DOH Medicaid Update May 1999 Vol.14, No.5

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The February 1999 Medicaid Update included incorrect information identifying the level of CLIA certification required for performing procedure code 81000. Procedure code 81000 cannot be performed by a physician holding a CLIA Certificate of Waiver. A physician performing this laboratory test must possess a CLIA Certificate of Physician Performed Microscopy Procedure (PPMP). If you have a PPMP CLIA Certificate and have had claims for procedure code 81000 denied for Medicaid payment, please resubmit the claims for reconsideration. We apologize for any inconvenience this may cause.

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These instructions apply only to those providers who are named plaintiffs in the above-cited action.

This article will remind providers that all edit correction and data submission opportunities ended with the May 11, 1999 deadline. Only voids may continue to be submitted after that date.

For assistance, please call your CSC Healthcare Systems representative at:

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Below is an updated listing of the managed care plan codes which are reported to you when you request eligibility verification for a Medicaid recipient via the Electronic Medicaid Eligibility Verification System (EMEVS). Please keep this information for easy reference.

PLAN CODE	PLAN NAME	PHONE NUMBER
77	HEALTHPLUS (LUTHERAN)	(718) 745-0030
82	BRONX PHSP (BRONX HEALTH PLAN)	(718) 733-4747
85	ELDERPLAN HMO, INC.	(718) 921-7990
91	MANHATTAN PHSP (CENTER CARE)	(800) 545-0571
92	METRO-PLUS (METROPOLITAN HEALTH PLAN)	(212) 597-8600
98	HIP OF GREATER NY	(212) 630-5316
99	HIP OF GREATER NY	(212) 630-5316
AN	HEBREW HOSPITAL HOME, INC.	(718) 379-0793
AR	PATEL, ARJUNJ MD (BROOME COUNTY)	(607) 778-2669
AT	DYGERT, STEPHEN L. MD	(607) 778-2737
AX	ABC HEALTH PLAN	(800) 298-2420 (212) 675-3692
BU	BLUE CARE PLUS	(315) 798-4336
C2	COMMUNITY BLUE HMO	(716) 887-8720
C7	COMP. CARE MGMT. CORP.	(718) 515-8600
CF	COMPRE CARE PHSP	(518) 798-3555
CG & CV	CAPITAL DISTRICT PHYSICIANS HEALTH PLAN	(518) 862-3800
CQ	VYTRA HEALTH CARE - CHOICE CARE	(516) 694-4000
CW & SP	NYS CATHOLIC HEALTH PLAN (FIDELIS)	(800) 749-0820
DC	SMA MANAGED CARE (BROOME COUNTY)	(607) 778-2737
DD	DRISCOLL, DANIEL MD (BROOME COUNTY)	(607) 778-2737
