Provider Services

Last updated: 07/12/2004

For Providers who send electronic claims to Medicaid:

E learning
Checklist
Pharmacies
Switching from Test to Live Claims
Informational Bulletins
Dual Support
Local Codes
Data Elements
Problems
HIPAA Compliant Clearinghouses & Billing Agents
FAQ's

E Learning Tutorial

The WAMedWeb E-Learning Tutorial is now on line!   Click here to connect to the E-Learning site.

Medicaid providers who have enrolled with MAA as Trading Partners can take advantage of the new WAMedWeb On-Line Tutorial e-learning site.  Additional modules of instruction will be added to the tutorial as the corresponding HIPAA transactions are implemented. If you are unable to view the tutorial on-line and would like to request a compact disk or if you have any questions, please contact the HIPAA E-Help Desk at 1.800.562.3022.

HIPAA's THREE-step Checklist:

• Complete the ACS EDI enrollment packet. Select this link for Enrollment Packet Download, or call 1-800-833-2051 to have the enrollment packet sent to you.
• Obtain an ACS EDI trading partner number from ACS (If you are already billing Washington Medicaid electronically and have a trading partner number, it should not change) Receive testing instructions from ACS.
• Contact your clearinghouse or billing agent if you have one. Tell them to test YOUR claims through the Medicaid System

Detailed checklist

Pharmacy "Point of Sale" (POS)
To test POS, pharmacies should first contact the ACS Prescription Benefits Management (PBM) Provider Relations Department at:

1-800-365-4944
or by e-mail at provider.relations@acs-inc.com

Pharmacy Payment & Recipient Inquiries: 1-800-365-4944

POS CLAIMS: The Medical Assistance Administration is increasing efforts to complete the transition of Pharmacy Providers from the 3.2 format version of the National Counsel for Prescription Drug Programs (NCPDP) software to the 5.1 HIPAA compliant format. We are planning to implement this change in phases with a targeted cutover date of August 15, 2004. Please contact your software vendor to request an upgrade of your Medicaid billing software from 3.2 to 5.1 NCPDP format. Contact the MAA HIPAA E-Help Desk for additional assistance with this transition.

Pharmacy help is available from: Randy Stamp (randy.stamp@acs-inc.com)

Switching from Test to Live Claims
All enrolled providers are defaulted to test status. Providers who are ready to file HIPPAA-compliant claims or their clearinghouses MUST call ACS EDI (850) 558-1630 to notify ACS EDI Gateway they are ready to send production claims.

Bulletins
The State of Washington began distributing informational bulletins to Washington State health-care providers, outlining the information the Medicaid program needs to continue accepting claims and making payments under the Health Insurance Portability and Accountability Act (HIPAA).

• HIPAA Provider Bulletin No. 13 (02/03/04 PDF): MAA resets timetable for finishing HIPAA transactions, MMIS modifications during 2004
• HIPAA Provider Bulletin No. 12 (11/04/03 PDF): Rapid 270/271 transaction checks Eligibility and flashes its reply to the provider.
• HIPAA Provider Bulletin No. 11 (11/04/03 PDF): HIPAA compliance continues to make progress; more than half of pharmacy claims using new formats
• HIPAA Provider Bulletin No. 10 (10/27/03 PDF): Pharmacy continues to lead the HIPAA-compliant list, with other providers slow to switch to 837 format
• HIPAA Provider Bulletin No. 9 (10/17/03 PDF): HIPAA's "Morning After" - Things went smoothly, with many providers and submitters still on old systems!
• HIPAA Provider Bulletin No. 8 (10/15/03 PDF): HIPAA's "H-Day" -- October 16, 2003 - is FINALLY here, and Washington State Medicaid has got you covered!
• HIPAA Provider Bulletin No. 7 (10/10/03 PDF): Before October 16, providers should run down checklist - what have you done, what needs to be done?
• HIPAA Provider Bulletin No. 6 (09/30/03 PDF): On October 16, providers have to let Medicaid know if 837 claims are switching from "test" to the real thing.
• HIPAA Provider Bulletin No. 5 (09/19/03 PDF): Washington Medicaid program scores HIPAA touchdown with "end zone-to-end zone" adjudication of test claim
• HIPAA Provider Bulletin No. 4 (09/12/03 PDF): Washington pharmacists rush to test 5.1 system as Medicaid works to bring its POS adjudication on line
• HIPAA Provider Bulletin No. 3 (09/08/03 PDF): Washington's Medicaid program installs HIPAA upgrade for September testing on agency's MMIS computer
• HIPAA Provider Bulletin No. 2 (09/01/03 PDF): Medicaid Providers: Get Ready For Testing Now To Make Sure Your Reimbursements Don't Hit HIPAA Snags
• HIPAA Provider Bulletin No. 1 (08/20/03 PDF): Medicaid Distributes Free Registration Information to Health-Care Providers Preparing for HIPAA Deadline

Codes, Local and National

• Numbers for New Waiver Service HCPCS Level II Codes (06/12/2003 PDF) via NMEH Listserve. Be advised that even though there may be a national code that could be used, it doesn't necessarily mean that it is a code that we will cover. Providers need to understand that the covered codes they will need to use will be published in our billing instructions. See our Billing Instructions web section.
• Health Care Claim Professional Addenda: http://www.wpc-edi.com/ select HIPAA, scroll down to Addenda Available.

Data Elements

• NEW DATA ELEMENTS THAT MAY BE REQUIRED ON HIPAA CLAIMS: These matrices will let providers quickly check required information on the new HIPAA 837 claims form. Fields on the new form are listed at the left. On the right are the circumstances in which the information must be provided.
• Data elements for Professional (Physician) Claims (09/19/03 Word)
• Data elements for Dental Claims (09/19/03 Word)
• Data elements for Institutional Claims (09/19/03 Word)
   
• Providers with further questions about these matrices should consult with:
• The billing instructions filed on the MAA web site
• The companion guides posted on the ACS (Affiliated Computer Services) web site at: http://www.acs-gcro.com/Medicaid_Accounts/medicaid_ accounts.htm (then click on Washington State)

Problems:
Remember when calling  MAA or ACS call centers to have your provider/submiter number ready.  Copy any error messages you may have encountered. Look at how do I route my call?

HELP LINES: Providers who need technical advice from Medicaid's contractor, Affiliated Computer Services (ACS), can try to time their calls to 1-800-833-2051 for best effect. The line is open from 8a.m. to 5 p.m. PDT, but the late afternoon is the best time to call because the call center is located in Florida, the base for ACS state services. By 3 or 4 p.m. our time, calls from states back East will fall off, leaving more operators available to handle queries from Washington.

The Washington DSHS Provider Relations Unit is available to assist you with information regarding Medicaid policy, recipient eligibility or claim status.  To contact them, call 1.800.562.3022.