Department of Medical Assistance Services

Department of EducationMedicaid Eligibility Verification Options and Billing

October 6, 2009www.dmas.virginia.gov

As a Participating ProviderYou must

• Accept as payment in full, the amount paid by Medicaid

• Determine the patient's identity

• Verify the patient's age

• Verify the patient's eligibility

• Maintain records for minimum 5 years

DOB: 05/09/1994 F CARD# 00001

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

COMMONWEALTH OF VIRGINIA

V I RG I N I A J. R E C I P I E N T

9 9 9 9 9 9 9 9 9 9 9 9

002286

Medicaid Verification Options

• MediCall • ARS- Web-Based Medicaid Eligibility

MediCall/ARS- Information Available

• Medicaid client eligibility/benefit verification• Service limit information• Claim status• Prior authorization• Provider check log• Primary Payer Information• Medallion Participation• Managed Care Organization Assignment

MediCall

800-884-9730800-772-9996804-965-9732804-965-9733

Automated Response System (ARS)

• Web-based eligibility verification option– Free of Charge– Information received in “real

time”– Secure– Fully HIPAA compliant

Automated Response System- Registration

• Registration

virginia.fhsc.com• Questions concerning registration

process

Web Support Helpline 800-241-8726

ARS User Guide

• Located on the DMAS web-site under Provider Services section

• General information on ARS eligibility verification

• Instructions on the using the system• “FAQ”(frequently asked questions) section

Provider Call Center

Claims, covered services, billing inquiries:

800-552-8627

804-786-62738:30am – 4:30pm (Monday-Friday)

11:00am – 4:30pm (Wednesday)

Provider Enrollment

New provider numbers or change of address:

First Health – PEUP. O. Box 26803Richmond, VA 23261888-829-5373804-270-5105804-270-7027 - Fax

Electronic Billing

Electronic Claims Coordinator

Mailing Address

First Health Services CorporationVirginia Operations

Electronic Claims Coordinator4300 Cox Road

Glen Allen, VA 23060

E-mail: edivmap@fhsc.com

Phone: (800) 924-6741

Fax: (804) 273-6797

Billing on the CMS-1500

MAIL CMS-1500 FORMS TO:

Department of Medical Assistance Services

PractitionerP. O. Box 27444

Richmond, VA 23261

TIMELY FILING• ALL CLAIMS MUST BE SUBMITTED AND

PROCESSED WITHIN ONE YEAR FROM THE DATE OF SERVICE

• EXCEPTIONS– Retroactive/Delayed Eligibility– Denied Claims

• Submit claims with documentation attached explaining the reason for delayed submission.

CMS-1500 CLAIM FORM

Use ONLY the ORIGINAL RED & WHITEWHITE

Invoice

Photocopies are not Acceptable

Computer generated claims must match NUBC uniform standards

MEDICAID

(Medicaid #)

Locator 1: Medicaid

CHAMPUS

(Sponsor's SSN)

1. MEDICARE

(Medicare #)

MEDICAID CLAIM

2. PATIENT'S NAME (Last Name, First Name, Middle Initial)

TRICARE

1a. INSURED'S I.D. NUMBER (FOR PROGRAM IN ITEM 1)

Locator 1a: Recipient ID Number

(Be sure to include all 12 digits)

123456789014

Locator 2: Patient's Name

2. PATIENT'S NAME (Last name, First Name, Middle Initial)

Smith, Sam5. PATIENT'S ADDRESS (No., Street)

Locator 10: Accident-Related

10. IS PATIENT'S CONDITION RELATED TO:

a. EMPLOYMENT? (CURRENT OR PREVIOUS)

b. AUTO ACCIDENT?

c. OTHER ACCIDENT?

YES NO

PLACE (State)

YES

YES

NO

NO

You MUST check YES or NO for a, b & c

21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY

1.

2.

3.

4.