DE	CHENANGO BRIDGE MEDICAL GROUP	(607) 778-2737
DY	LOURDES PRIMARY CARE ASSOCIATION	(607) 778-2737
E4	ROSENTHAL, THOMAS MD PCMP IIA (ERIE COUNTY)	(716) 898-5966
E7	SENIOR CARE CONNECTION	(518) 382-3290
EI	DAIGLER, GERALD MD PCMP I (ERIE COUNTY)	(716) 878-7355
EK	ROSENTHAL, THOMAS MD PCMP II	(716) 898-5966
EL	MEDICAP - ROCHESTER HLTH. NETWORK	(716) 882-1212
EM	UNIV. MED. SERVICE BUFFALO PCMP III	(716) 898-5400
EN	UNIV. MED. SERVICE ERIE PCMP III	(716) 898-5400
EO	LANCASTER-DEPEW PED. PCMP III	(716) 684-6140
EP	SERVICE MEDICAL PC PCMP III	(716) 592-7400
EQ	CONCORD MEDICAL GROUP PCMP III	(716) 592-3600
ER	SHEEHAN MEM. HOSP. PCMP III	(716) 842-2200
ES	CPCP GROUP INC. PCMP III	(716) 882-8989
ET	TONAWANDA PEDIATRICS PCMP III	(716) 695-0560
EU	FAMILY MEDICAL FACULTY ASSOC. PCMP III	(716) 887-8200
FA	FAMILY HEALTH SERVICES	(716) 753-7107
G3	BHARD-WAJ, GAUR MD	(607) 770-0004
GE	GENESIS HEALTH PLAN	(914) 476-6000
GO	OGDEN, GARY MD (HEALTH CHOICE)	(607) 478-8421
GS	HUM HEALTHCARE SYSTEMS, INC.	(518) 798-3555
H2	GRAHAM, DAVID MD (HEALTH CHOICE)	(716) 593-6800
H5	DEPNER, CHRIS MD (HEALTH CHOICE)	(716) 593-4250
H6	GULATI, RAJAN MD (HEALTH CHOICE)	(716) 968-1628
H7	LAWRENCE, THOMAS MD (HEALTH CHOICE)	(716) 968-3210
H9	COCH, WILLIAM MD (HEALTH CHOICE)	(607) 478-8421
HH	HEALTHSOURCE/WESTCHESTER PHSP	(914) 631-1611
HK	HEALTH CARE PLAN, INC.	(716) 847-1480
HT	HIP-SUFFOLK	(212) 630-5316
HW	HIP-WESTCHESTER	(212) 630-5316
HX	HMO-CENTRAL NEW YORK	(315) 448-6870
HY	HIP-NASSAU	(212) 630-5316
HZ	EMPIRE BLUE CROSS/BLUE SHIELD (HEALTHNET)	(800) 552-6630
IE & IN	INDEPENDENT HEALTH ASSOCIATION	(716) 631-3086
IL	INDEPENDENT LIVING FOR SENIORS (MONROE)	(716) 336-2025
IM	MEM. HOSP. W/G JONES (HEALTH CHOICE)	(716) 593-1564
IS	LORETTO HMO	(315) 469-5570 EXT. 613
IV	INDEPENDENT HEALTH HMO	(914) 631-0939
JD	MIDDLETOWN PSYCHIATRIC CENTER	(914) 342-5511 EXT. 3525
JE	MOHAWK VALLEY PSYCHIATRIC CENTER	(315) 738-4426
JF	NEW YORK PSYCHIATRIC INSTITUTE	(212) 543-5000
JG	PILGRIM PSYCHIATRIC CENTER	(516) 434-4026
JH	ROCHESTER PSYCHIATRIC CENTER	(716) 473-4379
JI	ROCKLAND PSYCHIATRIC CENTER	(914) 359-1000 EXT. 2235
JJ	ST. LAWRENCE PSYCHIATRIC CENTER	(315) 393-3000 EXT. 3529
JK	SOUTH BEACH PSYCHIATRIC CENTER	(718) 667-2823
JL	BINGHAMTON PSYCHIATRIC CENTER	(607) 724-1391
JM	BRONX PSYCHIATRIC CENTER	(718) 931-0600 EXT. 2749
