Providers Performing EPSDT Blood Lead Level (BLL) Tests New

May 31, 2017

Focus On…  Providers Performing EPSDT Blood Lead Level (BLL) Tests – New  Medicaid Remittance Advices – New  Provider Enrollment Applications Top 5 Errors  Provider Enrollment Online  Billing Secondary Claims Electronically  Adjustments, Reconsiderations and Voids  Return to Provider (RTP) Top 4 Reasons  2017 HCPCS Codes  ITU Service Providers Monthly IHS Open Forum BOM Meeting  Conduent Contact Information

Providers Performing EPSDT Blood Lead Level (BLL) Tests The Food and Drug Administration (FDA) has issued a statement that blood lead test results may be inaccurate. The FDA reported that Magellan LeadCare Testing Systems for venous tests have been found to underestimate blood lead levels, resulting in a false negative.

Magellan Diagnostics has been working to mitigate this problem since August 2014. The Centers for Disease Control (CDC) recommends that pregnant or lactating women who received this test be retested using another method.

Children should be retested using another method if they meet all of the following criteria:

1. Currently under 6 years old;

2. Had a venous test evaluated on the Magellan LeadCare Testing Systems; and

3. Had a blood lead level (BLL) test result less than 10 µg/dL.

The complete article can be viewed at:

http://www.aappublications.org/news/2017/05/17/LeadTest051717 The FDA safety notice can be accessed at:

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm558769.htm For assistance or additional guidance, you may contact Magellan Diagnostics at 800-275-0102 http://magellandx.com/# or the FDA at 800-638-2041 or [email protected].

For New Mexico Medicaid providers, claims submitted for retesting BLL should be submitted with the following modifiers:

 Procedure Code 83655 - Modifier 76 – Repeat Procedure by Same Physician

 Procedure Code 83655 - Modifier 77 – Repeat Procedure by Another Physician

If you have any questions related to this communication, please call the New Mexico Medicaid Call Center at 1-800-299-7304, option 6.

Medicaid Remittance Advices

Effective May 8th, 2017, Conduent will no longer respond to Remittance Advice (RA) requests either printed or through secure email for RAs that are available on the New Mexico Medicaid Web Portal.

RAs requests not accessible on the portal will be sent to requestor via secure email only, no exceptions. RA requests submitted to NM Provider Support with paid dates greater than 3 months, will take 8 weeks from date of recipient.

Important Reminders:  Retrieve your weekly RA from the New Mexico Medicaid Web Portal  Only the current eight (8) RAs are available on the web portal (https://nmmedicaid.acs- inc.com/static/providerlogin.htm). If you are having trouble accessing your accounts via the web portal or need additional assistance, please contact the HIPAA Helpdesk at 1-800-299-7304, option 6, then option 4.

Provider Enrollment Applications Top 5 Errors

The New Mexico Medicaid Provider Enrollment team is taking steps to implement more timely and efficient processing so you can become a provider with New Mexico Medicaid. Conduent is working towards reducing the number of Provider Applications that are deferred for missing or incorrect information.

Here are our top five (5) errors to keep in mind while completing the provider enrollment application.

1.) Incorrect National Provider Identification Number (NPI)

Note: MAD-312 applications (for individuals) need a Type 1 NPI, and MAD-335 applications (for groups) need a Type 2 NPI.

Tip: We recommend visiting the National Plan and Provider Enumeration System (NPPES) website to ensure the correct NPI is entered on the application. The NPPES website is listed directly below:

https://nppes.cms.hhs.gov/NPPES/Welcome.do

2.) Expired Insurance

Tip: To ensure processing is not delayed, we cannot accept any licenses that will expire within 30 calendar days from the day Conduent receives your application.

3.) Incomplete or Missing Information – IRS Letter/W-9 or Approval Letters

Tip: We recommend you refer to the Provider Type and Specialty List before submitting your application in order to review the required attachments for your specific provider type.

4.) Board Certification

Tip: Refer to the Provider Type and Specialty List before sending in your application. Verify that all pertaining documents associated with credentialing your provider type have been included in your enrollment application.

5.) Signature

Tip: Double check that your application has been signed before submitting. Paper applications must be signed in blue ink. Photocopied, stamped, or scanned signatures will not be accepted.

To reduce the chance of your application getting returned, consider submitting the application through the NM Medicaid Web Portal. On the web portal, you will be able to refer to the Provider Type and Specialty List while completing the application, and will receive error messages when required fields are not populated to further assist in the process.

Please review the Provider Enrollment Online Application Process article listed directly below to learn more about the online submission process.

Provider Enrollment Online Application Process

NM Medicaid is taking steps to reduce paper application handling in an effort to improve and streamline the provider enrollment process. MAD 335(Group or Individual Billing Providers) and MAD 312 (Provider Affiliated with a Billing Group) Provider Enrollment Applications can be submitted electronically on the NM Medicaid Web Portal at the link below:

Provider Enrollment Web Application

There are advantages to submitting provider applications electronically:

 Application rejections and resubmissions are minimized  Applications are delivered to Conduent immediately through the portal  Processing occurs expeditiously, improving timeliness of the applications process

Attention MAC users: Safari browser may not be compatible with certain devices when navigating the online enrollment process. Please use other browsers such as Firefox, Explorer etc. to complete the process. Conduent is aware of the issue and is working to resolve the problem.

If you are unable to submit a Provider application using the online enrollment process, please contact the Provider Relations department for assistance at [email protected] or 1-800-299-7304.

