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2007 Medicaid Provider Updates

Posted 11-23-2007

Posted 10-23-2007

Posted 10-22-2007

Posted 9-7-2007

  • DME August 2007 Questions
  • Medical Nutritional Therapy Guidelines
  • Providers Billing Date of Placement - A revision has been made to the policy that previously stated providers are to bill for certain items using date the item is ordered rather than the date of placement. For items ordered on or after May 1, 2007, the revised policy states providers are allowed to bill either the date of placement or the date ordered for services, for example: dentures, prosthetics, glasses. Please be reminded the following policies still apply - i.e. eligibility for the receipient, receiving glasses froman NDMA contractor, or appropriate prior authorizations.
  • Maintenance and Servicing (DME Claims)
    • Capped Rental Items - Maintenance/Servicing or repairs is not allowed on rental items during the rental period. Once the recipient owns the capped rental item, Medicaid will cover reasonable and necessary repairs and labor.
    • Oxygen and Ventilator Equipment - Payment may be made for maintenance/servicing every six months starting six months after the recipient owns the equipment. Maintenance/servicing payment will be paid in 15 minute intervals and shall not exceed 30 minutes. Medicaid will cover reasonable and necessary repairs when medically necessary. Medicaid will allow one month of rental of replacement equipment when patient owned equipment needs to be sent to the manufacturer for repairs.

      Maintenance and Servicing requires the Provider to submit prior authorization with the HCPCS code of E1340 indicating the number of units or with the base HCPCS code for the oxygen or ventilator equipment and the MS modifier for maintenance and servicing for oxygen equipment. If the MS modifier is missing the prior authorization will be denied.
    • Maintenance and Servicing (T-Codes for Incontinence Products )
      • T-Codes for Incontinence Products - Effective 8-17-07, provider's request for consideration of T-codes to be added to the DME fee schedule has been denied at this time. Providers are required to use:
        • A4520 - Incontinence garment, anytype, (e.g., brief, diaper), each Prior Authorization is required and is limited to 180 diapers/pullups per month.
        • A4554-Disposable underpads, all sizes (e.g., Chux's) does not require prior authorization and is limited to 70 underpads per month.
  • Updated Fee Schedules as of July 1, 2007
  • Pharmacy Quantity Limits updated as of 9-5-07

Posted 8-9-2007

  • Provider Memo date 7-25-07 - to Providers that bill J-codes and the Deficit Reduction Act of 2005 (DRA) implications.
  • Provider Memo 7-19-07 to Medicaid enrolled Physicians, Clinics, Hospitals, Prescribers (NP's, PA's, etc.) and enrolled Pharmacies- regarding Tamper Resistant Prescription Drug Pads.
  • Provider Memo 7-20-07 to ND Medicaid Pharmacy Providers rgarding AMP - New Federal Upper Limits.
  • HCPC Codes added to the DME Fee Schedule - they are: S8189, E2215, L3702, L1831, and E1392.
  • A new UB04 has been posted to our web site.
  • The Pharmacy Manual has been updated.

Posted 7-27-2007

  • Fee Schedule Update – Effective 07/01/2007

In accordance with the legislative mandate to update provider rates with a 4.0% inflationary increase the first year of the 07-09 biennium, we have increased provider rates effective for 7-1-2007 dates of service and after. Codes which are priced off a fee schedule will be adjusted with the 4% inflationary increase accordingly.

Codes which are priced using the Relative Value Unit (RVU) methodology have had the conversion factor adjusted. The adjustment in the conversion factor takes into account the implementation of the 2007 RVUs for dates of service on or after July 1, 2007. Based on previous 12 month’s claims volume, the new relative value unit adjustments along with the 4.0% inflationary increase result in the conversion factor being adjusted to $36.68. The previous conversion factor was $34.99. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease.

Posted 7-27-2007

Posted 6-19-2007

  • DEPO PROVERA Reimbursement Update -- ND Medicaid has increased the reimbursement for J1055 (injection, medroxyprogesterone acetate for contraceptive use, 150 mg. {Depo-Provera}) to $47.00 for dates of service July 1, 2006 and after. Adjustments can be submitted if payment was made before the increase.

  • False Claims Education PROVIDER NOTICE -- Selected North Dakota Medicaid Participaing Providers are mandated under Section 6032 of the Deficit Reduction Act of 2005 (Pub. L. 109-171) that any provider or provider entity that receives payments, in any federal fiscal year, of at least $5,000,000 from any state Medicaid program, must have written policies for all employees, including management, and for all employees of any contractor or agent. Please click the Provider Notice link to view the notice mailed to select North Dakota Medicaid providers. The False Claims Education Certification form referenced in the Provider Notice is available at www.nd.gov/e-forms.

Posted 6-11-2007

  • DME UPDATES -- The DME Purchase Fee Schedule has been updated. Click this link for added and deleted codes.
  • Please reference the example claims forms for the new CMS 1500 and UB04. The new CMS 1500 claim forms are required starting June 1, 2007 for dates of service April 1, 2007 and forward. The UB04 claim forms are required starting July 1, 2007. Please note the yellow highlights on the UB04 which indicate the most significant changes.

