December 2001 NC Medicaid Bulletin title

Printer Friendly Version

In This Issue. . .  
All Providers: Carolina ACCESS Providers: Community Alternatives Program Lead Agencies: Durable Medical Equipment Providers: Head Start Programs: Home Health Agencies: Independent Practitioners: Private Duty Nursing Providers:

Attention: All Providers

Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed Monday, December 24, 2001 through Wednesday, December 26, 2001 in observance of Christmas, and on Tuesday, January 1, 2002 in observance of New Year's Day.

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Noninvasive Pulse Oximetry Reimbursement (CPT Codes 94760 and 94761)

Effective with date of service December 1, 2001, noninvasive pulse oximetry reimbursement is included in the payment of other payable services provided on the same date of service. The N.C. Medicaid program allows separate reimbursement for noninvasive pulse oximetry when the following conditions are met: EDS, 1-800-688-6696 or 919-851-8888

Attention: Durable Medical Equipment Providers

Change in HCPCS Codes for Oxygen Concentrators

In order to comply with HCPCS changes, the following code changes in the Oxygen and Oxygen-Related Items section of the Durable Medical Equipment (DME) Fee Schedule will become effective with date of service January 1, 2002.

Code E1390, "oxygen concentrator, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate," will replace all current oxygen concentrator codes, E1400, E1401, E1402, E1403, and E1404. The maximum reimbursement rate for monthly rental of code E1390 is $223.30.  Providers must bill their usual and customary rate.

Code E1390 will require prior approval. The coverage criteria is the same as those previously established for codes E1400, E1401, E1402, E1403, and E1404. These criteria are provided on pages F-3 and F-4 of the March 1, 1999 reprint of the N.C. Medicaid Durable Medical Equipment Manual.

Providers who currently have temporary or permanent prior approvals for codes E1400, E1401, E1402, E1403, and E1404 will be required to send a copy of the approved Certificate of Medical Necessity and Prior Approval form to EDS Prior Approval indicating the need for a change of coding in the system. These requests must be sent to:

Attn: Prior Approval
P.O. Box 31188
Raleigh, NC 27622

Melody B. Yeargan, P.T., Medical Policy
DMA, 919-857-4020

Attention: Independent Practitioner and Head Start Programs

Change in Prior Approval Process

Effective December 1, 2001, the prior approval process for the Independent Practitioner (IP) and Head Start programs has been suspended. It is no longer necessary to submit forms to Purchase of Medical Care Services (POMCS) for review. However, until a new process is implemented, the provider's records are subject to retrospective review.

Providers should continue to submit claims for medically necessary services to EDS. Claims that exceed current IP program limits will deny.

Carol Robertson, Medical Policy Section
DMA, 919-857-4020

Attention: Carolina ACCESS Providers

Reduction in Management Fee

Effective January 1, 2002, the Carolina ACCESS (CA) management fee for any CA provider not linked with an ACCESS II and ACCESS III administrative entity will be reduced to $2.00 per member per month. In addition, management fees paid to ACCESS II and ACCESS III providers for the first 250 enrollees will be reduced from $3.00 per member per month to $2.50 per member per month. The management fee will continue to be paid on the first checkwrite of every month for the current month.

Betty West, Managed Care Section
DMA, 919-857-4022

Attention: All Providers

Tax Identification Information

Alert - Tax Update Requested
The N.C. Medicaid program must have the correct tax information on file for all providers. This ensures that 1099 MISC forms are issued correctly each year and that correct tax information is provided to the IRS. Incorrect information on file with Medicaid can result in the IRS withholding 30.5 percent of a provider's Medicaid payments. The individual responsible for maintenance of tax information must receive the information contained in this article.

How to Verify Tax Information
The last page of the Medicaid Remittance and Status Report (RA) indicates the tax name and number on file with Medicaid for the provider number listed. Review the Medicaid RA throughout the year to ensure that correct tax information is on file for each provider number. If you do not have access to a Medicaid RA, call EDS Provider Services at 919-851-8888 or 1-800-688-6696 to verify the tax information on file for each provider.

