May 2000 Medicaid Bulletin

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Providers are responsible for informing their billing agency for information in this bulletin
In This Issue

All Providers:

All Physicians:

Dental Providers:

Health Departments:

Home Health Providers:

Hospice Providers:

Hospital Providers:

Mental Health/Substance Abuse Providers:

Nursing Facility Providers

OB/GYN Providers

Attention: All Providers

Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Monday, May 29, 2000 in observance of Memorial Day.

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

Attention: All Providers

Fee Schedules, Reimbursement Plans and Medicaid Bulletin Subscriptions

Request for Paper Schedules/Plans

There is no charge for fee schedules or reimbursement plans requested from the Division of Medical Assistance. However, all requests for publications should be made on the Request for Paper Schedules/Plans Form  and mailed to the following address below, or you can fax your request as indicated:


Division of Medical Assistance
Financial Operations - Fee Schedules
2509 Mail Service Center
Raleigh, N. C. 27699-2509

You may fax your request to (919) 715-0896/ DMA Financial Operations.

Do not mail your requests for paper schedules to EDS.

Request for Diskette of Physician Fee Schedule and Anesthesia Base Units Schedule

The PHYSICIAN FEE SCHEDULE and the ANESTHESIA BASE UNIT SCHEDULE are available on diskette or via email from DMA at no charge. The North Carolina Division of Medical Assistance stipulates that the information provided be used only for your internal analysis. The actual billed amount on your claims must always contain your regular billed amount and not the price on the fee schedule unless the listed price represents what you normally bill another payer or patient. The billed amount is considered during rate setting efforts.

Request for Diskette of Physician Fee Schedule and Anesthesia Base Units Schedule Form

Medicaid Bulletin Subscriptions

N. C. Medicaid bulletins are mailed to all enrolled providers. Non providers (e.g. billing agencies) may subscribe to the bulletin for an annual subscription fee of $12.00. To subscribe, send a letter including the subscriber's mailing address and a check for $12.00 payable to EDS to:

Attention: Provider Enrollment
P. O. Box 300009
Raleigh, N. C. 27622

DMA - Financial Operations for fee schedules and/or reimbursement plans at 919-857-4015 or
EDS - Provider Enrollment for Bulletin Subscriptions, at 1-800-688-6696 or 919-851-8888

Attention: All Providers

Accessing Hospice Participation Information on Automated Voice Response (AVR) System

Effective May 1, 2000, Hospice stickers are no longer required on Medicaid ID Cards. Hospice participation information can be determined through the AVR system by dialing 1-800-723-4337 and following the call flow as provided below.

When a provider calls the AVR system, the AVR responds with one of the following messages.

If the system is unavailable, the provider receives the following message:

"Thank you for calling EDS. The North Carolina Medicaid voice inquiries system is unavailable between 1:00 AM and 5:00 AM on the 1st, 2nd, 4th, and 5th Sunday of the month, and between 1:00 AM and 7:00 AM on the 3rd Sunday of the month. Please try your call again later."

If the system is available, the provider receives the following greeting:

"Thank you for calling the EDS Voice Response System. Please listen carefully, our menu options have been modified since (last modify date)."

"Welcome to the EDS voice inquiry. For North Carolina Medicaid inquiries, please press 1. If you are calling from a rotary telephone or for other business, please call 919-851-8888 or 1-800-688-6696."

If the provider presses 1, the call flow continues to Step 1.0. If no entry is made after the 10-second timeout, AVR assumes the provider is calling from a rotary phone and disconnects the caller.

"Please choose one of the following options. To verify the status of a claim, press 1. To receive provider check write information, press 2. To verify drug coverage, press 3. To verify procedure code pricing and modifier information, press 4. To verify prior approval, press 5. To verify Recipient Eligibility and Coordination of Benefits, Managed Care and Hospice status, press 6. To verify the status of a hysterectomy statement or sterilization consent, press 7. If you are calling for pre-admission certification, please call (919) 851-8888 or 1(800) 688-6696. To repeat these options, press 9."

