Targeted Case
Management
Topics for Today
− Provider Training − Provider Manuals − Submitting Claims
− Claim Adjustments and Voids
− Current CPT Codes and Place of Service Codes − Timely Filing
− WebRA − ICD-10
− Provider Enrollment Frequently Asked Questions − Hewlett Packard Enterprise Contacts
Provider Training
Arkansas Medicaid Website
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Provider Training
Virtual Classes
− Arkansas Medicaid Billing 101 (includes Arkansas Medicaid passwords and WebRa)
− PES Billing 101 (Provider Solutions Software) / DDE Demonstration (Arkansas Medicaid website data entry)
Provider Training
Training Materials
− Training Materials from Past Workshops − Arkansas Medicaid Billing Guides
− Billing tips
Provider Training
Arkansas Medicaid Website
www.medicaid.state.ar.us
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HPE Virtual Training
Arkansas Medicaid and BreastCare providers
are invited to participate in our virtual training program. HPE has a curriculum targeted specifically for you. Lead by experienced Arkansas-based trainers, these courses deliver information in a convenient, real-time and interactive approach. We offer courses for new billers, therapists, durable medical equipment providers and more.
For more information and to sign up for a course, please visit the Provider section of our website at
Provider Training
Provider Workshops
• Provider workshops will be posted under the Provider Training tab of the Arkansas Medicaid
website along with a link to register for the workshop. Workshops are usually posted 14-28 days before the workshop date.
• Workshop invitations are also mailed to providers 14-28 days before the workshop date.
Provider Manuals
Provider Manuals
Provider Manuals
Sections
General information, sources, beneficiary eligibility and responsibilities, provider participation, administrative (and non-compliance) remedies and sanctions, and PCP case management program and required services and activities
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Section I
General Policy
Program- or provider-specific information, program coverage, prior authorization, reimbursement and billing procedures
Section II
Provider Manuals
Sections
General information, Remittance Advice (RA) and status report, adjustment request, additional or other payment sources, pseudo claims and reference books
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Section III
Billing Information
Arkansas Medicaid acronyms and terms
Section IV
Glossary
Claim forms, Arkansas Medicaid forms, contacts and links
Section V
Provider Manuals
Sections
Update Log
Number and release dates for updates
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Appendix A
Submitting Claims
Ways to Submit Claims
─ Claims on Paper
─ Direct Data Entry (DDE)
─ Provider Electronic Solutions (PES) ─ Your Vendor Software
Claims Adjustments and Voids
Paper Adjustments
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Paper Adjustments
─ Paper adjustment request forms are found on the Arkansas Medicaid website in the Section V provider manual.
─ You may print adjustment forms as needed.
─ Paper adjustment requests should be mailed to: Arkansas Medicaid
Attn: Adjustments P.O. Box 8036
Little Rock, AR 72203
Direct Data Entry (DDE)
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– Arkansas Medicaid Website www.medicaid.state.ar.us
Once you are logged on, your provider name will appear under “Welcome Back.”
To start a new claim, click on “Professional Claim.” To void or adjust a
previous claim, click on “Professional Claim reversal.”
Direct Data Entry (DDE)
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Direct Data Entry (DDE)
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Direct Data Entry (DDE)
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Provider Electronic Solutions
(PES) Software
Provider Electronic Solutions (PES) Software
Provider Electronic Solutions (PES) Software
Provider Electronic Solutions (PES) Software
Provider Electronic Solutions (PES) Software
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When submitting, adjusting and voiding claims in PES, be sure to pull back your response report to see rejections and claims accepted.
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Current CPT Procedure Codes and Place of
Service Codes
Assisted Living CPT Procedure Codes
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National Code Modifier
U21 21+
60+ Local Code Description
T1017 U21 (Assessment/Service Plan Development) T1017 U2 21+ (Assessment/Service Plan Development) T1017 U5 60+ (Assessment/Service Plan Development)
T1017 UA 21+ in
ARChoices
(Assessment/Service Plan Development)
T1017 U4 U21, 21+ (Service Management/Referral and Linkage) T1017 U6 60+ (Service Management/Referral and Linkage)
T1017 UB 21+ in
ARChoices
(Service Management/Referral and Linkage)
T1017 U1 U21 (Service Monitoring/Service Plan Updating) T1017 U3 21+ (Service Monitoring/Service Plan Updating) T1017 U7 60+ (Service Monitoring/Service Plan Updating)
T1017 UC 21+ in
ARChoices
Assisted Living Place of Service Codes
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Electronic and paper claims now require the same National Place of Service Codes.
Place of Service POS Codes
Doctor’s Office 11
Patient’s Home 12
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Timely Filing
Medicare/Medicaid Crossover Claims and Claims with Retroactive Eligibility (Pseudo Claims)
Timely Filing
Medicaid requires providers to submit all claims no later than 12 months from the
date of service. The 12-month filing deadline applies to all claims, including:
− Claims for services provided to recipients with joint Medicare/Medicaid eligibility − Adjustment requests and resubmissions of claims previously considered
− Claims for services provided to individuals who acquire Medicaid eligibility retroactively
Timely Filing
Claims With Retroactive Eligibility (Pseudo Claims)
─ Retroactive eligibility does not constitute an exception to the filing deadline policy. If an appeal or other administrative action delays an eligibility determination, the provider must submit the claim within the 12-month filing deadline.
─ If the claim is denied for recipient ineligibility, the provider may resubmit the claim when the patient becomes eligible for the retroactive date(s) of service. Medicaid may then consider the claim for payment because the provider submitted the initial claim within the 12-month filing deadline and the denial was not the result of an error by the provider.
