**Submitter Notification** DDE 837I NDC fields are currently unavailable. Data entered in these fields will not properly generate with your submission. We are currently working on the resolution.
Web Portal Updates: "Member Not On File" Rejection Resolved With the implementation of Molina Medicaid Solution's EDI 5010 system, some claims were inappropriately rejected for 'Member Not On File'. This has now been corrected in our system. If you have received this rejection and believe the member information is accurate, please resubmit the claim(s).
LTC Roster Submissions Resolved LTC roster submissions are available once again. In addition, submissions containing valid NPI should no longer reject for the corresponding error.
DDE 837P Resolved The DDE 837P submissions are now available again.
Member Validation: 5010 Transactions As part of the new 5010 HIPAA transactions and effective February 1st, 2012, ALL Submitted claims will be matched on the Member’s Medicaid ID and Date Of Birth as part of the Claim EDI validation. Claims will be rejected if the Member Medicaid ID and Date of Birth do not match what is in the Molina System.
WVMMIS Now Supports 5010 Transactions Effective 1/1/12, the Health PAS Online portal will support 5010 transactions for production processing. In order to submit 5010 transactions, successful testing is required for completion. Trading partners are required to submit a minimum of three files containing a minimum of fifteen transactions per file. All three files must pass validation. Please submit with the ISA15 set to “T” to avoid a corresponding TA1 rejection. The 5010 testing website, www.wvmmis5010.com, is no longer active. The correct website to test 5010 transactions is www.wvmmis.com.
Providers who currently only use direct data entry (DDE) into the web portal are not required to test.
Please contact Molina's EDI Helpdesk at 1-888-483-0793 option 6 or edihelpdesk@molinathealthcare.com for questions and to schedule your testing.
While 5010 compliance is legislatively mandated effective January 1, 2012, both the West Virginia Bureau for Medical Services and CMS are sensitive to the needs of the West Virginia provider community. At this time, Molina, the Bureau’s fiscal agent, will have the capability to accept both 4010 and 5010 HIPAA compliant submissions. You will be given advance notification when the 4010 format will no longer be accepted for West Virginia Medicaid.
5010 Electronic Submission Readiness West Virginia Medicaid along with the fiscal agent Molina Medicaid Solutions, is working on implementation activities to transition from the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 Version 4010A1 to ASC X12 Version 5010. In order to determine web portal electronic submitter’s readiness, we are requesting all WV electronic submitter’s complete a 5010 Survey form. Please print and complete this form. Once completed, email the completed form to edihelpdesk@molinahealthcare.com, or fax to (304) 348-3380.
Document link provided below:5010 Molina Survey Molina 5010 (X12) 270 Companion Guide Molina 5010 (X12) 276 Companion GuideMolina 5010 (X12) 837 Companion Guide
2011 CPT Code Rejections If you have received 824 rejections related to the new 2011 codes, the system has now been corrected and you may now resubmit your claims. We apologize for this inconvenience.
WV Molina Medicaid Solutions Now Supports X12 Upload 270 Transactions Trading Partners who wish to submit eligibility requests (270/X092A1) in X12 format, via the Upload File Exchange option, may do so by completing the X12 270 Batch Upload Election Form located under "Forms" in the navigation pane to the left. Trading Partners must undergo successful testing with the Molina EDI Helpdesk prior to approval for production submissions.
Effective 11/22/10, all eligibility requests (270/X092A1) require NPI logic unless considered "atypical".
Document link provided below:Molina 270 X-12 Upload Election Form
Molina now offers WV Medicaid Providers Online Training Molina has implemented a web-based e-learning system referred to as the West Virginia Medicaid Training Center. This training center is available 24 hours a day, 7 days a week to all WV Medicaid Providers. The WV Medicaid Training Center will assist with claims processing information as well as offer various training sessions that can benefit providers participating in the WV Medicaid Program.
Providers will access the Medicaid Training Center through a link after logging into the web portal. The provider will then select the Medicaid Training Center link. Upon arriving at the Training Center page, the user will need to complete self registration with the correct corresponding access code. This code is available after a successful login on the web portal and located directly below the Medicaid Training Center link. The WV Medicaid Training Center Self Registration Information and WV Medicaid Training Center User Guides are located on the left hand side under "Reference" and then "Documents". Web portal user access can be obtained by contacting our EDI Helpdesk at 1-888-483-0793, option 6. The initial course that's posted will be an introduction to WV Medicaid. This will be a good refresher course for any provider and their billing staff, but it will be especially beneficial to providers and their billing staff who are new to Medicaid. We will give a brief overview of the roles between Molina and West Virginia Medicaid, as well as a brief explanation of the billing process.
