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					                                                                 August 10, 2011




                                              Table of Contents
Does Your Billing/Coding Department Know Our Mailing Address? .................................................... 2
The New Mexico Medicaid Electronic Health Record Incentive Program Is Here! ................................ 2
Attention Tab Run Users! ......................................................................................................................... 3
Anesthesia Denials.................................................................................................................................... 3
Critical Incidents ....................................................................................................................................... 4
New Electronic Claim Formats Required on January 1, 2012 ................................................................. 4
Timely Filing Limits ................................................................................................................................. 5
  Exceptions to the filing limit ................................................................................................................ 5
  Re-filing Claims and Submitting Adjustments ..................................................................................... 6
  Helpful Hints ........................................................................................................................................ 6
Submitting After a Recoupment ............................................................................................................... 6
Ambulatory Surgical Center (ASC) Service Providers ............................................................................ 7
Attention Providers! Have you read the supplement? .............................................................................. 7
Remittance Advices Online ...................................................................................................................... 7
Contact Information .................................................................................................................................. 7




                                                                             1
     Does Your Billing/Coding Department Know Our Mailing
                            Address?
                                  ACS – Claims
                                  PO Box 26500
                                  Albuquerque, NM 87125
                           You have changed the address in your records…

                           But does your Billing/Coding Department have the address?
                           Could they still be using an old address in their computer, address files,
                           rolodex? Also, be sure to update any training, communication or reference
                           manuals they use.




 The New Mexico Medicaid Electronic Health Record Incentive
                    Program Is Here!
The New Mexico Medicaid Electronic Health Record (EHR) Incentive Program was established by the
Health Information Technology for Economic and Clinical Health (HITECH) Act of the American
Recovery & Reinvestment Act of 2009. The program provides financial incentives to health care
professionals and hospitals for the adoption and meaningful use of electronic health records. New
Mexico has launched its EHR incentive program Monday, August 1, 2011.

The final rule governing this program was released July 13, 2010. It establishes parameters and
requirements for the Medicaid EHR incentive program under the HITECH Act. The final rule can be
viewed at http://www.cms.gov/ehrincentiveprograms/.

There are important steps you can take prior to the launch of the New Mexico Medicaid EHR Incentive
Program. Please visit the Center for Medicare and Medicaid Services (CMS) website at
http://www.cms.gov/ehrincentiveprograms/ to complete your CMS registration which is a prerequisite
for enrollment into the New Mexico Medicaid EHR program.
For Medicaid EHR Incentive Program information and updates, please visit the New Mexico provider
outreach page at http://nm.arraincentive.com.




                                                 2
                               Attention Tab Run Users!
Recently, you were notified that beginning in May, Paid claims reports (a.k.a Tab Runs) used to
complete Annual Cost Reports would be posted to the NM Medicaid website for all hospitals,
residential treatment providers, FQHCs, hospice providers, rural clinical, and hospital based rural
clinics.

This notification is to inform you that at this time, not all of the providers noted above are in full
production. Hospital providers should continue to request tab run reports from the State Medical
Assistance Division. While hospitals may see reports on the portal, they should still continue to use the
reports provided by the Department. On request tab runs should continue to be requested through ACS.
Information pertaining to the next phases will be forthcoming as it becomes available.




                                     Anesthesia Denials
A problem related to the calculation of anesthesia time units has resulted in incorrect payment to
anesthesia service providers. We are aware of the issues and are actively pursuing solutions to correct
them. We understand and apologize for the challenges but will reprocess the claims on your behalf via
a mass adjustment. If you have any questions or concerns please feel free to submit them to
NMPRSupport@acs-inc.com for assistance.




                                                   3
                                       Critical Incidents
As directed in a letter from Aging and Long Term Services Department (ALTSD) to CoLTS providers,
dated June 16, 2011, all CoLTS CRITICAL INCIDENTs (CoLTS C, PCO, Mi Via) must be reported
to the consumer’s Managed Care Organization, Adult Protective Services (abuse, neglect and
exploitation) and HSD/MAD, at this fax number (505) 827-3195.

 Detailed Incident Report documentation is essential to collecting accurate data when a Death is
reported.