When the provider selects option 6 in Step 1.0, main menu, the AVR prompts the provider to enter their North Carolina Medicaid provider number for verification.

"Please enter your provider number followed by the pound sign (#)."

The system asks the caller to verify their entry. The system then validates the given provider number. If the caller has correctly entered a valid provider number, AVR speaks the following message.

"To verify Recipient Eligibility and Coordination of Benefits, press 1. To verify Hospice Eligibility, press 2. To repeat these options press 3."

When the provider selects option 2, the AVR prompts the provider to enter a valid recipient identification number (MID).

"To obtain recipient Hospice status, please enter the ten-digit recipient identification number followed by the pound sign (#).

The AVR validates the entry for 9 numeric digits followed by an alpha. The system then asks the caller to verify their entry. Once the caller verifies their entry, AVR prompts the provider to enter the date of service.

"Please enter the date of service in an eight-digit month, date, century, and year format, followed by the pound sign (#)."

The AVR will validate that the MMDDCCYY entry is a valid date and that it is not a future date. If the user enters an invalid date, the standard error message will be given. If the user enters a future date, AVR will speak the following message.

"Hospice status cannot be obtained for future dates. Please re-enter the date of service."

If the user enters a valid date, the system will verify the entry. After the user verifies the entry, the system will play the following message:

"Please wait while the requested information is retrieved."

The system will then retrieve the information from the host. If the recipient identification number is not valid the caller will hear the following message:

"The recipient, (MID), is not on file."

If the MID is valid and the recipient is on Hospice for the requested date of service, AVR will speak the following message:

"The recipient, (MID), has been reported on Medicaid Hospice for (MMDDCCYY - the specified date). Medicaid Hospice covers most care related to a terminal illness; therefore, Hospice participation may affect your ability to be paid by Medicaid. Ask the recipient or the recipient's representative to give you the name of the hospice agency. Contact the hospice agency before rendering service."

If the MID is valid and the recipient is not on Hospice for the requested date of service, AVR will speak the following message:

"The recipient, (MID), has NOT been reported on Medicaid Hospice for (MMDDCCYY - the specified date). Nevertheless, if the recipient or the recipient's representative indicates possible Hospice participation, please ask the recipient or representative for the name of the hospice agency and contact the agency before rendering services. Medicaid Hospice covers most care related to a terminal illness; therefore, Hospice participation may affect your ability to be paid by Medicaid."

Once the AVR system has completed the Hospice status transaction, the provider is given the option to check another date of service, verify Hospice status for a different recipient, or return to the main menu.

"To repeat the Hospice status for this recipient, press 1. To verify another date of service for the same recipient, press 2. To verify Hospice status for a different recipient, press 3. To return to the main menu, press 8. To repeat these options press 9. To end this call, please hang up."

For further information on the North Carolina Automated Voice Response (AVR) System, please refer to the June 1999 North Carolina Medicaid Special Bulletin. Providers who have the Medicaid Community Care Manual may refer to Appendix D in the manual for information on AVR. Appendix D is a reprint of the June 1999 special bulletin.

The call flow for Option 6 has been modified to allow inquiry on recipient Hospice status, effective for dates of service on or after May 1, 2000.

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

Attention: All Mental Health/Substance Abuse Providers

New Health Benefit

Effective July 1, 2000 a new preventive/early intervention mental health benefit will be available to approximately 400,000 state employees and teachers and 60,000 children enrolled in N. C. Health Choice. Medicaid will adopt this policy for recipients under the age of 21. This plan will allow children to get mental health checkups similar to annual physicals.

Billing guidelines:
Medicaid will pay for six unmanaged visits without a diagnosis of Mental Illness.

