Announcement: Provider Notification
Thursday June 26:
Effective April 1, 2008, the Cabinet for Health and Family Services(CHFS) Department for Medicaid Services (DMS), has selected Health Care Excel (HCE) as the Medicaid Surveillance and Utilization Review System (SURS) contractor. Starting July 1, 2008, HCE will be conducting retrospective audits of Medicaid providers' paid claims.
For more information. click on the Provider Notification.
Attention Providers: Additional information on National Provider Identifiers on Crossover Claims
Monday June 16:
The Centers for Medicare and Medicaid Services (CMS) has been alerted that small numbers of Coordination of Benefits Agreement (COBA) trading partners are having difficulty accepting 837 professional crossover claims where the 2310A loop ("Referring Physician”) NM108 and NM109 segments are blank and also missing the accompanying "REF" segment. Providers would have transmitted these professional claims to Medicare prior to May 23, 2008, without an NPI. The Coordination of Benefits Contractor (COBC) has no method for re-sending these already transmitted claims with the 2310-A REF segment included. Therefore, if Kentucky Medicaid experience problems with accepting 837 professional claims due to translator programming, we will inform providers that it will be necessary for them to bill Kentucky Medicaid directly for these claims.
To mitigate further occurrences of the 2310-A REF problem within your 837 professional claim files, the COBC will, effective with June 11, 2008, no longer transmit claims that do not contain an NPI value where required.
If you have further questions, contact the EDI Helpdesk at (800) 205-4696.
Got Questions? Need More Information?
Still not sure what an NPI is and how you can get it, share it? Click to view the Frequently Asked questions regarding NPI registration. Providers may also contact First Health at (800) 639-5195.
Still not sure how to submit claims with your NPI? Click to view the Frequently Asked Questions regarding filing a claim with the NPI. Providers may also refer to the Provider Billing Instructions or contact Provider Relations at (800) 807-1232 or the EDI helpdesk at (800) 205-4696
Announcement - Policy Clarification for Tamper Resistant Prescription Pads (TRPP)
Tuesday April 8;
The April 1, 2008 implementation of the tamper-resistant prescription pad requirements for written prescriptions billed to Medicaid has been successful thus far. However, there are policy clarifications that seem appropriate based on the questions received. To view the clarifications, click the Policy Clarification for Tamper Resistant Prescription Pads.
Announcement - Tamper-resistant Prescription Pads Requirements effective April 1
Friday, March 21;
Effective April 1, Medicaid will require all written prescriptions for outpatient drugs, including over-the-counter drugs, to be on tamper-resistant prescription pads. As you may recall, Congress mandated the new requirement last year, but temporarily postponed implementation until April 1 to allow more time for states to respond.
For more information about the tamper-resistant pads, click on the General Provider Letter #A-80 - Tamper-resistant Prescription Pads Requirements Effective April 01, 2008.