RA Messages for February 8, 2005

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ATTENTION ALL PROVIDERS

EFFECTIVE APRIL 1, 2005, ALL HARDCOPY AND PROPRIETARY ELECTRONIC MEDIA CLAIMS ELIGIBLE FOR 837 HIPAA COMPLIANT TRANSACTIONS SUBMISSION WILL BE HELD AT LEAST 21 DAYS PRIOR TO FINAL ADJUDICATION. ALL CLAIMS RECEIVED FOR LONG TERM CARE, CASE MANAGEMENT, AND NON-EMERGENCY TRANSPORTATION SERVICES AND CLAIMS REQUIRING ATTACHMENTS WILL NOT BE DELAYED BY THIS PROCESS. IT IS IMPERATIVE THAT YOU BEGIN SUBMITTING ELECTRONIC CLAIMS IN APPROVED 837 TRANSACTIONS PRIOR TO THIS IMPLEMENTATION TO ENSURE THAT PAYMENTS WILL NOT BE DELAYED. FOR ANY QUESTIONS, PLEASE CALL PROVIDER RELATIONS AT 800-473-2783 OR (225)924-5040.

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ATTENTION HOSPITAL PROVIDERS

THIS WILL SERVE AS A CLARIFICATION OF THE POLICY CONCERNING BILLING OUTPATIENT SERVICES PROVIDED LESS THAN 24 HOURS PRIOR TO AN INPATIENT ADMISSION. OUTPATIENT SERVICES PROVIDED WITHIN 24 HOURS OF AN INPATIENT ADMISSION MUST BE ROLLED INTO THE INPATIENT STAY AND BILLED AS PART OF THE INPATIENT CLAIM. THE ADMISSION DATE ON THE CLAIM SHOULD BEGIN WITH THE ACTUAL DATE OF THE INPATIENT ADMISSION. THE EXCEPTION TO THIS RULE IS WHEN A PATIENT RECEIVES OUTPATIENT SERVICE AND DOES NOT DISCHARGE HOME PRIOR TO BEING ADMITTED AS AN INPATIENT. IN THESE CASES, THE ADMISSION DATE SHOULD BE THE DATE THE OUTPATIENT SERVICES WERE PROVIDED. ADDITIONALLY, PSYCHIATRIC PATIENTS ADMITTED THROUGH THE EMERGENCY ROOM SHOULD HAVE THE ER CHARGES ROLLED INTO THE INPATIENT PSYCHIATRIC BILL (EVEN WHEN THE FACILITY HAS SEPARATE PROVIDER NUMBERS FOR ACUTE AND PSCH SERVICES), AND THE ADMISSION DATE OF THE INPATIENT PSYCHIATRIC CLAIM SHOULD BE THE DATE THE PATIENT IS ADMITTED TO THE PSYCHIATRIC UNIT.

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ATTENTION KIDMED AND PREVENTIVE MEDICINE PROVIDERS

A DHH EMERGENCY RULE REQUIRES ALL MEDICAID PROVIDERS SUBMITTING KIDMED/PREVENTIVE MEDICINE CLAIMS TO SUBMIT DETAIL CLAIM DATA INCLUDING THE ACTUAL SCREENING AND IMMUNIZATION SERVICES AND THE IMMUNIZATION STATUS; SUSPECTED CONDITIONS; AND REFERRAL INFORMATION RELATED TO SUSPECTED CONDITIONS.  THIS REQUIREMENT APPLIES TO BOTH ELECTRONIC AND PAPER CLAIMS.  ELECTRONIC 837P KIDMED TRANSACTIONS MUST INCLUDE THE K3 SEGMENT, AND THE "FILE EXTENSION" MUST BE KID, NOT PHY.  PROVIDERS BILLING PAPER CLAIMS MUST USE THE CMS 1500 CLAIM FORM WITH ONLY THE SCREENING CODES MUST NOW SUBMIT THE KM-3 CLAIM FORM WITH ALL DETAIL INFORMATION.  EDUCATIONAL EDITS (517 AND 518 OR HIPAA ADJUSTMENT REASON CODE 16 FOR 835 ELECTRONIC RA) CURRENTLY APPEAR ON ANY ELECTRONIC AND HARD COPY CLAIMS PAYMENTS IF ALL APPLICABLE KIDMED CLAIM DETAIL IS NOT PROVIDED.  EFFECTIVE APRIL 1, 2005, EDITS 517 (KIDMED FORMAT REQUIRED - CLAIM MUST BE SUBMITTED IN KIDMED FORMAT), 518 (KIDMED INFORMATION MISSING - IMMUNIZATION AND SUSPECTED CONDITION INFORMATION REQUIRED) AND HIPAA REASON CODE 16 WILL DENY CLAIMS THAT ARE SUBMITTED ON THE 837P OR THE CMS 1500 CLAIM FORM WITHOUT KIDMED DETAIL.