If you have any questions or problems with your user registration, please contact wvmedicaidtraining@molinahealthcare.com Updated Companion Guides As of August 20th, 2009, the companion guides for 837I, 837I SNF, 837P, and 837D have been updated to include explanations of decimal point restrictions for service unit fields. Also, detailed explanations, instructions, and billing scenarios have been included for what is referred to as "One-to-Many" NPI billing. "One-to-Many" means more than one Medicaid provider ID number affiliated with one NPI number.
Absent Diagnosis Codes Results In Rejection All transactions submitted without proper diagnosis codes will result in 824 rejection reports.
276/277 Claim Status Request/Response Update Effective February 7th, 2009, the Claim Status option has been updated to accommodate NPI submissions to the web portal. Please note: If your NPI is a One To Many (NPI is linked to more than one Medicaid Legacy ID), the Organization name field(s) will need to match exactly as we have it on file in order for your response to come back correctly. For assistance, contact the EDI Helpdesk at 1-888-483-0793 option 6.
Pharmacy: Point of Sale NCPDP 5.1 and D.0 Acceptance While NCPDP D.0 compliance for the processing of pharmacy claims is legislatively mandated effective January 1, 2012, both the West Virginia Bureau for Medical Services and CMS are sensitive to the needs of the West Virginia provider community. At this time, Molina, the Bureau’s fiscal agent, will have the capability to accept both NCPDP 5.1 and D.0 HIPAA compliant submissions. You will be given advance notification where when the NCPCP 5.1 format will no longer be accepted for West Virginia Medicaid.
Provider Enrollment Updates: Provider Re-enrollment The provider re-enrollment process that was discussed at the June 2011 Provider Workshops has been delayed until Spring 2012. The Bureau of Medical Services is awaiting additional, final guidance from CMS to ensure that the re-enrollment process being used meets Federal guidelines. Should you have questions regarding this message, please call the Molina Provider Enrollment Department @ 1-888-483-0793.
Change of Ownership Policy Effective June 1, 2008 A change of ownership requires that all parties involved shall collaborate to ensure that services are billed and paid to the correct owner using the correct provider number. The new provider must obtain an enrollment number to participate in the West Virginia Medicaid Program. The effective date of the new owner's enrollment is determined when the enrollment application is approved by Molina. Providers are required to submit a complete and accurate enrollment packet 10 days prior to the change of ownership date and inform Molina of the exact change of ownership to ensure a seamless transition. Services rendered prior to the effective date will not be payable through Medicaid.
Federally qualified health centers (FQHC), rural health centers (RHC), home health providers, hospice, independent diagnostic testing facilities (IDTF), renal centers, ambulatory surgical centers, and critical access hospitals (CAH) are the only exceptions to this policy. These provider types will have their enrollment date correspond with their Medicare approval letter.
Revised License Maintenance Policy Health care providers, who, under the State Plan and/or State statute are required to be licensed in West Virginia (WV) or the state in which they practice, must maintain and ensure that a current license is on file at all times with West Virginia Bureau for Medical Services (BMS) Provider Enrollment Unit, Molina. A provider's participation in the WV Medicaid Program may be terminated if Molina cannot verify the current status of a provider's license.
Document link provided below:License Lapse Policy
WV Medicaid EHR Incentive Payment: West Medicaid is now ready for registered Medicaid Providers to complete their EHR Incentive Attestations Effective July 4th, 2011, providers eligible for the Provider Incentive Program (PIP) may register with the National Level Repository (NLR). Providers will be notified when attestation can occur with WV Medicaid.
Providers are required to have an active web portal account with a user name and password on file with Molina prior to attesting for their incentive payment. In orderto obtain your user name and password, you must first complete a Trading Partner Agreement (TPA) and an EDI Transaction form. Mail these forms to Molina Medicaid Solutions, Attn: EDI Helpdesk, P.O. Box 625, Charleston, WV 25322-0625. You can obtain detailed instructions for obtaining web portal access at: Molina Web Portal Account Instructions. If you need further assistance on obtaining a web portal account, you may contact our EDI Helpdesk at 1-888-483-0793, option 6.
For those providers who have already registered with CMS' National Level Repository (NRL) for incentive payment, the transition from the CMS NLR Incentive Registration to the WV Medicaid EHR Incentive solution can take 48 hours. You will be notified by the email you provided to the CMS NRL Incentive Registration when we receive and process this information. At that time, providers may proceed with their attestations by logging into the web portal at https://www.wvmmis.com/layout_login.jsp and look for the WV EHR Incentive solution on the left hand panel of the screen.
If you believe you are an eligible provider under the ARRA regulations and you are not registered yet with the CMS NLR system, click here to receive the CMS Incentive Users Guide for Professionals, or CMS Incentive Users Guide for Hospitals. Use these guides to start your Registration CMS Incentive Registration System (https://ehrincentives.cms.gov/hitech/login.action).