JN	BUFFALO PSYCHIATRIC CENTER	(716) 885-2261 EXT. 2009
JO	CAPITAL DISTRICT PSYCHIATRIC CENTER	(518) 447-9611 EXT. 6808
JP	CENTRAL ISLIP PSYCHIATRIC CENTER	(518) 473-8234
JQ	CREEDMOOR PSYCHIATRIC CENTER	(718) 464-7500
JR	ELMIRA PSYCHIATRIC CENTER	(607) 737-4740
JS	HUDSON RIVER PSYCHIATRIC CENTER	(914) 452-8000 EXT. 7656
JT	HUTCHINGS PSYCHIATRIC CENTER	(315) 473-4980 EXT. 4087
JU	KINGS PARK PSYCHIATRIC CENTER	(516) 544-2704
JV	KINGSBORO PSYCHIATRIC CENTER	(718) 667-2823
JW	MANHATTAN PSYCHIATRIC CENTER	(212) 369-0500 EXT. 2239
JZ	SOUTHERN TIER HEALTH CHOICE	(607) 587-8192
KA	COMMUNITY PREMIER PLUS, INC.	(877) 277-4456
KC	COMMUNITY CHOICE HLTH. PLAN WESTCHESTER	(914) 337-6908
KO	INTEGRATED COM ALTERNATIVE NETWORK	(315) 792-9039
KP	CARE PLUS HEALTH PLAN	(800) 535-2814 (800) 563-5581
KS	SALE, KEITH MD (HEALTH CHOICE)	(716) 593-6800
L1	CUSUMANO, LEO MD (HEALTH CHOICE)	(716) 968-4137
LE	LONG ISLAND HEALTH PARTNERS	(516) 264-4000
MK	MANAGED HEALTH CARE SYSTEMS	(800) 493-4647
MO	UNITED HEALTHCARE OF NY, INC.	(212) 216-6824
MR	MEDICAP - ROCHESTER HLTH. NETWORK	(716) 238-4394
MW	MANAGED HEALTH INC.	(800) 566-2678
MZ	MOHAWK VALLEY NETWORK	(315) 798-6093
NP	NEIGHBORHOOD HEALTH PROVIDERS	(800) 558-7970
NW	NEW YORK HOSPITAL COMMUNITY HEALTH PLAN	(212) 297-5510
OZ	BUFFALO COMMUNITY HEALTH, INC.	(716) 857-4448
PH	SOUTHERN TIER PRIORITY HEALTHCARE	(607) 732-1948
PQ	PREFERRED CARE ROCHESTER HMO	(716) 325-3920
PV	HEALTH SERVICES MEDICAL CORP. (HSMC)	(315) 638-2133
PW & PX	PRUDENTIAL HEALTH PLAN OF N.Y.	(914) 368-9699
SA	TOTAL CARE - SYRACUSE PHSP	(315) 476-7921 EXT. 415
SC	ST. BARNABAS COMMUNITY HEALTH PLAN	(718) 960-3843
SF	HEALTH FIRST	(800) 580-8540(212) 801-6000
SI	STATEN ISLAND UNIVERSITY HOSP.	(718) 226-8372
SK	SUFFOLK HEALTH PLAN	(800) 763-9132
SL	SAEED, AZMAT MD	(607) 748-7355
SN	SANUS HEALTH PLAN OF GRTR. NY (NYL CARE)	(718) 899-5200 EXT. 304
SP & CW	NYS CATHOLIC HEALTH PLAN (FIDELIS)	(800) 749-0820
SY	SOUTHERN TIER PEDIATRICS	(607) 734-3252
TV	UNITED HEALTHCARE UPSTATE NEW YORK	(315) 433-5867
VC	VNS CHOICE	(212) 290-1231
VG	GIORDANO, VINCENT MD	(607) 778-2737
WC	WELLCARE	(914) 334-4000
WD	WELLCARE (DUTCHESS)	(914) 334-4000
WG	WELLCARE (GREENE)	(914) 334-4000
WH	WESTCHESTER PHSP	(914) 631-1611
WK	BROOME COUNTY MAX PROGRAM	(607) 778-2702
WO	WELLCARE (ORANGE)	(914) 338-0202
X3, X4, X5, X6 & X7	COMMUNITY HEALTH PLAN (CHP)	(518) 783-1864

