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Department of Medical Assistance Services
Medicaid and SchoolsOctober 2, 2013
www.dmas.virginia.gov
Medicaid Web Portal
• A new enhance Web Portal will allow providers to transact all Medicaid business via one central location
• The web portal will provide access to:– Member Eligibility Status– Claim Status– Payment History– Remittance Advices– Service Authorizations– Direct Data Entry (DDE)
Medicaid Web Portal Registration
• To take advantage of the Portal and its functions, users must be a part of the security structure
• Detailed information regarding the overall web registration process and navigation can be found at:
https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/Webregistration
Web Registration SupportCall Center
• Questions regarding new user registration, existing user access letter, or temporay passwords– 1-866-352-0496– Available after June 8, 2010– 8 am – 5 pm Monday thru Friday– No holidays
Provider Call Center
Claims, covered services, billing inquiries:
800-552-8627 804-786-6273
8:30am – 4:30pm (Monday-Friday)11:00am – 4:30pm (Wednesday)
Provider Enrollment
NPI enrollment, EFT sign up, or change of address:
Provider Enrollment UnitP. O. Box 26803
Richmond, VA 23261888-829-5373804-270-5105
804-270-7027 – Fax
Electronic Billing
Electronic Claims Coordinator
E-mail: [email protected]
Phone: (888) 352-0766
Fax: (888) 335-8460
Billing
Claims DDE
• Claims DDE function is currently associated with the following types of claims:– Professional Claims (CMS-1500)– Institutional Claims (CMS-1450 {UB-04})– Medicare Crossover Claims
• You must be approved under the new role Authorized Staff-Claims to access DDE claims functions
• Users will have the option to create separate claim forms for submission or save each claim as a separate template for future submissions
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Accessing the Claims DDEhttps://www.virginiamedicaid.dmas.virginia.gov
• Upon successful login, you will be directed to the secure Provider Welcome Page• Navigational tabs will direct you to Claims DDE and Automated Response System functions
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Claims Menu-Access
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Claims Main Page
• DDE functions can be accessed here
• Create Crossover Part B Claim
• Create Crossover Part B Template
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Create New Professional ClaimCMS-1500
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Void/Replacement Claim
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Submitter Information
• Submitter ID- this field defaults to the User ID used to login into the portal
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Patient and Insured Information
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Physician or Supplier Information
This is notrequired
CLIA#
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Service Line ItemClick on ‘Add Service Line Item’Button to add additional Line items
After entering informationYou must Save, Reset, or Cancel
Note: Taxonomy Code isentered here if applicable
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Saved Service Line Items
After entering information you must Save, Delete, or Cancel
Click on Service Line Item to view
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Service Location and Attachments
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Service Facility Location Information
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Billing Provider Information
• This section details information about the provider requesting payment for services rendered.
• Billing Provider Information section has both required and optional/situational fields
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Claim Submitted Page
TIMELY FILING• Medical Assistance Program regulations
require the prompt submission of all claims• VA Medicaid is mandated by federal
regulations to require the initial submission of all claims (including accident cases) within 12 months from the date of service
• Providers are encouraged to submit claims within 30 days from the date of service or date of discharge
TIMELY FILING• Submission is defined as actual, physical
receipt of a claim by DMAS• Documentation of timely filing must be
submitted with all claim submissions for dates of service over 12 months from service date
TIMELY FILING EXCEPTION• DMAS is now requiring providers show due
diligence that they are actively pursuing claim payment-– Documentation of contacting DMAS via claim
submission or phone contact at least every six months
• Claims submitted without this required documentation will be considered untimely and denied
• Denied claims must be submitted and processed within 13 months from the initial date of denial where the initial claim was filed within the 12 month limit
NO TIMELY FILING EXCEPTION
• Accident Cases• Other Primary Insurance
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Create a Professional Template CMS 1500
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• Templates are a mechanism for the user to establish a baseline claim that can be reused as needed.
• They can :– be used to eliminate the need for having to rekey
static data with every submission (i.e. billing provider information).
– be established for common submissions (i.e. infant well care, immunizations, etc)
– be stored for reuse
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• To establish a template for a professional claim, select Create Professional Template from the Claims drop down menu.
• You will be transferred to the Create New Professional Template page for template creation
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Template Name
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• All the fields utilized in the Create Professional Template will be the same as the fields in the Create Professional Claim Except for the buttons below
• From this template page you can
– save the template by clicking on ‘Save Template’ button
– reset all the entered fields by clicking on the ‘Reset’ button or;
– navigate to the ‘Create New Professional Template’ page by clicking on the ‘Cancel’ button.
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• When saving the template, the system only validates the format of the data entered.
• After clicking 'Save Template' button, the system displays a successful save message by directing you to the ’Save Template‘ portlet.
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Save Template
• From this Save Template page you can– navigate to the ’Claims Main Page’ in order to
access other claims options by clicking on the 'Claims Main Page’ button or;
– create a new professional template by clicking on the 'Create Another Template' button.
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View/Manage/DeleteTemplates
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View/Edit/Delete Template
• Once a selection is made, you will be transferred to the request page
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View/Edit/Delete Request Page
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View/Edit/Delete Template –Search Results
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• Results that match the search criteria entered, will be displayed in the ‘Search Results’ section
• Clicking on the individual search result record will direct you to the response page containing detailed information for the selected template
• Except for the buttons above, all of the fields in the Template Response page will be the same as the fields in Create Professional Claim
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• After clicking on the ‘Delete Template’ button, the system deletes the template and displays a successful deletion message by directing you to the ‘Template Deleted’ portlet shown above
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DDE Tips
• Recommend using 6.0 or higher Internet Explorer
• Web-based cursor must be placed in correct location
• Templates limited to 100• Be as specific as possible when naming
templates-they are to be shared• Data entry only-no edits• When adjustments and/or voids of claims are
required, you must wait until the next business day to submit this information
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DDE Tips
• Print or save confirmation-Claim Submitted Page
• You will not receive prompts to submit required Supplemental Data
• Don’t worry about capitalization, punctuation, or symbols (except for TPL Supplemental Data)
• 3 year limit for adjustments and voids• Claims for Medallion II members enrolled in
Managed Care Organizations will continue to be submitted to the MCOs according to their guidelines
THANK YOU
http://dmasva.dmas.virginia.gov
POSITIVES & NEGATIVES of
School Based Claiming
Theresa BrownSpotsylvania County Schools
POSITIVES
Can Now Bill Electronically!!!!!!!! It’s as Easy as 1, 2, 3……………
POSITIVES
Templates can be set up & personalized to make billing easier. Enter Common info for faster billing.
POSITIVES
Remittance Statements Viewable On-Line Weekly.
Just Click and Print.
POSITIVES
Claims Paid Weekly!!!!Electronically Deposited!!!!
POSITIVESSchool Districts can now bill for Sped
Transportation Services!!!!Every day a student receives a serviceand rides on a specially adapted bus.
POSITIVES
Transportation Claims bring in additional revenue for School
Districts. Whoo Hoo………
NEGATIVESDelinquent Progress Notes or Transportation Logs Result in No Revenue coming in…….
NEGATIVES
It’s a Domino Affect……If one falls down they all fall down.
It’s About Time
Turning Progress Notes in on Time & in a Timely Fashion makes billing
easier &……………….
It’s about $
The more we bill……. the more revenue will be flowing in for
students and schools.
PAY DAYSo………..If you want your School
District’s Revenue to Increase don’t let the first domino fall and you will be sure to have more money in the bank.
THE ENDIf you follow these helpful hints money
in the bank for your district doesn’t have to be a dream any longer.
