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DMAS Division of Health Care Services

DMAS Division of Health Care Services. Billing for Emergency and Non-Emergency Transportation Services With Dates of Service October 31, 2009 and Before. Presentation Outline. Health Insurance Claim Form - 1500 Emergency Ground & Neonatal Ambulance Transportation

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DMAS Division of Health Care Services

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  1. DMAS Division of Health Care Services Billing for Emergency and Non-Emergency Transportation Services With Dates of Service October 31, 2009 and Before

  2. Presentation Outline • Health Insurance Claim Form - 1500 • Emergency Ground & Neonatal Ambulance Transportation • Emergency Air Ambulance Transportation • Title XVIII (Medicare) Deductible and Coinsurance Invoice • DMAS 30-R • DMAS 31-R • Resources • TrailBlazer • Revs Line • DMAS Website • Contact Information • Questions

  3. Health Insurance Claim Form CMS 1500 • What’s Changed? • We want to remind everyone that this is not a change in policy. • Effective April 1, Cross Over claims will be processed using the correct manner. • Medicaid reimbursement for these services is less than 80% of the Medicare payment level, Medicare crossover claims will be paid at $0.00 with the claims edit 364 (“Exceeds Medicaid Allowed Amount.”) • Use Font size 10 or larger • Mail all Ground Ambulance claims to First Health, address at end of presentation • Most Common Mistakes • Using a 2-code system (One code for base rate and second code for mileage) • Trying to bill using CPT/HCPCS mileage codes with: • A0425 • A0435 • A0436 • Block 10b, make sure and check yes for auto accidents • Block 10c, make sure to mark for other accidents

  4. Eligibility and Claims status information • DMAS offers a web-based Internet option (ARS) to access information regarding Medicaid or FAMIS eligibility, claims status, check status, service limits, prior authorization, and pharmacy prescriber identification. The website address the use to enroll for access to this system is http://virginia.fhsc.com. The Medical voice response system will provide the same information and can be accessed by calling 1-800-884-9730 or 1-800-772-9996. Both options are available at no cost to the provider.

  5. Transportation for Managed Care Organizations (MCO) • The Virginia Medicaid Program includes enrolling eligible Medicaid recipients in Managed Care Organizations (MCO). • Eligible enrollees receive emergency air ambulance, emergency ground ambulance and non-emergency transportation services through the MCO. • Please contact the appropriate MCO for billing instructions.

  6. Billing on the CMS-1500 6

  7. Printing • Must be RED OCR dropout ink or the exact match • Should be 10-pitch Pica type, 6 lines per inch vertical and 10 characters per inch horizontal • Claim has to match /line up with the original claim form

  8. Printing • Print 100% of actual size • Set page scaling to ‘none’ • Margins must be exact • DMAS will not reprocess claims denied for scanning issues as a result of failure to follow the above instructions

  9. TIMELYFILING • ALL CLAIMS MUST BE SUBMITTED AND PROCESSED WITHIN ONE YEAR FROM THE DATE OF SERVICE • EXCEPTIONS • Retroactive/Delayed Eligibility • Denied Claims • NO EXCEPTIONS • Accident Cases • Other Primary Insurance

  10. TIMELY FILING • Submit claims with documentation attached explaining the reason for delayed submission • You must have the word “Attachment” in Locator 10d and use modifier “22” in Locator 24D (Attachments include: Run sheets, Call sheets, Pre-hospital Patient Care Report (PPCR)

  11. Block 1 • Enter an ‘X’ in the MEDICAID box for the Medicaid Program

  12. Block 1 TRICARE MEDICAID 1.MEDICARE CHAMPUS (Medicare#) (Medicaid#) (Sponsor'sSSN) 2.PATIENT'SNAME(LastName,FirstName,MiddleInitial) MEDICAID CLAIM 12

  13. Block 1a: Recipient ID Number 1a.INSURED'SI.D.NUMBER(FORPROGRAMINITEM1) 123456789014 (Be sure to include all 12 digits) 13

  14. Block 2: Patient's Name 2.PATIENT'SNAME(Lastname,FirstName,MiddleInitial) Smith, Sam 5.PATIENT'SADDRESS(No.,Street) 14

  15. Is Patient’s Condition Related To Block- 10a,10b & 10c • 10a - Mark box with appropriate ‘Yes’ or ‘No’ • 10b - If the condition is related to an auto accident, mark ‘Yes’ and place the postal code (i.e. VA, TN, WV) of the state in which the accident occurred. • 10c - Mark box with appropriate ‘Yes’ or ‘No’

  16. Block 10: Accident-Related 10.ISPATIENT'SCONDITIONRELATEDTO: a.EMPLOYMENT?(CURRENTORPREVIOUS) YES NO PLACE(State) b.AUTOACCIDENT? WV YES NO c.OTHERACCIDENT? NO YES You MUST check YES or NO for a, b & c 16

  17. Block 10d 10d.RESERVEDFORLOCALUSE ATTACHMENT You MUST use the word "ATTACHMENT" if documents are attached to the HCFA form. 17

  18. Block 11c - Insurance Plan Name or Program Name c. INSURANCE PLAN NAME OR PROGRAM NAME Other Insurance COPAY 18

  19. Is There Another Health Benefit Plan?Block-11d • Providers should only check yes if there is another third party carrier

  20. Block 11d - Is There Another Health Benefit Plan? d. IS THERE ANOTHER HEALTH BENEFIT PLAN? If yes, return to and complete item 9 a-d. NO YES 20

  21. Block 21: Diagnosis Codes 21.DIAGNOSISORNATUREOFILLNESSORINJURY 31100 1. 3. 30130 2. 4. May enter up to 4 codes Omit decimals (List of frequently used diagnosis codes are in the Transportation Manual) 21

