March 2002 Medicaid Bulletin title

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In This Issue . . .

All Providers: Carolina ACCESS Primary Care Providers: Federally Qualified Health Centers: Health Departments: Long-Term Care Providers: Mental Health Services Providers: Nurse Midwives: Nurse Practitioners: Personal Care Services Providers: Physicians: Rural Health Clinics:

Attention: All Providers

Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Friday, March 29, 2002, in observance of Good Friday.

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

Attention: Long-Term Care Providers

Quality Control Eligibility Reviews of Medicaid Recipients in Long-Term Care

The Division of Medical Assistance's Quality Assurance Section is conducting a Quality Control (QC) pilot project that focuses on Medicaid eligibility of recipients receiving long-term care services in nursing facilities, ICF/MRs, and hospitals. The reviews are based on a statewide monthly sample of randomly selected cases. The purpose of the QC reviews is to determine if the county department of social services correctly determined the recipient's eligibility for Medicaid by verifying the recipient's income, resources, and all other eligibility criteria.

During the QC review process, the QC Analyst (QCA) reviews the county department of social service's case records as well as conducts a face-to-face interview with the recipient, when possible, and the recipient's responsible representative(s). The QCA also interviews the facility's business manager regarding the following issues as part of the recipient eligibility determination.

The QC reviews are being conducted by the QCAs listed below. If you have any questions about the Medicaid QC process or the QCAs visiting your facility, you may contact Debbie Chamblee or Elizabeth Goss with the Division of Medical Assistance at 919-733-3590.

Debbie Chamblee, Program Integrity
Elizabeth Goss, Program Integrity
DMA, 919-733-3590

Attention: Physicians, Nurse Practitioners, Nurse Midwives, Health Departments, Federally Qualified Health Centers, and Rural Health Clinics

Mirena (Levonorgestrel-Releasing Intrauterine System, Code J7302) Coverage Criteria

Effective with date of service September 1, 2001, the N.C. Medicaid program covers Mirena (levonorgestrel-releasing intrauterine system, also referred to as an IUD).

Providers must bill with code J7302 on the HCFA-1500 claim form. Providers are reminded that if an Evaluation and Management code is billed, the visit will count as one of the 24 legislative visits allowed per year. The legislative limitation on visits does not apply to individuals under the age of 21. CPT codes 58300, insertion of intrauterine device (IUD), and 58301, removal of intrauterine device (IUD), remain covered services.

Billing on the HCFA-1500 Claim Form:

Date(s) of Service
Place of Service
Procedures, Services or Supplies
Days or Units

Federal Qualified Health Centers and Rural Health Clinics must enter their six-digit provider number with the alpha "C" for physician services. If a face-to-face encounter with a physician or physician extender occurs on the same date of service as the IUD insertion, a core visit may be billed on a separate claim using the clinic's or center's six-digit provider number and the alpha "A."

Providers must bill their usual and customary charge. The maximum reimbursement rate for Mirena is $395.00.

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

Attention: Carolina ACCESS Primary Care Providers

Carolina ACCESS Provider Surveys

The Managed Care Section of the Division of Medical Assistance (DMA) is conducting a Provider Satisfaction Survey and a Contractual Compliance Survey on a random sample of Carolina ACCESS (CA) Primary Care Providers. The purpose of the surveys is to gather information, which will enable DMA to strengthen the CA program.

Your office may be contacted by telephone or letter during the months of March through May to complete one of the surveys. Provider participation is necessary to make the surveys a useful tool. Your cooperation in returning a prompt and accurate response is appreciated.

Laurie Giles, Managed Care Section
DMA, 919-857-4022

Attention: Mental Health Services Providers

Prior Approval and Medicare

Prior approval is not required for Medicare covered mental health services rendered to Medicare/Medicaid dually eligible recipients when Medicare is their primary payer. Because Medicare does not require providers to request prior approval for services, it is not necessary for Medicaid providers to request authorization from ValueOptions for inpatient or outpatient services to these clients.

When Medicare is not the primary payer for services rendered by Area Mental Health Programs or their employees who are not eligible to bill Medicare, authorization must be obtained from ValueOptions in accordance with Medicaid requirements.

Carol Robertson, Behavioral Health Services
DMA, 919-857-4020

Attention: All Providers

Health Insurance Portability and Accountability Act Compliance Training

Training sessions for compliance with the Health Insurance Portability and Accountability Act transaction standards are scheduled to begin this summer. Upcoming general Medicaid bulletins will have the registration form with a list of the dates and site locations for the training sessions.

