Effective January 6, 2009, all providers enrolling or re-enrolling in WV Medicaid will be required to complete the Ownership Information on page five (5) of the Medicaid Provider Enrollment Application. If the Ownership Information is not completed, your application will be returned.
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 Unisys. Providers are required to submit a complete and accurate enrollment packet 10 days prior to the change of ownership date and inform Unisys 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.
Provider Alert:
Attention Hospital Providers Acute Care and Critical Access hospital providers are advised that claims for inpatient maternity related services will process more quickly and accurately if the appropriate accommodation revenue codes for Nursery (017X) and Obstetrics (0112, 0122, 0132, 0142, and 0152) are used. Claims using other accommodation revenue codes require manual intervention which delays payment. Newborn claims may not be billed on the mother's ID number.
Updated Billing Instructions As of March 1, 2009, the billing instructions for claim forms CMS-1500 and UB-04 have been revised. These are located under "Manuals". Under the drop down box for "Choose a Category", select "Billing Instruction" and submit.
A Tip When Billing Secondary Claims When mailing your paper secondary claims to Unisys you need to have an EOB/EOMB with each claim. Unisys' 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.
Inappropriate CPT Code Denials CPT code 90473 was denying as mutually exclusive to CPT code 90471. As of Saturday, March 7, 2009 the claims system was enhanced to correct this issue. We will be adjusting claims for 90471 and 90473 back to date of service 08/01/2008 when 90473 became a covered service.
CPT code 90656-SL has occasionally denied due to an invalid procedure code/modifier combination. The desktop instructions have been corrected and you should no longer have an issue with claims denying for this CPT code. We will be adjusting claims for 90656 back to 10/01/2008 when the code became a VFC vaccine.
Claim denials related to both of these issues will be reprocessed by March 31, 2009 as long as they are finalized and do not need to age.
When Issuing a Check to Medicaid for Overpayments, Reversals, etc. Beginning in March 2009 when a check is provided as payment, this will constitute authorization to use the information from the check to be used as a one-time electronic fund transfer from your account or to process the payment as an image transaction. For inquiries, please call 1-866-243-9010. When information is used from your check to make an electronic funds transfer, funds may be withdrawn from your account as soon as the same day payment is made, and you will not receive your check back from your financial institution.
Attention Non-Emergency Transport Providers: Reimbursement Rate Change As a result of the most recent bi-annual review of the state's mileage reimbursement rate, the Bureau for Medical services will reduce its reimbursement for procedure code A0160 (Nonemergency transportation: per mile - member transportation by caseworker or social worker) to 45 cents per mile effective for services rendered on or after Tuesday, January 20, 2009. In order to receive correct payment, Providers must bill for these services with appropriate rates and/or date spans.
Change in Billing for the Medicaid Redesign Health Risk Assessment (99420) As of date of service July 1, 2008, for members enrolled in a Medicaid HMO and in the Medicaid Redesign Program (Basic or Enhanced) bill the HMO for the Health Risk Assesment code (99420). For members in Redesign not enrolled in a Medicaid HMO, continue to bill Unisys for the Health Risk Assessment code. Please contact Provider Relations at 1 888 483 0793 if you have questions.
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. NPI Update:
As of 5/23/08 providers must bill with an NPI in the billing and, if appropriate, the rendering provider fields on paper and electronic claims. This is not required for the "atypical providers" which are: Homemaker and Personal Care providers that do NOT bill for RN assessments; and Multi-passenger vans. Claims containing NPI and the Medicaid legacy number will not be rejected at this time. NPIs are not required in secondary fields such as referring, admitting, operating, etc. at this time. The Medicaid # is the preferred approval # for PAAS. Please call Provider Relations, Provider Enrollment or EDI help desk at 1-888-483-0793 if you have any questions concerning this requirement.
As of 12:01am Friday, May 23, 2008 NPI will be REQUIRED for ALL WV Medicaid claims*. This rule applies to claims submitted via clearinghouse, upload files, direct data entry on the Web Portal and paper. If you submit claims without an NPI your claims will be returned unprocessed.
Web Portal Updates:
Upload and Van Submitters: On 2/28/09 Unisys will be implementing a correction to the 997 transaction. In the past when the value of "E" was reported in the AK501, the value of "R" was incorrectly reported in the AK901. After 02/28/09, when a value of "E" is reported in the AK501, the AK901 will now report a value of "A". All other values reported in the AK5 and AK9 will remain unchanged. For submitters who wish to test this change prior to the implementation date, please contact the Unisys EDI Department for assistance.
Absent Diagnosis Codes Results In Rejection All transactions submitted without proper diagnosis codes will result in 824 rejection reports.
Decimal Points Within Unit Submissions Effective March 2, 2009, electronic and paper claims received with a decimal point within the unit field will be returned/rejected to the provider. Please make sure when submitting claims, decimal points are not included. NOTE: This does not apply to NDC billing. Decimals may still be used in the shaded area of field 24D of the CMS-1500 and field 43 of the UB-04 per the current billing instructions. Please contact Provider Relations if you have questions.
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.
Enhancement to the Patient Default Manager (PDM) As of February 2, 2009, the PDM has been configured to allow a provider to save and submit claims using their NPI information. To update your Roster, use the "Edit" function on the Manage PDM Roster page. When editing, make sure you do not have both your WV Medicaid Provider ID and NPI fields populated. Please note: When using Taxonomy code(s), be advised that the PDM will allow you to save a Taxonomy code to both the Billing and the Group Provider, however when both are populated Unisys will only capture the Group Provider Taxonomy code in the claims processing system. If you have questions about billing your electronic claims using your NPI numbers please contact the Unisys EDI Help Desk. When entering the PAAS, Referring and Attending provider numbers you will continue to use the West Virginia Medicaid Provider Number. If you have questions about making sure your NPI is on file with Unisys you may contact the Enrollment Department, both can be reached at 1-888-483-0793. *This does not apply to atypical providers, i.e. non emergency transportation is not required to use NPI. Note to Nursing Home Providers: Please make sure to bill with NPI numbers when submittng your claims.
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