WV EHR Incentive Solution Provider Training Materials West Virginia has created user manuals and companion worksheets for providers to utilize while they are using the system to complete their attestation. The workbooks have detailed instructions to the provider on what data they need to pull prior to attesting and how to complete their attestation online.
Overview - West Virginia EHR Provider Incentive Program The Electronic Health Records (EHR) Provider Incentive Payment (PIP) is a federal program offering financial support to assist eligible providers to adopt (acquire and install), implement (train staff, deploy tools, exchange data), or upgrade (expand functionality or interoperability) certified EHR technology.
The program goals are to improve outcomes, facilitate access, simplify care, and reduce costs of health care nationwide by:
Enhancing care coordination and patient safety
Reducing paperwork and improving efficiencies
Facilitating information sharing across providers, payers, and state lines
Enabling communication of health information to authorized users through state Health Information Exchange (HIE) and the National Health Information Network (NHIN).
Provider Alert: Covered Diagnosis for Open Sacral Nerve Stimulator Codes Effective 9/1/2011, Open Sacral Nerve Stimulator Codes are covered for ICD-9 codes: 596.4, 788.20, 788.21, 788.29, 788.30 through 788.39, 788.41 OR 788.63 when billed by professional providers with specialties for (Urology, OB/GYN), Hospitals and Ambulatory Surgery Centers.
Code D7912 Rate Change Effective 8/15/2011, code D7912 - Complicated suture-greater than 5 cm, rate is $450.00.
Attention DME Providers Effective 8/1/11, the following services are covered: E2402 - Negative pressure wound therapy electrical pump, stationary or portable, and A6550 - Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories.
Emergency Room Visit 99283 Effective 8/1/11, Emergency Room Visit 99283 will be covered for Nurse Practitioners.
CPT Codes To Be Closed CPT Codes 92531, 92532, 92533, and 92534 are considered bundled according to RBRVS and should not be reimbursed separately. Therefore, they are being closed and will not be considered for separate reimbursement. They were opened inadvertently and we will close them on the effective date of the benefits.
Anesthesiologist & CRNA Billing Update Effective 9/1/2011, all anesthesia codes, except for 01996 must be billed with a modifier. All anesthesiologists must bill with the respective AA, AD, QK, or QY modifier and CRNAs must bill with QX & QZ.
Orthopedic Code Update The code 64455 (N Block Injection Plantar Digit) can now be billed by physicians that have the speciality (Orthopedics) effective 6/1/11.
Sanctioned/Excluded Providers Pursuant to Section 1128 and Section 1902(a)(39) of the Social Security Act, the West Virginia Medicaid Program will not reimburse a provider for any services or items that were rendered or ordered/prescribed by a sanctioned (e.g., suspended, excluded) provider. The effect of the provider's sanction precludes them from furnishing, ordering, or prescribing services or items to a Medicaid member. Claims for services/items rendered/ordered/prescribed by a sanctioned provider with dates of service or dispensing after the effective date of the sanction, will be rejected or disallowed if discovered during a post-payment review.
In accordance with the Patient Protection and Affordable Care Act (Pub. L. 111-148, enacted on March 23, 2010, as revised by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010, together known as the Affordable Care Act (ACA), the West Virginia Medicaid Program is required to terminate enrollment of any provider that is excluded under Medicare or any other state Medicaid Agency. Excluded individuals and entities prohibited from participating in the West Virginia Medicaid Program are identified in the following list. Excluded individuals and entities are listed according to the type of provider they were at the time of exclusion; however, they are excluded from participating in providing services in the Medicaid program in all categories of services and in any capacity. The exclusion remains in effect until they are removed from this list.
Any provider participating or applying to participate in the West Virginia Medicaid program must search this list and the Federal Office of Inspector General's List of Excluded Individuals and Entities (LEIE) at http://oig.hhs.gov/fraud/exclusions.asp on an annual basis to determine if any existing employee, contractor, owner or board member has been excluded from participation in the Medicaid program. Also, any provider participating or applying to participate in the West Virginia Medicaid program must search both lists prior to hiring staff to ensure that any potential employees, contractors, owners or board members have not been excluded from participating in the Medicaid program.
Document link provided below:Sanctioned/Excluded Provider List
Dorsal Column Spinal Stimulation Codes New Billing Update: Effective 4/1/2011, Medicaid will cover Dorsal Column Spinal Stimulation Codes with prior authorization.
WV Medicaid Mileage Rate Increase West Virginia Medicaid mileage rates will increase from $0.41 to $0.43 per mile. This change becomes effective February 1, 2011 and pertains to the following codes A0160, A0160 HE, and A0160 HI.
Attention FQHC and RHC Providers: Effective on dates of service December 1, 2010, FQHC and RHC providers will receive the same reimbursement rate for T1015 and T1015 HE.