Diagnosis coding: Claims may be diagnosis coded in either of two ways: (1) only the first two visits can be coded with ICD-9-CM code 799.9 (a non-specific code) and the following four visits can be coded with "V" diagnosis codes; or (2) the first visit can be coded with diagnosis 799.9 and the rest of the visits can be coded with "V" diagnosis codes. In either case, a specific diagnosis code should be used as soon as a diagnosis is established. After the sixth visit, a definitive diagnosis must be submitted in order for claims to be processed.

Prior approval:
Prior approval is not required for area mental health centers, however physicians and Ph.D. or Masters-level psychologists employed by physicians and who are not employed by area mental health centers must follow prior approval guidelines. Beyond the six unmanaged visits Medicaid will cover without a diagnosis of mental illness, Medicaid will cover up to 20 additional visits without prior approval. Prior approval must be requested for children under age 21 after the twenty-sixth visit. This permits a total of twenty-six unmanaged visits in a calendar year for the under 21 years of age population. This preventive mental health benefit will make it possible for children to receive services at the earliest signs of trouble.

Contact Carolyn Wiser, RN at 919-857-4025

Attention: Physicians and Health Departments

Medication Administration Codes

Effective with date of service July 1, 2000, the Medication Administration Code Q0124 will be replaced by medication specific CPT codes 90471-90788. There will be a grace period from July 1, 2000 to September 30, 2000 when the old or the new administration codes may be billed.

Health Check Providers must bill the Immunization Update Code W8012 for immunization administration for childhood immunizations. The CPT Therapeutic, Prophylactic, Diagnostic administration codes, 90782-90784, must be used for all other injections. W8012 can be billed with or without a separate office visit.

The newly covered CPT codes are:
90471 "Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration); one vaccine (single or combination vaccine/toxoid) CPT Codes 90476 through 90749 (Vaccines and toxoids)

For adults only. For childhood immunization use W8012.

When a significant separately identifiable Evaluation and Management service is performed, the appropriate E/M service code can be reported in addition to the vaccine and toxoid administration codes.

90472 " each additional vaccine (single or combination vaccine/toxoid List separately in addition to code for primary procedure (90471) for CPT codes 90476 through 90749

For adults only. For childhood immunization use W8012.

90782 "Therapeutic, prophylactic or diagnostic injection (specify material injected): subcutaneous or intramuscular For administration of subcutaneous or intramuscular injections. This includes the Immune Globulins. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.
90783 "Therapeutic, prophylactic or diagnostic injection (specify material injected); intra-arterial For administration of intra-arterial injections. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.
90784 "Therapeutic, prophylactic or diagnostic injection (specify material injected); intravenous For administration of intravenous injections. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.
90788 "Intramuscular injection of antibiotic (specify) For administration of an intramuscular injection of an antibiotic. The drug should be billed on a separate detail line. The administration code is not billable in addition to an office visit. Code is available for adults and children.

Administration codes are billable when the following conditions are met:

