MedicAide March 2011 Page 1 of 17 In This Issue System Improvements for Claims and Eligibility Status ................................................................. 2 Claim Status ........................................................................................................................ 2 Eligibility Status.................................................................................................................... 2 Using the Copy Claim Feature .................................................................................................... 2 Proof of Timely Filing ................................................................................................................ 2 Medicaid Program Integrity ....................................................................................................... 3 Fraud Reporting Procedures ................................................................................................... 3 AMR Acess2Care ...................................................................................................................... 3 Medicaid Fraud Control Unit....................................................................................................... 4 Twin Falls, ID resident found guilty of Provider Fraud ................................................................ 4 Tips for PCPs on Tobacco Cessation ............................................................................................ 4 Preventive Health Assistance for Wellness ................................................................................... 5 System Updates and Announcements ......................................................................................... 6 Medicare Excluded Service ..................................................................................................... 6 Mental Health Code H0031..................................................................................................... 6 Physical and Occupational Therapy POS ................................................................................... 6 Psychosocial Rehab Visit Limits............................................................................................... 6 Patient Information Notification .............................................................................................. 6 Need a Claim Reviewed? ........................................................................................................... 6 Provider Training Opportunities in March ..................................................................................... 7 Step One: Registering for Provider Training ................................................................................. 8 New User Registration Instructions ......................................................................................... 8 Step Two: Using the Idaho Medicaid Training Center ...................................................................10 How to Register for Provider Training Sessions ........................................................................10 The 2011 Idaho HealthCare Conference - SAVE THE DATES! ........................................................12 DHW Contact Information ........................................................................................................13 Insurance Verification ..............................................................................................................13 Prior Authorization Contact Information .....................................................................................14 Transportation ........................................................................................................................14 Molina Provider and Participant Services Contact Information .......................................................15 Molina Provider Services Fax Numbers .......................................................................................15 Provider Relations Consultant (PRC) Information.........................................................................16 Information Releases There are no new information releases this month. An informational newsletter for Idaho Medicaid Providers From the Idaho Department of Health and Welfare, March 2011 Division of Medicaid
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Division of Medicaid In This Issue Newsletters... · 2020. 5. 9. · Medicaid fraud and abuse affects everyone - taxpayers, Medicaid clients, and Medicaid providers. With the state’s
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MedicAide March 2011 Page 1 of 17
In This Issue System Improvements for Claims and Eligibility Status ................................................................. 2
Claim Status ........................................................................................................................ 2 Eligibility Status.................................................................................................................... 2
Using the Copy Claim Feature .................................................................................................... 2 Proof of Timely Filing ................................................................................................................ 2 Medicaid Program Integrity ....................................................................................................... 3
Fraud Reporting Procedures ................................................................................................... 3 AMR Acess2Care ...................................................................................................................... 3 Medicaid Fraud Control Unit ....................................................................................................... 4
Twin Falls, ID resident found guilty of Provider Fraud ................................................................ 4 Tips for PCPs on Tobacco Cessation ............................................................................................ 4 Preventive Health Assistance for Wellness ................................................................................... 5 System Updates and Announcements ......................................................................................... 6
Medicare Excluded Service ..................................................................................................... 6 Mental Health Code H0031 ..................................................................................................... 6 Physical and Occupational Therapy POS ................................................................................... 6 Psychosocial Rehab Visit Limits ............................................................................................... 6 Patient Information Notification .............................................................................................. 6
Need a Claim Reviewed? ........................................................................................................... 6 Provider Training Opportunities in March ..................................................................................... 7 Step One: Registering for Provider Training ................................................................................. 8
New User Registration Instructions ......................................................................................... 8 Step Two: Using the Idaho Medicaid Training Center ...................................................................10
How to Register for Provider Training Sessions ........................................................................10 The 2011 Idaho HealthCare Conference - SAVE THE DATES! ........................................................12 DHW Contact Information ........................................................................................................13 Insurance Verification ..............................................................................................................13 Prior Authorization Contact Information .....................................................................................14 Transportation ........................................................................................................................14 Molina Provider and Participant Services Contact Information .......................................................15 Molina Provider Services Fax Numbers .......................................................................................15 Provider Relations Consultant (PRC) Information .........................................................................16
Information Releases There are no new information releases this month.
An informational newsletter for Idaho Medicaid Providers
From the Idaho Department of Health and Welfare, March 2011
Division of Medicaid
MedicAide March 2011 Page 2 of 17
System Improvements for Claims and Eligibility Status
Claim Status
An exciting new feature has been added to the claim
status functionality. You are no longer required to
enter a date span to return claims upon entry into
the claim status module. Instead, the 40 most recent
claims will be displayed immediately. Along with the
40 most recent claims there is now a link at the
bottom of the claim screen that will allow you to
choose to go to the next page and return the next set of claims and also page back. You still
have all of the search options you had in the past to identify specific claims. This feature
makes it easier and quicker to get to recent submissions. The display also now includes the
primary diagnosis code on the first screen.
Eligibility Status
Along with the update to claim status there has also been an update to eligibility inquiries.
Dates will now only be displayed if the date span of the inquiry extends prior to or after the
dates of eligibility for the participant. If the date span entered on the inquiry falls fully
within the participant’s eligibility segment it will be displayed as fully ACTIVE and effective
or termination dates are not presented. If the FROM date is previous to the beginning date
of eligibility, then it will display with a status of PARTIAL and the effective date will show. If
the TO date is past the eligibility termination date, then it will display with a status of
PARTIAL and the termination date will show. Otherwise, dates are not displayed.
Using the Copy Claim Feature
When using the copy claim feature for online billing, please be aware that prior
authorizations (PAs) fill in automatically. Therefore, if the prior authorization has changed
from the last claim, you must remove the old prior authorization on the new claim, or it will
deny. Please remove any PA from claims when using the copy claim feature to avoid denials
for wrong PA entered on claim.
Proof of Timely Filing
Did you know that a copy of retro-eligibility is accepted as proof of timely filing for providers
and participants? Just attach a copy of the retro-eligibility letter along with the claim when
you submit. The claim will pend and then be manually reviewed for approval as long as the
proper documentation is attached.
MedicAide March 2011 Page 3 of 17
Medicaid Program Integrity
Fraud Reporting Procedures
Medicaid fraud and abuse affects everyone - taxpayers, Medicaid clients, and Medicaid
providers. With the state’s current budget crisis, it is crucial that the limited funds available
be used to pay for services that were actually provided, provided by qualified staff in
accordance with professional standards, medically necessary, and provided in accordance
with Department rules and regulations.
The Medicaid Program Integrity Unit conducts client and provider reviews, provider audits,
and preliminary fraud investigations. A separate unit within the Attorney General’s Office,
the Medicaid Fraud Control Unit, conducts criminal investigations and prosecutes cases of
health care fraud and elderly abuse. If you suspect fraud or abuse, there are four avenues