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

Attention: Personal Care Services Providers (excluding Adult Care Home Providers)

Cancellation of the Personal Care Services Seminars and Requests for Individual Visits

The Personal Care Services (PCS) seminars scheduled for March 2002 have been cancelled. EDS is now offering individual provider visits for PCS providers as an alternative. These visits are offered for new as well as existing providers with billing issues. Please complete and return theProvider Visit Request form. An EDS provider representative will contact you to schedule a visit and discuss the type of issues to be addressed.

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

Attention: All Providers

Basic Medicaid Seminar Schedule

Basic Medicaid seminars are scheduled for April 2002. Seminars are intended for providers who are new to the N.C. Medicaid program. Topics to be discussed will include, but are not limited to, provider enrollment requirements, billing instructions, eligibility issues, and Managed Care, including Carolina ACCESS and HMOs. Persons inexperienced in billing N.C. Medicaid are encouraged to attend.

Due to limited seating, preregistration is required and limited to two staff members per office. Unregistered providers are welcome to attend when reserved space is adequate to accommodate. Please select the most convenient site and return the completed Basic Medicaid Seminar Registration form to EDS as soon as possible. Seminars begin at 10:00 a.m. and end at 1:00 p.m. Providers are encouraged to arrive by 9:45 a.m. to complete registration.

Directions to the sites
Tuesday, April 2, 2002
Catawba Valley Technical College
Highway 64-70
Hickory, NC
Tuesday, April 9, 2002
Martin Community 
Kehakee Park Road
Williamston, NC
Tuesday, April 16, 2002
Coast Line Convention Center 
501 Nutt Street 
Wilmington, NC
Tuesday, April 23, 2002
Andrews Conference Center 
3000 New Bern Avenue
Raleigh, NC

Directions to the Basic Medicaid Seminars


Take I-40 to exit 125. Travel approximately .5 mile to Highway 70 East. The college is located approximately 1.5 mile on the right. Ample parking is available. The entrance to the Auditorium is between Student Services and the Maintenance Center. Follow the sidewalk (toward satellite dish) and turn right to Auditorium entrance.


Take Highway 64 into Williamston. Martin Community College is located approximately 1 to 2 miles west of Williamston. The Auditorium is located in Building 2.


Take I-40 east to Wilmington. Take the Highway 17 exit. Turn left onto Market Street. Travel approximately 4 or 5 miles to Water Street. Turn right onto Water Street. The Coast Line Inn is located one block from the Hilton on Nutt Street behind the Railroad Museum.


Driving and Parking Directions

Take the I-440 Raleigh Beltline to exit 13A, New Bern Avenue.

Paid parking ($3.00 maximum per day) is available on the top two levels of parking deck P3. To reach the parking deck, turn left at the fourth stoplight on New Bern Avenue, and then turn left at the first stop sign. Parking for oversized vehicles is available in the overflow lot for parking deck P3. Handicapped accessible parking is available in parking lot P4, directly in front of the conference center.

To enter the Andrews Conference Center, follow the sidewalk toward New Bern Avenue past the Medical Office Building to entrance E2 of the William F. Andrews Center for Medical Education.

Illegally parked vehicles will be towed. Parking is not permitted at East Square Medical Plaza, Wake County Human Services or in parking lot P4 (except for handicapped accessible parking).

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

A copy of an order for a preliminary injunction related to Home Health Services and Personal Care Services (in private residences) is available on the Division of Medical Assistance's website.

Checkwrite Schedule
March 5, 2002 
April 9, 2002 
May 7, 2002 
March 12, 2002 
April 16, 2002 
May 14, 2002 
March 19, 2002 
April 25, 2002 
May 21, 2002 
March 28, 2002 
May 30, 2002 

Electronic Cut-Off Schedule
March 1, 2002  April 5, 2002  May 3, 2002 
March 8, 2002  April 12, 2002  May 10, 2002 
March 15, 2002  April 19, 2002  May 17, 2002 
March 22, 2002    May 24, 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.

Providers are responsible for informing their billing agency of information in this bulletin.

Bold, italicized material is excerpted from the American Medical Association Current Procedural Terminal CPT Codes. Descriptions and other data only are copyrighted 2001 American Medical Association. All rights reserved.

______________________ _______________________
Nina M. Yeager, Director Ricky Pope
Division of Medical Assitance Executive Director
Department of Health and Human Services  EDS

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