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

Attention: All Providers

Resubmission vs. Filing Adjustment

If one of the following EOBs is received and the validity is questionable, do not appeal by submitting an adjustment request. Please contact EDS provider services at 1-800-688-6696 or 919/851-8888. Adjustments submitted for these EOB denials will be denied with EOB 998 "Claim does not require adjustment processing, resubmit claim with corrections as a new day claim" or EOB 9600 "Adjustment denied - claim has been resubmitted. The EOB this claim previously denied for does not require adjusting. In the future, correct/resubmit claim in lieu of sending an adjustment request." (Last Revision 02/25/00)
0002 0003 0004 0005 0007 0009 0011 0013 0014
0017 0019 0023 0024 0025 0026 0027 0029 0033
0034 0035 0036 0038 0039 0040 0042 0041 0046
0047 0049 0050 0051 0058 0062 0063 0065 0067
0068 0069 0074 0075 0076 0077 0078 0079 0080
0082 0084 0085 0089 0090 0093 0094 0095 0100
0101 0102 0103 0104 0105 0106 0108 0110 0111
0112 0113 0114 0115 0118 0120 0121 0122 0123
0126 0127 0128 0129 0131 0132 0133 0134 0135
0138 0139 0141 0143 0144 0145 0149 0151 0153
0154 0155 0156 0157 0158 0159 0160 0162 0163
0164 0165 0166 0167 0170 0171 0172 0174 0175
0176 0177 0179 0181 0182 0183 0185 0186 0187
0188 0189 0191 0194 0195 0196 0197 0198 0199
0200 0201 0202 0203 0204 0205 0206 0207 0208
0210 0211 0213 0215 0217 0219 0220 0221 0222
0223 0226 0227 0235 0236 0237 0240 0241 0242
0244 0245 0246 0247 0249 0250 0251 0253 0255
0256 0257 0258 0270 0279 0282 0283 0284 0286
0289 0290 0291 0292 0293 0294 0295 0296 0297
0298 0299 0316 0319 0325 0326 0327 0356 0363
0364 0394 0398 0424 0425 0426 0427 0428 0430
0435 0438 0439 0452 0462 0465 0505 0511 0513
0516 0523 0525 0529 0536 0537 0548 0553 0556
0557 0558 0559 0560 0569 0572 0574 0575 0576
0577 0578 0579 0580 0581 0584 0585 0586 0587
0588 0589 0590 0593 0604 0607 0609 0610 0611
0612 0616 0620 0621 0622 0626 0635 0636 0641
0642 0661 0662 0663 0665 0666 0668 0669 0670
0671 0672 0673 0674 0675 0676 0677 0679 0680
0681 0682 0683 0685 0688 0689 0690 0691 0698
0732 0734 0735 0749 0755 0760 0777 0797 0804
0805 0814 0817 0819 0820 0822 0823 0824 0825
0860 0863 0864 0865 0866 0867 0868 0869 0875
0888 0889 0898 0900 0905 0908 0909 0910 0911
0912 0913 0916 0917 0918 0919 0920 0922 0925
0926 0927 0929 0931 0932 0933 0934 0936 0940
0941 0942 0943 0944 0945 0946 0947 0948 0949
0950 0952 0953 0960 0967 0968 0969 0970 0972
0974 0986 0987 0988 0989 0990 0991 0992 0995
0997 0998 1001 1003 1008 1022 1023 1035 1036
1037 1038 1043 1045 1046 1047 1048 1049 1050
1057 1058 1059 1060 1061 1062 1063 1064 1078
1079 1084 1086 1087 1091 1092 1152 1154 1156
1170 1175 1177 1178 1181 1183 1184 1186 1197
1198 1204 1232 1233 1275 1278 1307 1324 1350
1351 1355 1380 1381 1382 1400 1404 1442 1443
1502 1506 1513 1866 1868 1873 1944 1949 1956
1999 2024 2027  2235 2236 2237 2238 2335 2911
2912 2913 2914 2915 2916 2917 2918 2919 2920
2921 2922 2923 2924 2925 2926 2927 2928 2929
2930 2931 2944 3001 3002 3003 5001 5002 5201
5206 5216 5221 5222 5223 5224 5225 5226 5227
5228 5229 5230 6703 6704 6705 6707 6708 7700
7701 7702 7703 7704 7705 7706 7707 7708 7709
7712 7717 7733 7734 7735 7736 7737 7738 7740
7741 7788 7794 7900 7901 7904 7905 7906 7907
7908 7909 7910 7911 7912 7913 7914 7915 7916
7917 7918 7919 7920 7921 7922 7923 7924 7925
7926 7927 7928 7929 7930 7931 7932 7933 7934
7935 7936 7937 7938 7939 7940 7941 7942 7943
7944 7945 7946 7947 7948 7949 7950 7951 7952
7953 7954 7955 7956 7957 7958 7959 7960 7961
7962 7963 7964 7965 7966 7967 7968 7969 7970
7971 7972 7973 7974 7975 7976 7977 7978 7979
7980 7981 7982 7983 7984 7985 7986 7987 7988
7989 7990 7991 7992 7993 7994 7996 7997 7998
7999 8174 8175 8326 8327 8400 8401 8901 8902
8903 8904 8905 8906 8907 8908 8909 9036 9054
9101 9102 9103 9104 9105 9106 9174 9175 9180
9200 9201 9202 9203 9204 9205 9206 9207 9208
9209 9210 9211 9212 9213 9214 9215 9216 9217
9218 9219 9220 9221 9222 9223 9224 9225 9226
9227 9228 9229 9230 9231 9232 9233 9234 9235
9236 9237 9238 9239 9240 9241 9242 9243 9244
9245 9246 9247 9248 9249 9250 9251 9252 9253
9254 9256 9257 9258 9259 9260 9261 9263 9264
9265 9266 9267 9268 9269 9272 9273 9274 9275
9291 9295 9600 9611 9614 9615 9625 9630 9631
9633 9642 9684 9801 9804 9806 9807 9919 9947