Posted 5-25-2007

Posted 5-23-2007

  • NPI Contingency Plan - In order to assist North Dakota Medicaid Providers in processing their claims after the May 23, 2007 NPI implementation date, North Dakota Medicaid has developed an NPI Contingency Plan effective 5-23-2007. If this plan is not followed for HIPAA covered electronic transactions providers risk denial of claims.

Posted 5-15-2007

  • UPDATE ON MEDICARE CROSSOVERS-- The system changes necessary to process batch files are now complete and ND Medicaid is currently processing electronic Medicare Crossover claims that were held in our system due to unforeseen issues. Because of the high volume of claims, ND Medicaid will need to process the claims already submitted, in increments that will result in additional checkwrites.

    The additional checkwrites will take place between May 9, 2007 and June 15, 2007. After June 15, 2007, we encourage providers to verify the status of electronic crossover claims with Remittance Advices or status check calls to Provider Relations to determine whether or not you will need to submit a hard copy claim as the electronic claim has not been processed.

    North Dakota Medicaid does not want to hinder the claims process and adjudication of the electronic crossover claims. We are asking providers to continue to hold hard copy claims until you are able to verify if an electronic claims has been processed. ND Medicaid will notify all providers when we will begin accepting duplicated hard copy crossover claims that you have been asked to hold.

Posted 5-14-2007

  • ATTENTION DME PROVIDERS -- Effective July 1, 2007, DME providers are required to use the current PRIOR AUTHORIZATION REQUEST form SFN 1115 (7-2006). If outdated versions are submitted for review after 7-1-2007, the request will be returned to the provider for resubmission on the current form. The current form is available at www.nd.gov/eforms.

Posted 5-8-2007

  • MEDICARE CROSSOVER CLAIMS UPDATE -- The NDMA's system changes needed to alleviate the issues we were experiencing with Medicare Crossover Claims are nearing completion. Processing of electronic files which have been rejected in the past will occur during May and early June. Until the process is completed and the payment or status of an electronic claim is known, we continue to ask that providers not submit duplicate paper claims.
  • An updated Pharmacy Provider File has been added to the Pharmacy web site.

Posted 4-27-2007

  • Issue 61 - March 2007 -- The new Provider Bulletin (Your Reimbursement News Source) has been posted to the web.

Posted 3-30-2007

Posted 3-14-2007

  • New Swing Bed Rates - The new Swing Bed Rates (effective April 1, 2007 through March 31, 2008) have been posted.

Posted 3-8-2007

  • Attention DME Providers - please click the link (DME Update 2-13-07) for information regarding current policy and recent changes to current policy.

Posted 2-7-2007

Posted 2-1-2007

  • Laboratory Fee Schedule Update
    • The Department has revised our Laboratory Fee Schedule using the 2007 Medicare Clinical Diagnostic Fee Schedule amounts for dates of service on or after January 1, 2007.
  • PERM Update - Medical Review Request Letters Sent:
    • The Centers for Medicare and Medicaid Services (CMS) Payment Error Rate Measurement (PERM) program documentation/database contractor, Livanta LLC, has begun the process of contacting providers beginning in January 2007. If a claim has been selected for a service that you rendered as part of the sample, Livanta LLC will contact you to request a copy of your medical records to support the medical review of the claim. Medical records are needed to support medical reviews on claims to determine if the claims were correctly paid. It is critical that providers supply information on sampled claims in a complete and timely matter. Non-compliance will result in a claim adjustment against the provider’s claim with the monies being recovered by ND Medicaid. Failure to submit the requested medical information could also result in State errors.
    • We recognize providers are concerned with maintaining the privacy of patient information. However, providers are required by Section 1902(a)(27) of the Social Security Act to retain records necessary to disclose the extent of services provided to individuals receiving assistance and provide CMS (through Livanta) with information about any payments claimed by the provider for rendering services. Providing information includes medical records. Also, the collection and review of protected health information contained in individual-level medical records for payment review purposes is allowed by the Health Insurance Portability and Accountability Act (HIPAA) and implementing regulations at 45 Code of Federal Regulations, parts 160 and 164. This permits the collection and review of protected health information to meet the CMS PERM requirements. The records do not need to be de-identified.
  • Relative Value Unit Fee Schedule Update
    • Historically, the Department has implemented the latest relative value units (RVUs) on the first of each year. This year, the Department will implement the 2007 RVUs for dates of service on or after July 1, 2007.
    • Updating the RVUs effective July 1 allows us to do one update in unison with any provider increases granted by the legislature. Due to the limitations of our current system (MMIS), updating a fee effective date once per year, versus twice per year, is much more effective and ensures we are processing claims more efficiently and appropriately. Updating the fees on July 1 also provides more consistency with fees and aligns with the State Fiscal Year.

Posted 1-12-2007


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