  22. Blocks 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 • Instructions will be given on when the use of the shaded area is required for claims processing

  23. TPL Information Block 24A • Qualifier ‘TPL’ will be used followed by dollars/cents amount whenever an actual payment is made by a third party carrier • No spaces between the qualifier and dollars and no $ symbol used • Decimal between dollars and cents is required to read paid amount correctly • Must be left justified

  24. TPL Information Block 24A • DMAS will set COB code based on the information given in locator 11d. • No, or nothing indicated-no other carrier-old COB code 2 • No, or nothing indicated/system has other insurance-claim will deny bill other insurance • No, or nothing indicated/‘TPL’ qualifier with payment in 24a red area-old COB code 3

  25. TPL Information Block 24A • DMAS will set COB code based on the information given in locator 11d. • Yes, but nothing in 24a red area-other carrier billed and made no payment-old COB code 5 • Yes, and ‘TPL’ qualifier with payment in 24a red area-other carrier billed and paid-old COB code 3

  26. Block 24A: Dates of Service 24.A. DATE(S)OFSERVICE From To MMDDYY MMDDYY TPL27.08 06 06 03 01 03 01 1 2 BothFROMandTOdates must be completed 26 Dates must be within same calendar month

  27. Block 24B: Place of Service B. 41- Ambulance – Land Or 42-Ambulance – Air or Water “Not both” Place of Service 41 Medicaid accepts the same 2 digit CMS Place of Service codes as Medicare. 27

  28. 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

  29. Block 24C: EMG C. EMG Y Medicaid will accept a ‘Y’ in this Locator to indicate that the procedure was an emergency 29

  30. Block 24D: Procedure Codes D. PROCEDURES,SERVICES,ORSUPPLIES (ExplainUnusualCircumstances) CPT/HCPCS MODIFIER DMAS Recognizes the Following codes: A0225 A0427 A0429 A0430 A0431 A0225 22 All Claims must have modifier 22 30

  31. Block 24E: Diagnosis Code 21.DIAGNOSISORNATUREOFILLNESSORINJURY 34431 1. 3. 2963 2. 4. E. DIAGNOSIS POINTER 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. 1 1,2 31

  32. Block 24 F: Charges F. $CHARGES 500 00 Enter the usual and customary charges 32

  33. Block 24G: Days or Units G. DAYS OR Enter the number of “loaded miles” of transport. The 31 is an example that shows loaded miles. UNITS 31 33

  34. ID.QUALBlock-24I – Shaded Area • Qualifier ‘ZZ’ is to be used to indicate the taxonomy code-only when the NPI is used and only if necessary to adjudicate the claim.

  35. If Taxonomy codes are usedBlock-24J • If needed the shaded red area will contain the Taxonomy codes • If Taxonomy codes are used in shaded area, NPI number must be provided in the open area.

  36. Fill in only if Taxonomy codes are needed Block 24I: ID. Qual. & 24J: Rendering Provider ID # 3416A0800X Or 3416L0300X ZZ 3416A0800X is Air 3416L0300X is Land 36

  37. Block 24I: ID. Qual. & 24J: Rendering Provider ID # J. RENDERING PROVIDER ID. # I. ID. QUAL Taxonomy # (if needed) ZZ 12345647890 NPI 37

  38. Block 26: Patient’s Account Number (Optional) 26.PATIENTACCOUNTNUMBER 12345678918765 Can not exceed 17 alphanumeric digits 38

  39. Total ChargeBlock 28 • DMAS now requires this locator to be completed • Enter the total charges for the services in 24F lines 1-6.

  40. Block 28: Total Charges 28.TOTALCHARGE $ 40

  41. Block 29: Amount Paid (By Other Insurance) 29.AMOUNTPAID $ 41

  42. Block 30: Amount Paid (By Other Insurance) 30.Balance Due $ 42

  43. Block 31: Signature & Date 31.SIGNATUREOFPHYSICIANORSUPPLIER INCLUDINGDEGREESORCREDENTIALS (Icertifythatthestatementsonthereverse applytothisbillandaremadeapartthereof.) SIGNED DATE If there is a signature waiver on file, you may stamp, print, or computer-generate the signature. 43

  44. Service Facility Location InformationBlock-32 • Enter information for the location where services were rendered • First line-Name • Second line-Address • Third line-City, State, 9 digit zip code • 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

  45. Service Facility Location InformationBlock-32a-b Leave Blank

  46. Block 32: Service Facility Location Information Your Local Hospital XXXX Anywhere St. Your Town, ST 12345-1456 32. SERVICE FACILITY LOCATION INFORMATION Leave Blank a. Leave Blank b. 46

  47. Billing Provider Info & PH #-Block-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

  48. Billing Provider Info & PH #-Block-33a-b • Enter the 10 digit NPI number of the service location in 33a. • Enter ‘ZZ’ qualifier with the taxonomy code if needed, when using the NPI in 33a (example – ZZ3416L0300Z)

  49. Block 33: Billing Provider Info & PH # Your Local Hospital XXXX Anywhere St. Your Town, ST 12345-1456 33. BILLING PROVIDER INFO & PH # (123) 456-7890 a. 1234567890 ZZ3416L0300X (If needed) b. 49

  50. Block 22: Adjustments and Voids 22.MEDICAIDRESUBMISSION CODE ORIGINALREF.NO. 1032 xxxxxxxxxxxxxxxx From Original Adjustment or Void Remittance Resubmission Code Chap. V, Medicaid Transportation Manual has code list. 50

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