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

Attention: All Physicians

Correction To Injectable Drug List

Effective with date of service April 1, 2000, the following correction is made to the fee for Daunorubicin Citrate Liposome 10 mg, J9151. The fee listed in the April Medicaid Bulletin was for the previous dosage of 50 mg which was the dosage for the state code W5163.
New Code Description Fee
J9151 Daunorubicin Citrate Liposome 10 mg $61.37

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

Attention: Dental Providers

New Dental Claim Form and Code Updates for the Year 2000

The American Dental Association (ADA) has updated the ADA claim form and the Current Dental Terminology Users Manual for the year 2000. The ADA recommended use of the 1999 ADA claim form beginning in January, 2000. While keeping in compliance with the ADA changes, DMA and EDS must allow time for system changes to be implemented before accepting the 1999 ADA claim form. Providers should continue to use the 1994 ADA claim form for North Carolina Medicaid. DMA and EDS are working on the necessary system changes that must occur before acceptance of the 1999 form. Our anticipated implementation date for the 1999 ADA claim form is July 1, 2000. A transition period of three months will allow the 1994 and the 1999 claim forms to be accepted from July 1, 2000 through September 30, 2000.

Note: See a sample of the 1999 ADA claim form .

Updates to the Current Dental Terminology Users Manual contain revised procedure code descriptions, procedure code deletions, and new ADA procedure code additions. DMA and EDS strive to use codes in accordance with the ADA; however, providers should continue to submit the procedure codes identified in the North Carolina Medicaid Dental Services Manual until further notification. DMA and EDS are working on the necessary system changes that must occur before the new procedure codes will be implemented. The anticipated implementation date for the new ADA procedure codes is also July 1, 2000.

Watch upcoming Medicaid Provider Bulletins for exact dates and additional information regarding implementation of the 1999 ADA claim form and 1999 ADA code updates.

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

Attention: All Providers

Pap Smear Billing Changes

Based on recommendations to align with Medicare, the following policy changes are effective with date of service June 01, 2000 when billing Pap smears:

Physician Interpretation Procedure Code and Billing Information

CPT 88141 is the only code that physicians may use to bill the physician interpretation of a Pap smear. Because code 88141 has no components, it must be billed without a modifier. For dates of service June 1, 2000 and after, code 88141 appended with modifier 26 will be denied. Hospitals billing for the physician interpretation should bill 88141 on the HCFA-1500 claim form using the hospital's professional provider number.

Technical Pap Smear Component Procedure Codes and Billing Information

The technical procedure codes are listed below. The provider rendering the technical service must choose a technical procedure code from one of the following methods:
Thin Layer Non-Bethesda   Bethesda Not Specified

Laboratories and physicians: Bill the technical component procedure code without a modifier on the HCFA-1500 claim form.