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The Year 2000 (Y2K) issue continues to be New York Medicaid's highest system priority. We are making good progress and all Medicaid related systems for which we are directly responsible are scheduled to be Y2K ready by mid 1999. We have attempted to keep the impact of our Y2K activities as minimal as possible for providers and vendors. We feel this has been accomplished and providers will see no change in claims processing and billing due to Y2K systems changes. Following is a Y2K status of New York Medicaid's major computer systems and Y2K related information concerning these systems.

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Claims Processing

Computer Sciences Corporation (CSC), the Medicaid fiscal agent that processes Medicaid claims, will use systematic logic within the Medicaid Management Information System (MMIS) to default the century as necessary. For billers, claiming specifications and formats will remain the same as currently used. The only exception to this methodology is the addition of Version V billing format. Version V is similar to Version IV but is Y2K ready, with the use of eight character date fields. ONLY hospitals and clinics currently use Version IV for Medicaid billing. They will be able to use Version IV or Version V in the future (even after January 1, 2000). The new Version V format is available from CSC at this time. To obtain the Version V specifications, providers may call CSC's Provider Relations Institutional Unit at 1-800-522-1892 or (518) 447-9810.

Remittances

New York State Medicaid remittances will remain the same. Paper remittances will continue to carry only the two character year. There are currently two tape remittance formats in use, a 300 character format and a 340 character format. Only the 340 character format includes century in the date fields. All new providers currently receive the 340 character remittance. If you would like to switch to the 340 character remittance, or simply get the specifications to review, please call CSC's EMC Control Unit at (518) 447-9256.

PACES

PACES is an electronic claiming system developed by CSC for use in New York Medicaid billing. The PACES system is Year 2000 ready, providing the user with the ability to enter the century in all date fields. PACES generates claim output which is submitted to CSC in various formats. The claim formats do not carry the century as part of the date information, but systematic logic within the MMIS system will default the century component of date related information. The PACES system requires no user changes for billing into the Year 2000.

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Deluxe Electronic Payment Systems (DEPS) administers the Electronic Medicaid Eligibility Verification System (EMEVS) for the New York Medicaid program. There are five methods of accessing EMEVS data. The various methods are listed below along with their Year 2000 status and what needs to be done by DEPS and Medicaid providers to ensure Y2K readiness. Other EMEVS claims processing systems are also discussed in relation to Y2K.

Verifone Trans 330

The Trans 330 eligibility verification terminal is the standard EMEVS device used by many providers. All the Trans 330s must migrate to the latest, Y2K ready software (Version 0140). Currently, nearly one-half of these devices used by providers have the Version 0140 software. If you have a Trans 330 device and need to know the version, simply unplug the device. When it is plugged back in, the second display (prior to the date and time) will say "NYM0140". If you do not have software Version 0140, you can call the EMEVS Help Desk for assistance and instructions for getting the new Version 0140 software downloaded. The telephone number is 1-800-343-9000. This download of the 0140 software will be done over the telephone lines with limited effort on the provider's part.

PCs Using EMEVS Software

Providers using EMEVS software on their PCs to access EMEVS information will need to upgrade to Version 13 for Y2K. Version 13, release 4.1.0.5 is the latest release of the New York State Eligibility PC software. A copy of release 4.1.0.5 has been sent to all providers who are registered users of the State software.

CPU Link to EMEVS

CPU providers will need to upgrade to Version 13 to be Y2K compliant. In August, 1998, DEPS sent a letter to all CPU users that have not yet converted to Version 13. DEPS will assist the CPU providers in upgrading to the CPU EMEVS format (Version 13).

Batch Authorization System

Providers that use the Batch Authorization system will also need to upgrade to Version 13. DEPS sent the new batch specifications to all Batch Authorization providers in December, 1998.

EMEVS Telephone Verification

EMEVS information is also available through telephones. This method of inquiry will remain the same. There is no need for providers to do anything. EMEVS has made the necessary modifications internally.

Other EMEVS Systems

In addition to Medicaid eligibility verification, the EMEVS system also performs several other functions for providers. Drug Utilization Review (DUR), service authorizations, some prior approvals, and provider post and clear transactions are provided through the EMEVS system. We expect these functions to be performed the same as they currently are by the provider. Any necessary Y2K changes will be made internally.

In summary, New York Medicaid and its contractors have made Y2K the highest system priority. We are currently near full Y2K readiness for all our Medicaid systems and will be fully ready in mid 1999. Y2K systems testing has been going on for many months and will continue. Our early Y2K readiness will allow us a sufficient time to test our systems thoroughly. From a provider standpoint, there is little or nothing to do concerning Medicaid claiming into the new millennium. We will keep you apprised of our Y2K status through articles in the Medicaid Update. Also, any pertinent provider information concerning Y2K and New York Medicaid will be printed in the Medicaid Update. Additionally, the New York State Department of Health website contains recent editions of the Medicaid Update that will have Y2K related articles and special provider related Y2K information. To reach the New York State Department of Health Medicaid Updates and Y2K information, use the following website address:

This address will take you to the "Medicaid" screen and you will see Medicaid Update on the menu. Click on Medicaid Update and you will reach a screen that lists the various months of recent Medicaid Update editions. The May edition will carry this letter. More information will be included in future editions.