CPT 27899 Pre-Auth Changes Effective 1/1/2009, all providers, including podiatrists, will be required to obtain prior-authorization for CPT 27899 - Unlisted procedure, leg and ankle. WVMI will retrospectively review authorization requests dating back to 1/1/2009. Please contact Provider Relations at 1 888 483 0793 if you have questions, thank you.
A Tip When Billing Secondary Claims When mailing your paper secondary claims to Molina you need to have an EOB/EOMB with each claim. Molina's mailroom is getting mail packs where the EOBs are separated from the claims so the mail room has been trying to match them up. We are also receiving multiple claims for one member with only one EOB/EOMB attached causing the mailroom staff to make copies to add to the other claims. In order for your claims to process more efficiently, please attach the EOB/EOMB with each claim. In the future, when large volumes of claims are submitted in this manner the claims will be returned unprocessed to the provider for correction.
Facilitating Payment for Sterilization and Hysterectomy Procedures In order to facilitate payment for these procedures, please attach the "Transmittal Letter" to all Consent to Sterilization forms, Hysterectomy Acknowledgement forms, and Hysterectomy Certification forms.
Provider Workshops: BMS/Molina and APS Workshop Presentations June 2011 The following documents contain information that was reviewed during the workshops in June. They are also located in the "Documents" page under category "Training" or topic "Workshops".
Document links provided below:BMS & Molina Provider Workshop 2011 Presentation APS Provider Workshop 2011 Presentation
WV Provider Newsletter 2nd Quarter 2011: Exclusively Published to the Web Portal The 2nd quarter 2011 Molina WV Provider Newsletter is now available and published exclusively to the portal. The bulletin contains WV Medicaid general billing tips, policy updates, and other important information/announcements.
Document link provided below:Molina 2nd Quarter 2011 WV Medicaid Provider Newsletter
Friendly Reminders: New Website for Bureau for Medical Services The WV Bureau for Medical Services has released their new URL address for their website. The new address is: http://www.dhhr.wv.gov/bms/. The old address will redirect to the new one. Also, a "Visitor's Survey" is located at the bottom of the new BMS website under "Visitor Tools". Please feel free to submit your feedback. Additionally, the BMS website can be reached from a link provided at the bottom of this page under "Useful Links".
Login Session Inactivity Expiration Reminder Please keep in mind that extended inactivity during a login session will result in the session to expire. All DDE (Direct Data Entry) data not submitted will be lost with the expiration.
Email Information Request for Molina For EDI Agreements, TPAs, or electronic billing questions:
edihelpdesk@molinahealthcare.com
Charging for Duplicate RA Requests Effective July 1, 2006, Molina will be charging $10.00 per remit for duplicate remit requests for paper copies. Paper remits that are less than 25 pages will be mailed. Paper remits that are over 25 pages will be placed on a CD ROM and mailed to the provider. Providers will not be charged for the first 90 days after the original remit has been mailed.
Dental Updates: Dental Billing Changes Effective 4/1/2011 Attention all dental providers: Important changes effective 4/1/2011 to the BMS Dental Services Manual. A brief summary of the significant changes can be found in the document listed below.
Document link provided below:Dental Changes 4/1/2011
Long Term Care Updates: Attention: It has come to our attention that nursing homes are either placing their Medicare ID provider number in the A0100C block of the MDS 3.0 or leaving the item blank. A0100C is for the State Provider Number (Medicaid 10 digit provider ID number) and is not optional per the WV Medicaid guidelines. It must be included on each MDS assessment, or we will be unable to pick up the MDS assessment and load nursing home authorizations into the claims processing system.
Regarding Nursing Home Authorizations Created from MDS Assessments The information within the document linked below regard to MDS assessments for authorizations and provide example issue to solution scenarios.
Document link provided below:Provider Information Regarding Nursing Home Authorizations Created from MDS Assessments
LTC Members enrolled with Active Hospice Care Beginning June 28, 2010, Long Term Care claims will begin to deny with Reason Code 22 when our records indicate that the member is actively enrolled in hospice for the date of service. If you have questions regarding this denial, please contact Provider Relations at 1-888-483-0793.
WV Medicaid Training Center Updates: 2010 Provider Workshop Presentations The 2010 Provider Workshop presentations are now located on the WV Medicaid Training Site. If you have any problems trying to gain access to the training site, please contact the Molina Medicaid Solutions EDI Helpdesk at edihelpdesk@molinahealthcare.com or 1-888-483-0793, option 6. Technical support for the WV Medicaid Training Center, contact by email: wvmedicaidtraining@molinahealthcare.com
Useful Links: WV Casemix Workbook for MDS 3.0
Step-By-Step procedures for manually determining a resident's case-mix class using the MDS 3.0 assessment.
Registration