Billing Secondary Claims Electronically

You may bill Medicaid Fee-For-Service Medicare Crossover claims and Third Party Liability (TPL) claims electronically. This includes claims for which a copayment, deductible, or coinsurance is due following Medicare or Medicare Advantage Plan payment or following payment made by a recipient’s insurance plan. Typically, these claims have a Filing Indicator or SBR09 of MA, MB, or 16.

Please follow the rules specified in the ANSI ASC X12N 5010 Health Care Claim -Professional/Institutional 837 Implementation Guide regarding coordination of benefits information.

The New Mexico Human Services Department (HSD) and Conduent, have instructed providers to utilize electronic submission to expedite processing, reduce errors and to better protect the privacy of providers and recipients. Please review Supplement 15-03. This Supplement lists multiple topics, including Billing Using Paper Claims. Link below:

http://www.hsd.state.nm.us/providers/Registers_and_Supplements.aspx

Also visit the NM Medicaid Web Portal for a listing of valid required attachments for online billing. Link below:

https://nmmedicaid.acs-inc.com/static/PDFs/TrainingPresentations/Required%20attachments %20and%20Webportal%20selections%20for%20claim%20submissions.pdf

Effective July 1st, 2017 Conduent NM Medicaid Fee for Service will no longer accept the Third Party Liability (TPL) claims via paper submissions. Third Party Liability (TPL) claims can be submitted through EDI or Web portal.

Please contact the NM Medicaid HIPAA Help Desk if you have electronic billing questions at [email protected] or 1-800-299-7304, option 6, then 4.

Adjustments, Reconsiderations and Voids

The following article will provide information on when to use the Adjustment, Reconsideration or Void Form.

Please note that all completed Adjustments, Reconsiderations and Voids must have the requester’s signature. Forms must also have an original claim form attached; copied or computer generated claims are not accepted, therefore will be returned to the provider. Use the Adjustment request form to make any changes to a claim that was paid incorrectly.

 Must be submitted with a corrected CMS-1500 or UB-04 claim form and must include red drop- out ink and the legal claim notice printed on the back.

 Always fill out the corrected claim (replacement claim) exactly as the claim was originally filed, with the exception of the information being changed.

 Adjustment requests must be submitted within 90 days from the date on the Remit Advice (RA) for the original paid claim. Remittance Advice (RA) must be attached.

 Submitting Adjustments via the web portal can only be done for claims submitted online. I.e. Claims that were originally submitted through the web portal (these claims are indicated by TCNs that begin with a 9), can be adjusted via the web portal.

Use the Reconsideration request form to submit additional information for a previously denied claim for reprocessing.

 Must be submitted with a corrected CMS-1500 or UB-04 claim form and must include red drop- out ink and the legal claim notice printed on the back.

 Reconsideration requests must be submitted within 90 days from the date of the original denied claim.

 Reconsideration requests cannot be completed via the web portal. Denied claims that were originally submitted through the web portal (these claims are indicated by TCNs that begin with a 9), can be corrected using the Claim Re-Bill function via the web portal.

Use the Void request form for any paid claim that needs to be fully recouped.

 Only entire claims can be voided.

 Paid claims that need lines or a line voided are to be considered as an adjustment, not a void.

 There is no time limit on when a claim can be voided.

 Voids via the web portal can only be done for online submitted claims. I.e. Claims that were originally submitted through the web portal (these claims are indicated by TCNs that begin with a 9), can be voided via the web portal.

The Adjustment, Reconsideration and Void Forms can be printed from the New Mexico Medicaid Web Portal. See link below:

https://nmmedicaid.acs-inc.com/static/ProviderInformation.htm#FormsPubs

If you have any questions related to Adjustments, Reconsiderations or Voids, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6. Return to Provider (RTP) Top 4 Reasons

For a cleaner submission of your documents, avoid these common mistakes to prevent them from being returned. Listed below are the top 4 errors to avoid when submitting claims, attachments or forms to New Mexico Medicaid.

1.)Copied or computer generated claim forms

Tip: Do not use invalid claim forms. Paper submitted claim forms must have red drop-out ink and the legal claim notice printed on the back. Please review the Paper Claim Submission Tips article listed in this E-News to learn more about valid claim forms.

2.)Missing claim attachment for the request form

Tip: The forms must include a corrected CMS-1500 or UB-04 claim form. Please review the Adjustments, Reconsiderations and Voids article listed directly above to learn more about the submission process.

3.)Font alignment issues – is the third most commonly made error amongst submitted claims. Claims are returned to the provider because the information does not fit within the boxes.

Tip: The recommended font size is 10pt for paper claims. This will allow claim information to fit within the claim boxes. Larger font sizes can cause alignment issues when processed. Please review the Paper Claim Submission Tips article listed in this E-News to learn more about paper claim submissions.

4.)Claims and Explanation of Benefits (EOBs) are illegible

Tip: Do not modify the EOB by reducing the form content. Validate that the font color is vivid and that the information relevant to the clam is distinct.

If you have any questions related to this article, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.

2017 HCPCS Code Update Conduent has completed the 2017 HCPCS Code Update. Please continue to bill your usual and customary charges.

ITU Service Providers

 Monthly IHS Open Forum

o Second Wednesday of every month; 2:00pm - 3:00pm (MST)

 BOM Meeting

o Monday, June 19, 2017 . Location: NAO Main Conference Room, 1st Floor, St. Michaels, AZ

For more information or questions about IHS matters, please contact the Conduent IHS Provider Field Representative: [email protected].

Conduent Contact Information

Disclosure- The objective of the E News, training, and webinars is to inform and educate. Articles reflect information at current time and may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their content. E News is published monthly and available on the NM Medicaid Web Portal.