The tax information listed for a group practice is as follows:

How to Correct Tax Information
All providers are required to complete a W-9 form for each provider number with incorrect information on file. Corrected information must be received by December 15, 2001. The procedure for submitting corrected tax information to the Medicaid program is determined by the provider type. Copies of the change forms and the W-9 form can be obtained from the DMA website.

Refer to the following instructions for completing the W-9.  Additional instructions can be found on the IRS website at under the link "Forms and Pubs."

Change of Ownership DMA Provider Services will assign a new Medicaid provider number if necessary and will ensure the correct tax information is on file for Medicaid payments.

If DMA is not contacted and the incorrect tax id number is used, that provider will be liable for taxes on income not necessarily received by the provider's business. DMA will assume no responsibility for penalties assessed by the IRS or for misrouted payments prior to written receipt of notification of ownership changes.

Physician Group Practice Changes
When a physician leaves or a physician is added to a group practice, contact BCBSNC to update Medicaid enrollment and tax information. CA providers must also report changes to DMA Provider Services using the Carolina ACCESS Provider Information Change form.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Durable Medical Equipment Providers

Completion of Certificate of Medical Necessity and Prior Approval Form

Current efforts to resolve problems with incomplete Certificate of Medical Necessity and Prior Approval (CMN/PA) forms are delaying the review and disposition of durable medical equipment (DME) requests. EDS will not process incomplete forms. All incomplete forms will be returned to the DME provider for correction and resubmission. Correction fluid and strips are not permitted on the CMN/PA form and forms will be returned to the provider without review if they have been used on the form.

Please ensure that each request corresponds to the instructions for completion of the CMN/PA form given in Step 2 of Subsection 6.4 of the N.C. Medicaid Durable Medical Equipment Manual. It is not necessary to complete fields 3, 6, and 10. Entering ICD-9-CM codes in fields 11 and 12 and a CPT-4 code in field 13 is optional. All of the remaining fields must be completed. Field 24 is required for the following HCPCS codes: E0608, E0609, E0480, E0784, E0202, E0935, W4006, and W4007.

N/A must only be used in the following fields under the following circumstances:

When completing field 26, be sure to fully identify the equipment that is being requested. The provider's return address must be entered in field 29. Failure to do so will delay the return of the form. A stamped address may be used.  All of the information provided must be accurate and thorough.

Note:  Each page of documentation with the CMN/PA must contain the recipient's name and Medicaid identification number.  Effective immediately, EDS will retain all documentation attached to the CMN/PA.  It is the provider's responsibility to maintain copies for their records.

EDS, 1-800-688-6696 or 919-851-8888

Attention: Home Health Agencies, Private Duty Nursing Providers, and Community Alternatives Program Lead Agencies

HCPCS Code W4646

Effective with date of service December 31, 2001, HCPCS code W4646 (Nebulizer kit, plastic or glass) will be end-dated because of low utilization. However, if a physician specifically orders this item and it meets the criteria listed in Section 5.1.6 of the N.C. Medicaid Community Care Manual, providers may bill Medicaid using HCPCS code W4655.

Providers must bill their usual and customary rates.

Dot Ling, Medical Policy Section
DMA, 919-857-4021

Checkwrite Schedule
December 11, 2001  January 15, 2002  February 12, 2002 
December 18, 2001  January 23, 2002  February 19, 2002 
December 28, 2001  January 30, 2002  February 27, 2002 

Electronic Cut-Off Schedule
December 7, 2001  January 11, 2002  February 8, 2002 
December 14, 2001  January 18, 2002  February 15, 2002 
December 21, 2001  January 25, 2002  February 22, 2002 


Electronic claims must be transmitted and completed by 5:00 p.m. on the cut-off date to be included in the next checkwrite. Any claims transmitted after 5:00 p.m. will be processed on the second checkwrite following the transmission date.
______________________ _______________________
Nina M. Yeager, Director Ricky Pope
Division of Medical Assitance Executive Director
Department of Health and Human Services  EDS

Back Home