Each time a Death is reported, the Incident Report form must be completed and include the following
information:

      Expected (natural) or unexpected Death.
      Where was the consumer at the time of Death? List the location of the consumer at the time of
       Death (at home, in the hospital, nursing facility, etc).
      What natural supports are available to the consumer? (consumer alone, no natural supports
       available to this consumer at the time of Death or consumer has no natural support system,
       found by family member or caregiver).
      Please include details related to the consumer cause of Death. Was the consumer Death the
       result of a chronic illness, sudden illness, car accident, etc.
      Whenever possible include a diagnosis that caused the consumer’s Death.

Thank you for your cooperation! If you have questions related to Incident Reporting, please call Ellen
Maestas-Waller, HSD/MAD/Quality Assurance Bureau at (505) 827-1305.



   New Electronic Claim Formats Required on January 1, 2012
ACS, your New Mexico Medicaid Fiscal Agent, has been tasked with testing electronic claims
submissions for the transition from 4010A to 5010 standards. What does this mean for you? The vast
majority of Medicaid providers submit claims via a billing agent or a clearing house. Billing agents
and clearing houses must use the new 5010 formats, so Medicaid providers should verify with these
entities their preparation and readiness for 5010 transactions.

Below is a check list to assist you with your inquiries to your billing agent or clearing house:

      Will you be upgrading your systems for the new 5010 standards?
      When will upgrades be completed?
      When will testing for the new upgrades be conducted?
      Will your system support concurrent 4010A and 5010 submissions?
      Will we need to re-enroll to file 5010 transactions?
      Are there any new charges for 5010 transactions?

Entities must be 5010 ready by January 1, 2012. If you would like your billing agent or clearing house
to assist with testing, please feel to have them send an e-mail to NMPRSUPPORT@acs-inc.com
along with their contact information and 5010 readiness date.
Please keep a look out for future 5010 communications.
                                                     4
                                     Timely Filing Limits
Effective September 1, 2010, the timely filing limit for Medicaid fee for service and Children’s
Medical Services claims changed to:

   90-days from the date of service for all providers except for schools and Indian Health Service and
    PL-638 tribally operated providers.

       Any outstanding claims for which a provider wishes the current limits to apply rather than the
       new 90 day limit must be received by ACS prior to September 1, 2010.

   For a claim which met the initial filing period, but was denied, partially denied, or requires an
    adjustment, there is an additional one-time 90-day grace period counted from the date of payment
    or denial, during which the claim can be re-filed or an adjustment submitted to ACS. It is to the
    provider’s advantage to resubmit a claim, if necessary, within the initial 90-day filing period in
    order to have the greatest amount of time in which to re-file or submit an adjustment during the 90-
    day grace period if another re-filing or adjustment is necessary.

   The claim may be re-filed during the 90-day grace period as many times as necessary, but claims
    filed after the 90 day grace period will be denied.



                                  Exceptions to the filing limit
   When other primary payers have denied or made payment on a claim, the filing limit of 90-days is
    counted from the date of payment or denial by the other party, but not to exceed 210 days from the
    date of service. A provider should file claims in sufficient time with other payers to allow
    submission in time to meet the Medicaid 210 day limit.

   When the recipient has retroactive eligibility, the initial filing limit is 120 days from the date the
    eligibility was added to the ACS eligibility file and was therefore available to providers.

   When the provider was not originally enrolled as a MAD provider on the date of service, the filing
    limit of 90-days is counted from the date the provider was notified of the enrollment, but must not
    exceed 210 days from the date of service. A provider should submit a provider participation
    agreement in sufficient time to allow processing and still meet the Medicaid 210 day limit for
    submitting the claim.

   When a claim previously paid by a Medicaid managed care organization is recouped from a
    provider due to retroactive disenrollment of the recipient from the managed care organization, the
    filing limit of 90-days is counted from the date of the managed care organization’s notice or
    recoupment from the provider.

   For schools, the filing limits are 120 days for the initial filing period and 120 days for the grace
    period (rather than 90 days). For IHS and tribal 638 compact facilities, the filing limit is 2 years
    from the date of service with no additional grace period.




