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Department of Medical Assistance Services Medicaid and Schools October 2, 2013

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Presentation on theme: "Department of Medical Assistance Services Medicaid and Schools October 2, 2013"— Presentation transcript:


2 Department of Medical Assistance Services Medicaid and Schools October 2, 2013

3 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)

4 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: Webregistration

5 Web Registration Support Call 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

6 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)

7 Provider Enrollment NPI enrollment, EFT sign up, or change of address: Provider Enrollment Unit P. O. Box 26803 Richmond, VA 23261 888-829-5373 804-270-5105 804-270-7027 – Fax

8 Electronic Billing Electronic Claims Coordinator E-mail: Phone: (888) 352-0766 Fax: (888) 335-8460

9 Billing

10 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

11 Accessing the Claims DDE 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 10

12 Claims Menu-Access 11

13 Claims Main Page DDE functions can be accessed here 12 Create Crossover Part B Claim Create Crossover Part B Template

14 Create New Professional Claim CMS-1500 13

15 Void/Replacement Claim 14

16 Submitter Information Submitter ID- this field defaults to the User ID used to login into the portal 15

17 Patient and Insured Information 16

18 Physician or Supplier Information This is not required 17 CLIA#

19 Service Line Item Click on ‘Add Service Line Item’ Button to add additional Line items After entering information You must Save, Reset, or Cancel 18 Note: Taxonomy Code is entered here if applicable

20 Saved Service Line Items After entering information you must Save, Delete, or Cancel Click on Service Line Item to view 19

21 Service Location and Attachments 20

22 Service Facility Location Information 21

23 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 22

24 Claim Submitted Page 23

25 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

26 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

27 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

28 NO TIMELY FILING EXCEPTION Accident Cases Other Primary Insurance

29 Create a Professional Template CMS 1500 28

30 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 29

31 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 30

32 Template Name 31

33 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. 32

34 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. 33

35 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. 34

36 View/Manage/Delete Templates 35

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42 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 41

43 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 42


45 POSITIVES & NEGATIVES of School Based Claiming Theresa Brown Spotsylvania County Schools

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

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

48 POSITIVES Remittance Statements Viewable On-Line Weekly. Just Click and Print.

49 POSITIVES Claims Paid Weekly!!!! Electronically Deposited!!!!

50 POSITIVES School Districts can now bill for Sped Transportation Services!!!! Every day a student receives a service and rides on a specially adapted bus.

51 POSITIVES Transportation Claims bring in additional revenue for School Districts. Whoo Hoo………

52 NEGATIVES Delinquent Progress Notes or Transportation Logs Result in No Revenue coming in…….

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

54 It’s About Time Turning Progress Notes in on Time & in a Timely Fashion makes billing easier &……………….

55 It’s about $ The more we bill……. the more revenue will be flowing in for students and schools.

56 PAY DAY So………..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.

57 THE END If you follow these helpful hints money in the bank for your district doesn’t have to be a dream any longer.

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