Hospitals: Bill the technical component procedure code, without a modifier, using Revenue Code (RC) 311 on the UB-92 claim form.

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

Attention: All Nursing Facility Providers

Discharge of a Nursing Facility Resident

When a Nursing Facility resident requires hospitalization, the Nursing Facility provider must indicate a discharged status in form locator 22 and a discharged bill type in form locator 4 on the UB-92 claim form. Nursing Facility claims billed incorrectly are subject to recoupments.

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

Attention: Physicians, Health Departments, Nurse Practitioners, Nurse Midwives, Rural Health, and FQHC Providers

Implantable Contraceptive Capsules

Effective with date of service July 1, 2000, all physicians will bill the Current Procedural Terminology (CPT) codes for the Implantable Contraceptive Capsules (previously referred to as Norplant). There will be a grace period from July 1, 2000 to September 30, 2000 when the Implantable Contraceptive Capsules may be billed using state created codes or CPT codes. The state created codes that will be end-dated with date of service October 1, 2000 are:

W5131 Insertion procedure Norplant system
W5132 Removal procedure Norplant system
W5133 Removal and re-insertion plus Norplant System kit

The following CPT/HCPCS codes will be used for physician billing on the HCFA-1500 claim form:

CPT 11975 "Insertion, implantable contraceptive capsules".
CPT 11976 "Removal, implantable contraceptive capsules".
CPT 11977 "Removal with reinsertion, implantable contraceptive capsules".
A4260 " Levonorgestrel (contraceptive) implant system, including implants and supplies".

The global period for the procedure codes are one (1) pre-care day and ninety (90) post-operative days.

Reminder: Please indicate "F" in item 24H on the HCFA-1500 claim form or append modifier "FP" to the procedure code to indicate Family Planning.

Hospital expenditures for the contraceptive kit and needed supplies will be included in the DRG for the procedure.

The Division of Medical Assistance sought clarification from the Attorney General's Office with respect to the capacity of minors to consent to the use of the implantable contraceptive capsules. The General Statute is as follows:

General Statute 90-21.5. Minor's consent sufficient for certain medical health services.

(a) Any minor may give effective consent to a physician licensed to practice medicine in North Carolina for medical health      services for the prevention, diagnosis and treatment of (i) venereal disease and other diseases reportable under G.S. 130A-135, (ii) pregnancy, (iii) abuse of controlled substances or alcohol, and (iv) emotional disturbance. This section does not authorize the inducing of an abortion, performance of a sterilization operation, or admission to a 24 hour facility licensed under Article 2 of Chapter 122C of the General Statutes except as provided in G.S. 122C-222. This section does not prohibit the admission of a minor to a treatment facility upon his own written application in an emergency situation as authorized by G.S. 122C-222

(b) Any minor who is emancipated may consent to any medical treatment, dental and other health services for himself or for his child.

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

Attention: Home Health Providers

HCPCS Codes for Skilled Nursing Visits

Several questions were asked at the February Home Health Provider Seminars regarding the appropriate HCPCS code that should be used to describe certain skilled nursing visits. This article provides clarification for providers who were not in attendance when the questions were asked.