─ To resolve this dilemma, Arkansas Medicaid considers the pseudo recipient identification number 9999999999 to represent an “...error originating within (the) State’s claims system.” Therefore, a claim containing that number is a clean claim if it contains all other information necessary for correct processing.
Timely Filing
Claims With Retroactive Eligibility (Pseudo Claims)
─ Providers have 12 months from the approval date of the patient’s Medicaid eligibility to resubmit a clean claim after filing a pseudo claim. After the 12-month filing deadline (12 months from the Medicaid approval date), claims will be denied for timely filing and will not be paid. It is the responsibility of the provider to verify the eligibility approval date. ─ Once a beneficiary receives retro eligibility, the provider must submit a paper claim, proof of the Pseudo claim, and a
cover letter to Research for special processing. HP Enterprise Services
Attn: Research Analyst PO BOX 8036
Little Rock, AR 72203
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WebRA
WebRA
WebRA
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Your name will appear here after
you log on. Let’s open WebRA.
WebRA
Overview
− Effective July 2011, ALL providers should be retrieving WebRAs from the Arkansas Medicaid website.
− Remittance Advices (RAs) are in a PDF format, referred to as WebRAs. − WebRAs will only be available on the website for 35 days.
A charge will apply for RAs requested after the 35-day period.
− For WebRA training, refer to the Provider Training link on the Medicaid website.
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Provider Electronic Solutions (PES) Software
Problem:
Vendors/Providers receive errors when using PES versions older than 2.23.
Solution:
Upgrade to PES Version 2.23.
PES V2.23 allows alphanumeric characters for diagnosis codes (all claim types) and surgery procedure codes (inpatient claim type only).
Provider Electronic Solutions (PES) Software
New Edit Clarification for Electronic Claims (Tandem)
− Edits Y830 and Y831 (#7 & 8) – All claims go through this logic.
• Edit Y830 – Claims containing mixed ICD-9 or ICD-10 SURG or DIAG codes will reject for this edit.
• Edit Y831 – Claims containing ICD-9 and ICD-10 AND spanning 10/1/15 will reject for this edit.
− Edit Y832 (#5) – Only Inpatient Claims with DOS spanning 10/1/15 AND ICD-9 present will reject for this edit.
− Edit Y833 (#6) – Only Professional Global OB Claims with DOS spanning 10/1/15 AND ICD-9 present will reject for this edit.
New Denial Codes for ICD-10
Descriptions
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─ EOB 713 – Dates of service spanning 10/1/15 must be split billed – Rebill (Bill ICD-9 prior to 10/1/15; Bill ICD-10 on/after 10/1/15).
─ EOB 714 – Inpatient Claim must contain only ICD-10 surgical procedure and diagnosis
codes when dates of service span 10/1/15.
─ EOB 715 – Professional Global OB Claim must contain only ICD-10 diagnosis codes
when dates of service span 10/1/15.
─ EOB 717 – Claim must not mix ICD-9 and ICD-10 diagnosis codes; Must bill ICD-9 prior to 10/1/15; Must bill ICD-10 on/after 10/1/15 – Rebill with only ICD-9 codes/dates of
New Denial Codes for ICD-10
Descriptions
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─ EOB 725 – Claim must not mix ICD-9 and ICD-10 surgical procedure codes; Must bill
ICD-9 prior to 10/1/15; Must bill ICD-10 on/after 10/1/15 – Rebill with only ICD-9
codes/dates of service or only ICD-10 codes/dates of service. • A “mixed” claim could be any of the following:
o Both ICD-9 and ICD-10 coding,
o ICD-9 coding with DOS on/after 10/1/15, or o ICD-10 coding with DOS before 10/1/15.
Contact information
– Monday through Friday (8 a.m. – 5 p.m.)
• Toll-free in Arkansas
(800) 457-4454
• Local or out-of-state
(501) 376-2211
• Dedicated fax
(501) 374-0746
HP Enterprise Services
PO Box 8105
Little Rock, AR 72203-8105
HP Enterprise Services
Provider Enrollment
Provider Assistance Center (PAC)
Hewlett Packard Enterprise
Your first point of contact for billing, claim status, and other general questions is the Provider Assistance Center:
Monday through Friday (8 a.m. – 5 p.m.)
Toll-free in Arkansas (800) 457-4454
Local or out-of-state (501) 376-2211
Electronic Data Interchange (EDI)
Hewlett Packard Enterprise
The HP Enterprise Services EDI Support Center assists providers with electronic
claim submission issues, 997 batch responses, PES software delivery and setup
support, software training and data transmission failures.
Monday through Friday (8 a.m. – 5 p.m.)
• Toll-free in Arkansas (800) 457-4454
• Local or out-of-state (501) 376-2211
Research Analyst
Hewlett Packard Enterprise
The HP Enterprise Services Research Analyst answers emails sent to region
mailboxes, researches claims issues from providers and submits eligible claims
with appropriate override.
Providers need to attach a cover letter explaining the reason for their inquiry and
attach an original red and white claim form with their cover letter to the address
below.
HP Enterprise Services
Attn: Research Analyst
PO Box 8036
Provider Representatives
Hewlett Packard Enterprise
Provider Representatives handle billing and policy issues that have been
escalated from the Provider Assistance Center. They are also available to visit
your office by appointment.
Don’t know who your Provider Representative is? On the Medicaid website,
click on “Meet your HP Enterprise Services Provider Rep” and then click on your
county
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Questions?
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