                                                      5
                     Re-filing Claims and Submitting Adjustments
   When resubmitting a claim or requesting an adjustment on a claim that is past the 90 day filing
    limit but originally met the filing limit, the “TCN” number which appears on the remittance advice
    (RA) will be used by ACS to evaluate the claim. The provider must supply that TCN number in
    order for ACS to be able to evaluate the claim.

        CMS 1500 form: Put the TCN in block 22 on the paper form. Leave the “Code” blank, and put
        the TCN in the “Original Reference No.” field.

        UB Form: Put the TCN in Form Locator 64 “Document Control Number” (DCN) matching the
        appropriate payer line, using a paper form.

        Dental Claim Form: Put the TCN on the left side in box 35 “Remarks”.




                                            Helpful Hints
   There are two filing limits to meet - the initial filing limit and the grace period limit. Continuing to
    refile a claim does not continue to extend the filing limit. So it is to the provider’s advantage to file
    or request an adjustment on the most recently filed claim that met the original filing limit.

   When requesting an adjustment on an adjusted claim, use the TCN of the final payment or denial,
    not the credit record which has a negative amount on the RA.

   The filing limit does not apply when the provider is returning an overpayment to the Medicaid
    program.




                           Submitting After a Recoupment
If you’re submitting a claim due to retro-active disenrollment from a SALUD, CoLTS, or SCI, please
follow the steps below for the appropriate situation.

                              Claims within 2 years from date of service
       Please follow the normal claims submission process and attach the recoupment EOB.

                              Claims 2 years or more from date of service
       Submit claims to Attn: ACS Appeals
       Include cover letter stating the issue
       Attach EOB of recoupment to each claim

            Claims must be submitted within 90 days from the date of the recoupment!




                                                     6
         Ambulatory Surgical Center (ASC) Service Providers
You have probably noticed that ACS has adjusted claims for dates of service 01/01/2009 through
06/30/2010. The reason for claims adjustments is related to the implementation of a change in the method
that Medical Assistance Division (MAD) reimburses for ASC services. MAD changed from a grouper
method of reimbursement to a fee schedule method of reimbursement. The Medicare 2010 ASC fee
schedule was used as the source for determining the Medicaid ASC fee schedule rates.

The fee schedule was loaded to the claims payment file on 07/01/2010, therefore, surgical services from
that date forward were paid at the new rates. The fee schedule rates were loaded with an effective date of
01/01/2009. Prior to the update, CPT Procedures that did not have an assigned grouper were being
priced using the Medicare ASC fee schedule rate, a grouper was not assigned. To ensure that all ASC
providers were reimbursed for surgical procedures allowed in an ASC setting under the fee schedule
method, MAD had the claims adjusted.

What you will see as part of the claims adjustment process is that some services that were allowed under a
grouper method of reimbursement are currently not allowed under a fee schedule method of
reimbursement. As a result of the change, payments were recouped. These adjustments are considered
final and further adjustments will not be made.

However, also note that some services that were not allowed under the grouper method are now being
reimbursed.

If you have any questions, you may contact Rosemary Medrano, Benefits Bureau, MAD at (505) 827-
1339.



         Attention Providers! Have you read the supplement?
A supplement was recently mailed to all providers participating in the New Mexico Medicaid Program
on a number of different subjects, including the implementation of federal requirements for billing for
drug items administered in practitioners’ offices, outpatient clinics and hospitals; and changes to how
providers should bill the MAD Fee-for-Service program for vaccine codes, among many other topics.
It is important that all providers review this supplement. This supplement is available on both the New
Mexico Medicaid Portal website and the Medical Assistance Division website at
http://www.hsd.state.nm.us/mad/pdf_files/Registers/Registers2011/11-03%20provider.pdf. In
addition, a copy has been sent with the email version of this newsletter.


                              Remittance Advices Online
Remember that providers are responsible for keeping their billing records complete. Don’t forget to
download your remittance advice on line at the New Mexico Medicaid Web Portal and save copies in a
secure place. Please be aware that only the last eight RAs are available.


                                    Contact Information
  THANKS FOR READING THE NEW MEXICO MEDICAID NEWSLETTER
 If you would like to receive this newsletter by email, send request to DL-NM PRSupport and we will
                                           add you to the list.


                                                    7

				
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