  1. Q. For supply-only patients, what code should be used to describe the 60-day RN assessment visit to ensure the patient is receiving the appropriate medical supplies?
    A. W9958 (Home Health skilled nursing visit not otherwise classified).
  2. Q. Our agency provides monthly skilled nursing visits to CAP/DA clients - which we refer to as "CAP
    assessment visits." What code should be used?
    A. Medicaid guidelines do not include a service identified as a "CAP assessment visit." Home Health services to CAP clients are based on the same criteria used for all Medicaid recipients. There are no special exemptions or allowances for CAP recipients. When billing for a skilled nursing visit, determine if the purpose of the visit is described on the MEDICARE-Medicaid Billing Guide in Section 5 of the Medicaid Community Care Manual. If Medicare covers the visit, bill Medicare. When Medicare does not cover the visit, determine if the monthly visit to a CAP recipient meets the description in Item A.4 on the chart. This visit is for observation and evaluation after a period with no significant changes in intervention - the patient's condition is chronic but stable yet there continues to be a documented medical necessity for intermittent nursing visits. In such situations, W9952 is the appropriate code and the limits on the chart apply. When a need for a Medicare-covered intervention is identified, MEDICARE becomes the primary payer.
  3. Q. If more than one skilled nursing task/activity described on the chart is provided during the same visit, such as prefilling a medi-planner and prefilling insulin syringes, which code is used?
    A. First, determine if either activity meets Medicare coverage guidelines. If so, bill the visit to Medicare. If Medicare does not cover the visit, then determine which Medicaid HCPCS code to use based on the code that describes the most important skilled nursing activity in relation to the patient's health and well-being. If the activities appear equal in importance, use your best judgement to select the code. The HCFA-485 and your clinical documentation should support your HCPCS code selection.
  4. Q. When documentation supports that wound care no longer meets Medicare criteria for a dually-eligible patient, which code should be used to bill Medicaid?
    A. In rare cases when Medicare does not cover wound care, use W9958 (Home Health skilled nursing visit not otherwise classified). Before billing Medicaid, pay special attention to instructions in the note in C.13 on the MEDICARE-Medicaid Billing Guide, page 5-20, Section 5, Community Care Manual.
Dot Ling, Medical Policy
DMA, 919-857-4021

Attention: Hospice Providers

Frequently Asked Questions (FAQ's) About the Hospice Participation Reporting Requirements

This article gives the answers to the most frequently asked questions regarding the new Hospice participation reporting requirements.

  1. Q. Do I need to report when one of my patients dies?
    A. No. The patient's date of death is put in the system through the Eligibility Information System.
  2. Q. I have a patient who has elected the Hospice Medicaid benefit; however, their Medicaid is still pending. When do I call to report their election?
    A. When you encounter this situation, you will need to make two telephone calls to the EDS Prior Approval unit.
      1. Make the initial call when the patient elects Hospice within the six-day time frame.
      2. Once the patient's Medicaid is approved call EDS and let them know this patient was previously reported as a pending Medicaid patient. EDS will then give you a confirmation number that dates back to your original telephone call.
  3. Q. I have a Medicaid Hospice patient whose next benefit period starts next Monday. I am sure the patient will re-elect Hospice. Because I will be on vacation next week, I would like to call the election in on Friday. May I do so?
    A. No. You may not call in the election of a new benefit period until the date the patient re-elects Medicaid Hospice.
  4. Q. Our Hospice admitted a patient on March 1, 2000. The office manager was out of town and could not call the election in until March 14, 2000. Can we get a retroactive confirmation number?
    A. No. Hospice agencies must make sure they have a procedure to report all patients within the six-day grace period.
  5. Q. I have a patient with Medicare and Medicaid. The patient has elected both Medicare and Medicaid Hospice. The patient is at home and Medicaid will never be billed. Do I need to call this patient's information to EDS?
    A. No. It is not necessary to call EDS unless you are planning on billing Medicaid.
  6. Q. The patient who has elected Medicare and Medicaid Hospice has now decided to enter a nursing home.  Our agency will need to begin billing Medicaid for the room and board. When do we need to call EDS for a confirmation number?
    A. You must call EDS within six days of the patient's admission to the nursing home. The benefit start date will be the date the patient entered the nursing home and the benefit end date will coincide with the end date for the current Medicare benefit period.


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

Attention: OB/GYN Providers

OB/GYN Seminar Schedule

Seminars for OB/GYN providers are scheduled in June 2000. Business office managers, Medicaid billing supervisors, and other billing personnel should plan to attend. These seminars will review program guidelines, coding, claim form completion, and follow-up, and will also focus on the most common denials for this provider type. Electronic claims submission will also be discussed as it is encouraged to facilitate faster claims payment.

