Attention: Provider Enrollment Paper Application
June 28th, 2013 - Last date for distribution of current paper application. The current paper enrollment application will no longer be distributed to providers who wish to enroll. Instead, providers will be highly encouraged to use the WEB PORTAL at www.wvmmis.com
, or, if they do not have an Internet connection, a NEW paper application will be supplied.
Week of June 17, 2013 - Molina will notify providers with incomplete applications of missing information and remind providers of upcoming deadline of July 15, 2013, for submission of additional information.
June 28, 2013 - Will be the last date Molina will accept the current paper enrollment application.
July 15, 2013 - Incomplete applications received before July 1, 2013, will be denied. This includes applications for which the provider has been notified by Molina that information is missing.
If you have questions, contact Provider Enrollment at (888) 483-0793, Option 4 or (304) 348-3360, Option 4.
PERM Cycle 2 Provider Education Webinar
The Centers for Medicare & Medicaid Services (CMS) is hosting four PERM Provider education Webinar/Conference calls during PERM Cycle 2 (2013). The purpose is to provide opportunities for the providers of the Medicaid and Children's Health Insurance Program (CHIP) communities to enhance your understanding of specific Provider responsibilities during PERM.
The Payment Error Rate Measurement (PERM) program is designed to measure improper payments in the Medicaid and CHIP programs, as required by the Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Act or IPERA).
Webinar participants will learn from presentations that feature:
- The PERM process and provider responsibilities during a PERM review.
- Frequent mistakes and best practices.
- The Electronic Submission of Medical Documentation, esMD program.
The webinars are held on the following dates:
- Tuesday, May 21, 2013 3:00-4:00pm ET
- Wednesday, June 5, 2013 3:00-4:00pm ET
- Tuesday, June 18, 2013 3:00-4:00pm ET
- Tuesday, July 2, 2013 3:00-4:00pm ET
Please review the 2013 PERM Cycle 2 Provider Education Webinar Invitation
for additional information.
Pneumococcal Conjugate Vaccine Coverage Update
Effective 6/20/2013, CPT code 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use, is approved for coverage for adults 19 years of age and above per Advisory Committee on Immunization Practices (ACIP) recommendations. Note: The administration of the vaccine is included in 90670. For children up to age six years, the administration of the immunization is covered when VFC provides the vaccine.
Enrolled Advanced Registered Nurse Practitioners CPT Code 11983 Coverage
Effective 6/1/2013, Enrolled Advanced Registered Nurse Practitioners, within their scope of practice, are approved for coverage of CPT code 11983 (Removal with reinsertion, non-biodegradable drug delivery implant).
S3854 Reimbursement for Independent Reference Laboratories
Effective January 1, 2013 independent reference laboratories will be reimbursed for HCPCS code S3854 (Gene expression profiling panel for use in the management of breast cancer treatment for Oncotype Dx). Prior authorization is required by Utilization Management Contractor. Denied claims will be reprocessed by the Fiscal Agent.
Cardiovascular Denied Claims (CPT 37225 & 37226)
Retroactive to January 1, 2011, CPT codes 37225 and 37226 are billable by cardiologists. Denied claims will be reprocessed.
Dental - Supernumerary Teeth Coverage
Effective 1/1/2012, The following codes are covered to supernumerary teeth; Procedure Codes: D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2391, D2392, D2393, D2394, D2930, and D2920. Denied claims will be reprocessed.
Outpatient Services in Hospitals/Ambulatory Surgery Centers Prior Authorization Requirement
Effective May 1, 2013, the following CPT surgery codes require prior authorization when performed as an outpatient service in a hospital or ambulatory surgery center: 29820, 29821, 29825, 29860, 29891, 29895, 29897, 29898, 29899, 29900, 29901, 41820, 61797, 61798, 61799, and 61800.
Physician's claims for services provided on an inpatient basis will be reviewed to assure the inpatient hospital stay was approved.
Prior Authorization for Outpatient Facility Update
Beginning May 1, 2013, prior authorization is no longer needed when providing the following services in an outpatient facility: 11600, 11601, 11602, 11603, 11604, 11606, 11620, 11621, 11623, 11624, 11626, 11640, 11641, 11642, 11643, 11644, 11646, and 95873.
Additional Administration of Intranasal/Oral Vaccines Update
Effective January 1, 2013, 90474, additional administration of intranasal/oral vaccines, may be billed when other vaccines are being administered at the same time.
Documents for Enhanced Primary Care Provider Payments Available
The Affordable Care Act (ACA) requires that Medicaid reimburse eligible primary care providers at parity with Medicare rates in 2013 and 2014 for certain evaluation and management (E&M) and vaccination codes beginning with January 1, 2013 dates of service (42 CFR 447.400(a)). Prior to receiving the enhanced rate, eligible physicians and advanced practice registered nurses (APRNs) must self-attest (please see the Self-Attestation Form below). Physician assistants (PAs) are not required to complete a Self-Attestation Form, but instead should be listed in the appropriate section of their supervising physician's Self-Attestation Form.
The West Virginia Bureau for Medical Services (BMS) is currently undergoing system changes to their Medicaid Management Information System (MMIS) required to implement these enhanced payments to primary care providers. Additionally, BMS is working with the Centers for Medicare & Medicaid Services (CMS) for approval to change West Virginia's Medicaid State Plan. Payments will not be made until necessary system changes are complete and CMS approves West Virginia?s Medicaid State Plan Amendment. Therefore, there may be lag time between when a Self-Attestation Form is submitted and approved and when the enhanced payments begin. However, because retroactive payments will be made, the lag time will not impact the amount providers are reimbursed each calendar year. This enhanced rate will only be available during the calendar years 2013 and 2014. At the end of this period, the enhanced Federal funding for this program expires and the enhanced rate for Medicaid services will end.
The following documents are intended to provide information to providers who wish to participate in the enhanced primary care payment program:
All participating providers should read the Provider's Guide (above) prior to completing the Self-Attestation Form. The required Self Attestation Forms, and the Self-Attestation Form Cover Letter, are provided below:
If you have additional questions, please contact Molina's Provider Enrollment Department within the West Virginia Medicaid call center at:
Phone: (888) 483-0793
Fax: (304) 340-2763
Cardiac Service Codes Opened for Outpatient Coverage
Effective March 1, 2013, cardiac service codes C1714, C1766, C1786, C1874, C1893, and C2629 and Brachytherapy codes C2616 and C2638 have been opened for outpatient coverage to acute care hospitals and CAHs. The codes require Prior Authorization and are restricted by diagnosis codes. They will be reimbursed by the hospital's cost-to-charge ratio. Denied claims will be reprocessed.
- 78226 and 78227 allow A9537 to pay;
- 78579, 78582 & 78597 allow A9540 and A9558 to pay;
- 78598 allows A9524, A5939, A9540, A9558, and A9567 to pay.
Denied claims will be reprocessed. Please refer to the "Drug Code List" under "HCPCS/Drug Codes" on the BMS webpage www.dhhr.wv.gov/bms
to see what CPT codes must be billed with each radiopharmacological code in order for payment to be considered.
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.