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This is to reaffirm the Department policy with regard to the submission of claims over two years old. Acceptable reasons for a claim to be submitted after two years are:

• if the provider establishes that the delay was caused by the Department, the local social services district, or other agents of the Department;
• if a court has ordered the Department to make payment.

Please note that when a provider voids a previously paid claim and now wishes to resubmit, the resubmission is treated as a new claim and will be subjected to the criteria above for the submission of claim(s) over two years old. The new claim will not be considered as an agency error and, therefore, will not qualify for a waiver of the two year regulation. ADJUSTMENTS, RATHER THAN VOIDS, SHOULD ALWAYS BE BILLED TO CORRECT PAID CLAIMS.

All claims/requests/appeals must be resubmitted with supporting documentation within 90 days of the date the Department or Local Social Service Office takes final action to establish Medicaid coverage, the date of notice to rebill from authorized agencies, et cetera, to:

Claims submitted for review without the appropriate documentation, or those not submitted within the 90 day time period after providers are in control of billing, will not be considered.

For questions with regard to two year old claims, call 1-800-562-0856 or (518) 473-4029

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The Durable Medical Equipment Manual (Rev. 4/99) was recently mailed to you. In addition to the corrections published in the April Medicaid Update, please make the following corrections to your copy:

Page 4-4	Quantity/Size for code A4347, remove notation "(up to 30)". The maximum allowed is 5 (5 dozen or 60)
Page 4-83	Delete the section entitled CUSTOM MADE SUPPORT (JOBST OR EQUIVALENT) Price for code L8190, change to $62.72 Price for code L8195,change to $101.23 Price for code L8200, change to $104.94 Code L8200 requires EMEVS (#). Insert code L8220 Gradient compression stocking, lymphedema $30.00 below code L8210 Change the description for code L8230 to # Gradient compression stocking, garter belt

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The Pharmacy Provider Manual was recently mailed to you. In addition to the corrections published in the April Medicaid Update, please make the following corrections to your copy:

Page 4-13

Quantity/Size for code A4347, remove notation "(up to 30)". The maximum allowed is 5 (5 dozen or 60)

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This is to advise you of a clarification relating to inpatient detoxification services provided to Supplemental Security Income (SSI) recipients enrolled in Medicaid managed care.

For the period April 1, 1998, the effective date of the SSI health-only benefit package, through June 30, 1999, detoxification services provided on an inpatient basis in Article 28 hospitals to SSI Medicaid managed care enrollees should be billed directly to MMIS by the Medicaid provider. The system has been modified to allow Medicaid fee-for-service payments for DRG codes 743 through and including 751. Managed care plans that have paid providers for these services may seek recovery from the provider of service and instruct them to bill Medicaid fee-for-service.

Effective July 1, 1999, all inpatient detoxification services provided by Article 28 hospitals to SSI Medicaid managed care enrollees will be included in the SSI benefit package provided by managed care plans. For services on or after July 1, 1999, providers will bill the patient's managed care plan. All other detoxification services will continue to be considered alcohol and substance abuse services and are not included in the SSI health-only benefit package provided by the managed care plan.

If there are any questions, please contact Barbara Frankel at (518) 473-7467.

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A review of the Medicaid Management Information System (MMIS) has identified a discrepancy that has caused a small number of duplicate claims to be paid. Consequently, the Department of Health has instructed Computer Sciences Corporation (CSC) to void the claims in question in order to recover the resulting overpayments.

The voids will appear on the remittance statement corresponding to cycle 138 (dated June 11, 1999). The claims to be voided have service years in the range 1989-1995. Providers will be able to identify these voids by looking at the Claim Reference Number (CRN), which will be in the range 991009800001000 - 991009800830999. Also, these voids will have a remittance message (Remarks) which will read: QAA Void.

Providers who identify these voids on their remittance statements and have questions can call CSC at the following numbers:

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The State Department of Health welcomes your comments or suggestions regarding the Medicaid Update.

Please send suggestions to the editor, Timothy Perry-Coon:

NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
(e-mail MedicaidUpdate@health.state.ny.us)

The Medicaid Update, along with past issues of the Medicaid Update, can be accessed online at the New York State Department of Health web site: http://www.health.state.ny.us/health_care/medicaid/program/main.htm