID 83501 First Floor Conference Room Capacity 20 Pocatello Human Development Center 421 Memorial Drive Pocatello, ID 83201 Room 225 (Parking passes need to be obtained from the front desk for Holt Arena– potential charge for parking
($2.00/vehicle) if no overflow parking available) Capacity - 15 Idaho Falls Idaho Falls - State Office Building 150 Shoup Ave, Suite 17, Room 240 Idaho Falls, ID 83402 Capacity-20
For more information, please contact Lisa Packard, Washington & Idaho Regional Extension Center, [email protected] or (206) 288-2565.
May Changes for Long Term Care Providers As the Department works to streamline processes and increase efficiencies, we are making some operational and system changes that will affect Long Term Care providers. The following changes will be implemented in May for Providers of ICF-ID and Nursing Facilities.
1) Providers will no longer submit the paper HW-0458 to the Self Reliance Long Term
Care Unit. Instead, providers will key entrance and discharge information directly into the Molina Portal for Medicaid participants in a nursing facility or ICF-ID.
2) Providers will no longer be required to collect additional share of cost from Medicaid
participants when share of cost is recalculated for past months. If share of cost is determined to be higher for past periods, the Department’s Self Reliance Division will collect the additional amount from the participant.
3) Per IDAPA, 16.03.10, the date of discharge from a long term care facility has not
been covered by policy except in specific cases. The system is being modified to enforce this and the day of discharge will no longer be paid except in certain circumstances. A provider can be paid for the date of discharge, if the following criteria can be established. Documentation will need to be included on the claim using the discharge time and patient status code to alert Molina to one of the following exceptions:
• Discharge is equal to the date of Death • Participant is discharged from an ICF-ID facility after 3:00 pm. This does not
apply to Nursing facilities and does not apply if participant is discharged to a facility within the same company
• Participant enters a facility the same day they are discharged. Training will be available during the month of April for Nursing Home / ICF-ID providers to learn more about the new functionality of the portal.
MedicAide March 2013 Page 6 of 27
MA13-02 Preferred Agents for Drug Classes Reviewed at Pharmacy and Therapepeutics Committee Meetings on October 19 and November 16, 2012
MedicAide March 2013 Page 7 of 27
MedicAide March 2013 Page 8 of 27
MedicAide March 2013 Page 9 of 27
MedicAide March 2013 Page 10 of 27
MedicAide March 2013 Page 11 of 27
MedicAide March 2013 Page 12 of 27
MedicAide March 2013 Page 13 of 27
MedicAide March 2013 Page 14 of 27
MedicAide March 2013 Page 15 of 27
MA23-03 Federally Funded Incentive Payment for Certain Primary Care Services in 2013 and 2014
MedicAide March 2013 Page 16 of 27
MedicAide March 2013 Page 17 of 27
MedicAide March 2013 Page 18 of 27
MedicAide March 2013 Page 19 of 27
MedicAide March 2013 Page 20 of 27
MedicAide March 2013 Page 21 of 27
MedicAide March 2013 Page 22 of 27
Provider Training Opportunities in March You are invited to attend the following webinars offered by Molina Medicaid Solutions Regional Provider Relations Consultants.
• Eligibility Training - This course is designed to instruct primary care physicians (PCP) on how to determine eligibility.
Training is delivered at the times shown in the table below. Each session is open to any region but space is limited to 25 participants per session, so please choose the session that works best with your schedule.
Region 2 and State of Montana Kristi Irby [email protected] (208) 991-7138 Region 3 and State of Oregon Rainy Natal [email protected] (208) 860-4682 Region 4 and all other states
Prior Authorization Contact Information Please use these numbers to submit prior authorization requests to Medicaid or to communicate with Medicaid staff regarding details of prior authorization requests. For questions regarding claims with an existing prior authorization, please call Provider Services at 1 (866) 686-4272. DME Specialist, Medical Care P.O. Box 83720 Boise, ID 83720-0036
Medical Care Attention: Surgery Authorizations P.O. Box 83720 Boise, ID 83720-0009
1 (208) 287-1148 Fax: 1 (877) 314-8779
Qualis Health (Inpatient hospital stays greater than three days and selected diagnoses & procedures, Telephonic & Retrospective Reviews) 10700 Meridian Avenue N., Ste 100 PO Box 33400 Seattle, WA 98133-0400 http://www.qualishealth.org/healthcare-professionals/idaho-medicaid
Transportation Idaho Medicaid contracts with American Medical Response (AMR) for all non-emergency medical transportation services. Please go to www.idahonemt.net or call 1 (877) 503-1267 for more information. Ambulance Review
Region 1 and the state of Washington Dianna Adams 120 Ironwood Drive Suite 102 Coeur d’Alene, ID 83814 1 (208) 559-4793 [email protected]
Idaho Regional Map
Region 2 and the state of Montana Kristi Irby 1118 F Street P.O. Box Drawer B Lewiston, ID 83501 1 (208) 991-7138 [email protected] Region 3 and the state of Oregon Rainy Natal 3402 Franklin Caldwell, ID 83605 1 (208) 860-4682 [email protected] Region 4 and all other states Deb Schiller 1720 Westgate Drive, Suite A Boise, ID 83704 1 (208) 373-1343 [email protected] Region 5 and the state of Nevada Brenda Rasmussen 803 Harrison St. Twin Falls, ID 83301 1 (208) 484-6323 [email protected] Region 6 and the state of Utah Kelsey Gudmunson 1070 Hiline Road Pocatello, ID 83201 1 (208) 870-3997 [email protected] Region 7 and the state of Wyoming Kristi Harris 150 Shoup Avenue Idaho Falls, ID 83402 1 (208) 991-7149 [email protected]
MedicAide is available online by the fifth of each month at www.idmedicaid.com. There may be occasional exceptions to the availability date as a result of special circumstances. The electronic edition reduces costs and provides links to important forms and websites. To request a paper copy, please call 1 (866) 686-4272. MedicAide is the monthly informational newsletter
for Idaho Medicaid providers. Editors: Shelby Spangler and Shannon Tolman
If you have any comments or suggestions, please send them to:
