Molina Healthcare Introduces Molina Medicaid Solutions: Company Closes Acquisition of Unisys Medicaid Health Information Management Business Long Beach, California (May 3, 2010) - Molina Healthcare, Inc. (NYSE:MOH) today announced that, effective May 1, 2010, it closed on its acquisition of the Health Information Management (HIM) business of Unisys Corporation (NYSE:UIS). HIM will operate as a subsidiary of Molina Healthcare under the name, Molina Medicaid Solutions. "We believe that Molina Medicaid Solutions will lay the foundation for an exciting new opportunity for our company," said, J. Mario Molina, MD, Molina Healthcare's president and chief executive officer. "Molina's expertise in both Medicaid and in managed care gives us unique knowledge that will enable us to deliver Medicaid health information solutions for states and to optimize efficiency in ways that will reduce costs." Molina Medicaid Solutions provides design, development, implementation, and business process outsourcing solutions to state governments for their Medicaid Management Information Systems (MMIS). MMIS is a core tool used to support the administration of state Medicaid and other health care entitlement programs. Molina Medicaid Solutions currently holds MMIS contracts with the states of Idaho, Louisiana, Maine, New Jersey, and West Virginia, as well as a contract to provide drug rebate administration services for the Florida Medicaid program.
BMS Announcement PERM Provider Education Information Updated July 26, 2010- CMS is hosting Payment Error Rate Measurement (PERM) Provider Education Conference Call to provide an opportunity for live dialogue between CMS and the Medicaid provider community in the States of New Hampshire, Vermont., West Virginia, and Utah. Provider forum participants will learn from PERM related presentations such as: An overview of the PERM program, the PERM process and what you may be required to do during a PERM review; The documentation request letter/what are your responsibilities when the documentation request letter is received; The follow up schedule and the requirements; Frequent mistakes and best practices. The PERM 101 for Medicaid Providers and Sample document request letter materials will be discussed and are available at the PERM Providers page of the CMS Website, http://www.cms.gov/PERM/. There will be time available for Q&A's however; CMS encourages your questions to be submitted in advance to our designated PERM provider email address at: PERMProviders@cms.hhs.gov or, you may also contact your State PERM Representatives with any questions and for information about educational and training events in your area. For West Virginia Providers: ScottWinterfeld@wv.gov.
The call will be held Wednesday, August, 4, 2010 at 2:00pm to 3:30pm. Participant Dial-In Number: (800) 603-1774 Your conference ID # is 87754610. To view the entire announcement please see: http://www.cms.gov/PERM/Downloads/Invite Aug 4.pdf".
WV Provider Newsletter 3rd Quarter 2010: 3rd Quarter 2010 Newsletter Published Exclusively to the Web Portal Molina would like to introduce the first quarterly issue for 2010 of the WV Provider Newsletter that has been published exclusively to the portal. The bulletin contains WV Medicaid general billing tips, policy updates, and other important information/announcements.
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
Long Term Care Updates: 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.
Dental Updates: Updated Dental Fee Schedule and Important Information Regarding the Dental Claims Reprocessing Dental rates were updated in the WVMMIS on 6/1/10 with an effective date of 7/1/09. All claims with a date of service 7/1/09-6/1/10 will be reprocessed by Molina. Providers do not need to submit reversal/replacement forms for these claims. The claims reprocessing will begin on 6/7/10 with an anticipated end date of 7/26/10.
All claims will be reprocessed; however, those providers whose billed charges are equal to the previous Medicaid fee will pay the same rate. It is the responsibility of the provider to reverse/replace these claims and bill their usual and customary rate to ensure proper payment. Please refer to the section below for reversal/replacement instructions.
Document links provided below:Updated Dental Fee Schedule Dental Letter for Special Claims Reprocessing
Provider Enrollment Updates: Forms Formerly Provided by Unisys, Now Provided by Molina: Effective June 30, 2010 we will no longer accept correspondence form providers (Enrollment Applications, EFT forms, etc.) that speak of Unisys or obtain the Unisys logo. Please call Provider Services at 1-888-483-0793 if you need revised correspondence forms.
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 Servies (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
Web Portal Updates: BRAND NEW! 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/Reponse 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.
Provider Alert: Vagus Nerve Stimulators (VNS) added to Outpatient Services Vagus Nerve Stimulators (VNS) have been added to Outpatient Hospital and Critical Access Hospital benefits and contracts. VNS will only be reimbursed based on FDA approval that the Durable Medical Equipment is being used to shorten the duration or reduce the severity of seizures based on medical necessity.
Established E&M Codes Effective 1/1/10, WV Medicaid will adopt the Medicare Billing Policy and terminate all consultation E&M codes 12/31/09. Services should be billed using the appropriate E&M service codes. Please contact Provider Relations at 1 888 483 0793 if you have questions, thank you.
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.
H1N1 Vaccine Coverage Based on CDC guidelines (www.CDC.gov), West Virginia Medicaid through the enrolled providers will cover the administration of the H1N1 flu vaccine for its members. WV Medicaid will not pay for the H1N1 vaccine itself as it is being supplied by the federal government at no charge, but will cover the administration thereof. Effective September 1, 2009 Providers may bill;
G9141 - Influenza A(H1N1) immunization administration, and
G9142 - Influenza A(H1N1) vaccine, any route of administration
These codes must be billed on the same claim in order to receive payment for the administration only.
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.
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
