Medicaid Billing and Enrollment Training. Major Changes Coming
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- Delphia Snow
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1 Medicaid Billing and Enrollment Training Major Changes Coming
2 Purpose of the Training Providers will need to: Get an NPI Register with Medicaid to direct bill Understand the PSA Process
3 Providers will: Bill Medicaid Directly Separate Medicaid Billable and Care and Supervision Adjust process of PSA
4 MENTAL HEALTH SERVICES CHILDREN IN STATE CUSTODY MEDICAID TRAINING
5 NPI What Does NPI Stand For? National Provider Identifier What Is A NPI Number? Unique Identifier For Health Care Providers And Health Plans. Why Do I Need A NPI Number? Health Insurance Portability And Accountability Act Of 1996 (HIPPA) Mandated The Adoption Of Standard Unique Identifiers For Health Care Providers. 5
6 NPI Continued Who Needs To Apply For A NPI Number? Each Agency And Individual Health Care Provider Will Be Required To Have Their Own NPI Number. How Do I Apply For A NPI? There Two Ways To Apply, Online Or Paper. To Apply On Line, Visit: To Request A Paper Application Call:
7 PROVIDER ENROLLMENT Provider Enrollment Forms Are Located On Our Website At: Must Have NPI To Enroll Questions Regarding The Enrollment Form Call Option 3, Then 4 7
8 Documents Required For Each Agency and Individual Provider: Cover Sheet With Program Type Checked (Pg 21) Utah Medicaid Provider Application Utah Medicaid Provider Agreement Ownership Disclosure Form Direct Deposit Authorization Form For Electronic Funds Transfer (EFT) Voided Check Or Letter From The Bank License 8
9 Taxonomy Code Box 34 On Application. All DHS Providers Will Need To Use This Taxonomy Code. 253J00000X If You Are A Provider For Another Program Such As: Medicaid, Baby Your Baby Or Crossovers, You Will Need To Submit A Different Taxonomy Code When Billing For These Services. 9
10 Enrollment Forms Send to: Utah Dept of Health Managed Health Care Attn: Merrila PO Box Salt Lake City, Utah Fax #
11 ELECTRONIC BILLING Why Bill Electronic? Turn Around Time Faster Less Man Power, Less Human Error Easy To Track, No Lost Claims Remittance Statement Every Monday Morning Ability To Fix, Void Or Replace A Claim On Line. 11
12 Electronic Billing Continued 997 Two Hour Turn Around Letting You Know We Received Your Claims. 277 Fe Overnight Process, Lets You Know The Next Morning At The Claim Level If That Claim Will Adjudicated On Friday Claims In Our System By End Of Business On Thursday Will Adjudicated That Weekend. The First Business Day Of The Week, Medicaid Process Money To Bank RECEIVE 835 REMITTANCE ADVICE 12
13 Utah Health Information Network Electronic Transactions Overview 13
14 What Is UHIN? 14
15 15
16 UHIN: A Not for Profit Company 16
17 17
18 WHAT IS INCLUDED IN YOUR UHIN MEMBERSHIP? Software (UHINT) Software Training Speedi Credentialing Tool UNLIMITED! Claim Submissions Claim Acknowledgement Reports Claim Status Eligibility Requests and Responses Helpdesk assistance 18
19 Please contact Payers prior to sending EDI Transactions. Enrollment may be required. 19
20 MEDICAID NOTE: There is an EDI enrollment (on-line) that providers have to submit in order to submit any electronic transaction with Medicaid. The URL is: oll/index.jsp 20
21 How do I connect? What are my options? UHINt Internet based tool SOFTWARE AND SUPPORT IS INCLUDED WITH YOUR UHIN MEMBERSHIP! Clearinghouse or Billing Service Direct connect If your system can produce the ANSI 837.X12, you can connect directly into UHINet using SOAP over HTTPS connection. Send and receive all ANSI electronic transactions. You must have a Technical Person on staff that can make this connection. UHIN will provide the Technical Reference Manual (TRM) 21
22 UHINT Internet based tool Can be linked to Practice Management systems that create the ANSI 837.X12 file Keyboard entry for Institutional, Professional and Dental Claim submissions Can produce claim status and eligibility requests to payers Able to view all reports from payer(s) and allow print Allow clinical attachments to be sent. (Medicaid only at this time) 22
23 Logging Onto UHINt 2.5 Input your login information 23
24 Patient Demographic Repository 24
25 CMS 1500 Manual Entry 25
26 Clinical Information Exchange UHINt 2.5 Has the ability to send, receive and translate many clinical messages to Medicaid. Rendered Images TIF/GIF/PDF DICOM (X-ray) Anything 26
27 COMMON X12 TRANSACTIONS FE/ Eligibility Request Eligibility Response Claim Status Request Claim Status Response Electronic Claim Acknowledgement Claim Acknowledgement Claim Payment/Remittance 27
28 SECURITY Additional users and permission for UHINt 2.5 are assigned through UHINet II. Currently because of the complexity of the process all permissions are assigned by UHIN administrators. 28
29 QUESTIONS? 29
30 UHIN is dedicated to your satisfaction. If there is anything we can do to help you transition to electronic transactions, please contact us at: or Denise Jeppson - Extension
31 PAPER CLAIMS CMS 1500 Required Fields (Page 28) Mail to : Medicaid Operations PO Box Salt Lake City, Utah
32 When to use a Taxonomy Code More Than One Contract That Shares The Same NPI Example: Provider A Has A Contract To See DHS Clients, Also Has A Contract To See Medicaid Clients. Taxonomy For DHS Will Be 253J00000X Medicaid Contract, Provider Will Need To Supply Different Taxonomy Code To Provider Enrollment. 32
33 Atypical Provider VS NPI Provider Billing Electronic You Need To Use Different Mailboxes. Providers With Atypical Contract And NPI Contract Currently. If Provider Chooses To Only Bill With NPI, (Previously Was Only Atypical) You May Contact Provider Enrollment To Change From Atypical Provider To NPI Provider. (Must Supply A Different Taxonomy Code For Each Contract.) 33
34 Customer Service Information line Toll Free Website: Manuals Medicaid Information bulletin (MIB) 34
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36 36
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