Due to limited seating, pre-registration is required. Providers not registered are welcome to attend if reserved space is adequate to accommodate.

Please select the most convenient site and return the completed 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.


Tuesday, June 6, 2000
Four Points Sheraton
5032 Market Street
Wilmington, NC
Thursday, June 15, 2000
Catawba Valley Technical College
Highway 64-70
Hickory, NC
Tuesday, June 20, 2000
Holiday Inn Conference Center
530 Jake Alexander Blvd., S.
Salisbury, NC
Monday, June 26, 2000
MEI Conference Center
3000 New Bern Avenue
Raleigh, NC
Park at East Square Medical Plaza

(registration form only)

OB/GYN Provider Seminar Registration Form

Directions to the OB/GYN Seminars



I-40 East into Wilmington to Highway 17 - just off I-40. Turn left onto Market Street and the Four Points Sheraton is located approximately ½ mile on the left.



Directions to the Parking Lot:

Take the I-440 Raleigh Beltline to New Bern Avenue, Exit 13A (New Bern Avenue, Downtown). Travel toward WakeMed. Turn left onto Sunnybrook Road and park at the East Square Medical Plaza which is a short walk to the conference facility. Parking is not allowed in the parking lot in front of the Conference Center. Vehicles will be towed if not parked in the East Square Medical Plaza parking lot located at 23 Sunnybrook Road.

Directions to the Conference Center from Parking Lot:

Cross Sunnybrook Road and follow sidewalk access up to Wake County Health Department. Walk across the Health Department parking lot and ascend steps (with blue handrail) to MEI Conference Center. Entrance doors at left.


Traveling South on I-85: Take exit 75 and turn right on Jake Alexander Blvd. Traveling North on I-85: Take exit 75 and turn left on Jake Alexander Blvd. Travel approximately ½ mile and the Holiday Inn is located on the right.



Take I-40 to exit 125 and go approximately 1/2 mile to Highway 70. Travel East on Highway 70 and the college is approximately 1.5 miles on the right. Ample parking is available. Entrance to Auditorium is between the Student Services and the Maintenance Center. Follow sidewalk (toward Satellite Dish) and turn right to Auditorium Entrance.

Attention: Hospital Providers

Hospital Seminars

Hospital seminars are scheduled in July 2000. The June Medicaid Bulletin will have the registration form and a list of site locations for the seminars. Please send any issues you would like addressed at the seminars to the following address:

Provider Services
P.O. Box 300009
Raleigh, NC 27622

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

Attention: Physicians

Injectable Drug Fee Change

Effective with date of service May 1, 2000, the maximum allowable fee has been changed for the following injectible drugs:
J1020  Methylprednisolone Acetate 20 mg  $2.29
J1030  Methylprednisolone Acetate 40 mg  $4.59
J1040 Methylprednisolone Acetate 80 mg  $9.17

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

Attention: Hospital Providers

ICD-9 Procedure Code 47.09

The September 1999 Medicaid Bulletin, page 11, published a list of noncovered services for providers. ICD-9-CM Procedure Code 47.09 (other appendectomy) was listed as noncovered. Effective with date of service November 1, 1999, DMA implemented coverage of Procedure Code 47.09 for abdominal appendectomy when the diagnosis code reflects appendicitis.

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

Checkwrite Schedule
May 9, 2000
June 13, 2000
July 11, 2000
May 16, 2000
June 20, 2000
July 18, 2000
May 23, 2000
June 29, 2000
July 27, 2000
May 31, 2000


Electronic Cut-Off Schedule
May 5, 2000
June 9, 2000
July 7, 2000
May 12, 2000
June 16, 2000
July 14, 2000
May 19, 2000
June 23, 2000
July 21, 2000
May 26, 2000

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.


Paul R. Perruzzi, Director John W. Tsikerdanos
Division of Medical Assitance Executive Director
Department of Health and Human Services EDS
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