Provider Notice Issued 10/17/2019

Date:    October 17, 2019
 
To:       All Medical Assistance Program Providers
 
Re:      Phase-out of Paper Claim Billing
 
 
This notice informs providers that effective with claims received on and after November 1, 2019, the Department will no longer accept paper claims that do not require an attachment for processing. This impacts fee-for-service paper claims for all institutional and non-institutional Medical Assistance Program providers.
 
As a step toward paperless billing, the Department will only accept paper claims if an attachment is required. Claims that do not require an attachment should be filed electronically. The Department encourages paperless billing through these mediums:
 
  • Medical Electronic Data Interchange (MEDI) System
 
The MEDI Authorization System is available free of charge and provides a repository for authorization information for access to HFS’ Internet applications. In order to gain access to these applications, a person must register in the MEDI system. The MEDI Getting Started page presents what is required to use these applications.
 
No additional hardware or special software is needed. The MEDI system is available to enrolled providers and their authorized staff, claim submitting agents and payees. During the registration process, providers and authorized personnel will be given access to specific claim formats based upon the provider’s enrollment status with the Department. 
 
This system's main purpose is to provide users with the ability to perform basic processing, including submitting claims, viewing claim status, downloading Remittance Advices, and accessing other Department information online through a web interface. Through electronic claim submission, providers receive immediate feedback on many of the required field entries. In addition, a confirmation page is available to print on each successful submission of a claim. The confirmation page displays all of the fields that were entered on the claim submission, including date of submission, time of submission and confirmation number, which can be used for tracking purposes.
 
  • X12 837 Professional Standard, Version 5010A
  • X12 837 Institutional Standard, Version 5010A
 
The Department accepts non-institutional claims in the X12 837 Professional standard, Version 5010A and institutional claims in the X12 837 Institutional standard, Version 5010A.
 
Pharmacies must bill electronically through the Pharmacy Benefits Management System
·         Recipient Eligibility Verification (REV)
 
The Recipient Eligibility Verification (REV) system is an interactive electronic system which allows providers to: verify a participant’s eligibility; submit claims electronically; check the status of claims in processing, and download batches of claim information.
 
Providers access the REV system through vendors (independent contractors) who have agreements with the Department to provide this service. REV vendors provide this service by various methods, including: standardized software for use on existing PCs; point-of-service devices, and custom programming of a provider’s existing computer system to accept and transmit the Department’s data.
 
All current REV vendors also act as clearinghouses for other public and private payers. In this role, REV vendors offer services beyond those related to the Department’s programs. For example, these vendors may offer general computer accounting support, preliminary claim editing, accounts receivable posting, and claims submittal to various third-party payers. Providers pay the REV vendors for whatever mix and volume of services are selected.
 
Attachments Required for HFS Processing
 
Effective with claims received on and after November 1, 2019, the Department will only accept paper claims that have one of the following attachments required for claims processing: 
 
·         HFS 1624 – Override Request Form (for non-institutional providers)
·         HFS 1624A – UB-04 Override Request Form (for institutional providers)
·         HFS 1977 – Acknowledgement of Receipt of Hysterectomy
·         HFS 2189 – Sterilization Consent Form
·         HFS 2432 – Split Billing Transmittal (for Medical Spenddown program)
·         HFS 2803 – Optical Prescription Order
·         Any required attachments for adjudication of the paper claim submission as referenced in the specific Chapter 200 provider handbook.
 
The HFS 2390, Abortion Payment Application, is being obsoleted effective with claims received on and after November 1, 2019 and will no longer be required for processing.
 
Paper claim forms received without one of the required attachments will be returned to the billing provider address submitted on the paper claim form if received after November 1, 2019.
 
Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services (non-institutional providers) or to the Bureau of Hospital and Provider Services (institutional providers) at 877-782-5565.
 
 
Doug Elwell
Medicaid Director
 

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