3441

Locator 21: Diagnosis Codes

May enter up to 4 codes

Omit decimals

2963

Locators 24A thru 24J

• These blocks have been divided into open areas and a shaded red line area

• The shaded area is ONLY for supplemental information

24. A.DATE(S) OF SERVICE

From ToMM DD YY MM DD YY

Locator 24A: Dates of Service

06 30 08 06 30 08

07 01 08 07 07 08

1

2

Both FROM and TO datesmust be completed

Dates must be within same calendar month

B.Place

ofService

Locator 24B: Place of Service

11

11-Office location

12 – Patients Home

Medicaid accepts the same 2 digit CMS Place of Service codes as Medicare

Note: Type of Serviceis no longer required

Emergency Indicator-24C

• This locator will be used to indicate whether the procedure was an emergency

• DMAS will only accept a ‘Y’ for yes in this locator

• If there was no emergency leave blank

C.

EMG

Locator 24C: EMG

Medicaid will accept a ‘Y’ in this Locator to indicate that the procedure was an emergency

Y

D.

Locator 24D: Procedure Codes

PROCEDURES, SERVICES, OR SUPPLIES(Explain Unusual Circumstances)

CPT/HCPCS MODIFIER

S9129

90806

21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY

1.

2.

3.

4.

34431

Locator 24E: Diagnosis Code

E.

DIAGNOSISPOINTER

1

2963

1,2

Enter the entry identifier of the ICD-9-CM diagnosis code listed in Locator 21. To identify more than one diagnosis code, separate the indicators with a comma.

F.

$ CHARGES

Locator 24 F: Charges

Enter the usualand customary charges

G.DAYS

ORUNITS

Locator 24G: Days or Units

3

Enter the number of times or hours the procedure, service, or item was provided during the service period

H.

Locator 24H: EPSDT/Family Plan

1

EPSDTFamilyPlan

1-EPSDT2-Family Planning Service

Rendering Provider ID #Locator-24I-J

• The open area of 24J will contain the NPI of the provider rendering the service

Locator 24I: ID. Qual.

& 24J: Rendering Provider ID #I.

ID.QUAL

J.RENDERING

PROVIDER ID. #

NPI 12345647890

26. PATIENT ACCOUNT NUMBER

Locator 26: Patient’s Account Number

(Optional)

12345678918765

Can not exceed 17 alphanumeric digits

Total ChargeLocator 28

• DMAS now requires this locator to be completed

• Enter the total charges for the services in 24F lines 1-6

28. TOTAL CHARGE

Locator 28: Total Charges

$

31. SIGNATURE OF PHYSICIAN OR SUPPLIERINCLUDING DEGREES OR CREDENTIALS

(I certify that the statements on the reverseapply to this bill and are made a part thereof.)

SIGNED DATE

Locator 31: Signature & Date

If there is a signature waiveron file, you may stamp, print,

or computer-generate the signature

Service Facility Location InformationLocator 32

• Enter information for the location where services were rendered

– First line-Name– Second line-Address– Third line-City, State, 9 digit zip code

• Multiple offices-the zip code must reflect the office location where services were rendered

• No punctuation in the address• Space between city and state• Include hyphen for the 9 digit zip code

Service Facility Location InformationLocator 32a-b

• Enter the 10 digit NPI number of the service location in 32a

Locator 32: Service Facility Location Information

32. SERVICE FACILITY LOCATION INFORMATION

a. b.NPI1234567890

Billing Provider Info & PH #-Locator 33

• Enter the information to identify the provider that is requesting to be paid– First line-Name– Second line-Address– Third line-City, State, 9 digit zip code

• No punctuation in the address• Space between city and state• Include hyphen for the 9 digit zip• Phone number is to be entered in the area to the right

of the field title, no hyphen or space used

Service Facility Location InformationLocator 33a-b

• Enter the 10 digit NPI number of the service location in 33a

Locator 33: Billing Provider Info & PH #

33. BILLING PROVIDER INFO & PH #

a. b.NPI1234567890

22. MEDICAID RESUBMISSIONCODE ORIGINAL REF. NO.

Locator 22: Adjustments and Voids

1032 xxxxxxxxxxxxxxxx

Adjustment or

Resubmission Code

From originalremittanceVoid

Chap. V, Medicaid Physician’s Manual has code list.

THANK YOUDepartment of Medical

Assistance Serviceswww.dmas.virginia.gov