|
Date
|
Subject
|
Providers
|
|
December 30, 2005 |
Proper Procedure for Sending Checks for Claims
Processing Errors |
All Pharmacies and MCOs |
|
December 30, 2005 |
Discontinuation of Default Medicaid Prescriber ID
Numbers - Effective February 1, 2006 |
All Pharmacies and MCOs |
|
December 30, 2005 |
Upcoming Changes to the Processing of Medicare
“Crossover” Claims |
All Providers and all MCOs |
|
December 27, 2005 |
New Federal Requirements Regarding the Compliance
with Seclusion and Restraint Regulations - Effective
Immediately |
Level C Residential Treatment
Providers and MCOs |
|
December 20, 2005 |
Termination of Erectile Dysfunction
Drug Coverage for Medicaid Enrollees – Effective
January 1, 2006 |
All Providers and all MCOs |
|
December 20, 2005 |
Virginia Medicaid Healthy Returns
(SM)
Disease Management Program Expands – Effective
January 13, 2006 |
All Providers and all MCOs |
|
December 20, 2005 |
Monitoring Kidney Functions & the
Classification Stages of Chronic Kidney Disease (CKD |
See Medicaid Memo |
|
December 20, 2005 |
Managed Care Organization (MCO)
Merger Between Anthem HealthKeepers Plus & UniCare
Health Plan of Virginia – Effective January 1, 2006 |
All Providers (except dentists)
in Northern Virginia and the Greater Charlottesville
area and the surrounding counties |
|
December 5, 2005 |
Modifications to the Virginia Medicaid Preferred
Drug List (PDL) Program and PDL Quicklist & Medicare
Part D Implementation – Effective January 1, 2006 |
All Providers and all MCOs |
|
December 5, 2005 |
Pending Cancellation of DMAS Disaster Relief Health
Care Coverage for Victims of Hurricane Katrina |
All Providers and all MCOs |
|
December 2, 2005 |
Implementation of ClaimCheck for all Physician and
Laboratory Services – Effective January 9, 2006
|
All Providers and all MCOs |
|
November 29, 2005 |
Managed Care Organization (MCO) Program Expands Into
the Winchester Region – Effective December 1, 2005
|
All providers in Winchester, Virginia
and surrounding counties |
|
November 7, 2005 |
Medicaid Reimbursement Rate Changes for Culpeper and
King George Counties – Effective January 1, 2006 |
Community-Based Care Waiver Service
Providers and Community Service Boards (CSBs) in
Culpeper and King George Counties |
|
September 16, 2005 |
Clarification of BabyCare Claims Process & FAMIS
MOMS Eligibility for BabyCare Services |
All BabyCare and MCOs |
|
September 6, 2005 |
Changes to Orthotic Services Pre-authorization (PA)
Process – Effective October 1, 2005 |
Durable Medical Equipment/Supplies.
Prosthetic Services Providers and Orthopedic
Surgeons |
|
August 19, 2005 |
FAMIS MOMS Enrollees – How to Apply for Newborn
Coverage |
Hospitals, Pediatricians and MCOs |
|
August 9, 2005 |
Expansion of Managed Care Organization (MCO) Program
in Northern Virginia |
All Providers and all MCOs |
|
August 1, 2005 |
Correction to the Billing
Instructions for the UB-92 Claim Form |
Inpatient Private Mental Hospitals,
Inpatient Psychiatric Residential Treatment
Facilities, State Mental Health Facilities, and
(MCOs) |
|
August 1, 2005 |
Rate Increases & New Patient Pay
Payroll Procedure for Consumer-Directed (CD)
Services – Effective July 1, 2005 |
Mental Health and Mental Retardation
Agencies, Service Facilitators and
Providers of Case under Medicaid Waivers, and
Medicaid Recipients Receiving Consumer-Directed (CD)
Services |
|
July 14, 2005 |
Reimbursement for Dental Services under Smiles For
Children – Effective July 1, 2005 |
Federally Qualified Health Centers (FQHCs),
Rural Health Centers (RHCs), and MCOs |
|
July 8, 2005 |
Coverage Changes to the FAMIS Program (FAMIS MOMS &
FAMIS Select) – Effective August 1, 2005 |
All Providers and MCOs |
|
June 28, 2005 |
Billing Changes to Date of Discharge for Hospice
Services – Effective July 1, 2005 |
Hospice and MCOs |
|
June 28, 2005 |
Preferred Drug List (PDL) Changes
Affecting Nursing Home Providers – Effective August
1, 2005 |
Nursing Homes |
|
June 14, 2005 |
Coverage of Orthodontics Billing Procedures for
Medicaid FAMIS, and FAMIS Plus Children – Effective
July 1, 2005 |
Orthodontists and MCOs
|
|
June 14, 2005 |
Dental Program Coverage of Medical/Surgical
Procedures for Medicaid, FAMIS and FAMIS Plus
Children – Effective July 1, 2005 |
Oral Surgeons and MCOs
|
|
June 10, 2005 |
Smiles For Children, Virginia’s Dental Program for
Medicaid,
FAMIS, and FAMIS Plus Children – Effective July 1,
2005 |
Dental Services and MCOs
|
|
June 10, 2005 |
Annual Review of Phases II and III of the Virginia
Medicaid Preferred
Drug List (PDL) Program, Review of New Drugs,
Dispensing Fee for
Generic Drugs, and PDL Quicklist – Effective
July 1, 2005 |
All Providers and all MCOs
|
|
June 3, 2005 |
Termination of Erectile Dysfunction (ED) Drug
Coverage for Individuals Convicted of a Sex Offense |
Pharmacies, Out-of-State Pharmacies, Physicians
and (MCOs)
|
|
May 19, 2005 |
Change in Reimbursement Policy for School-Based
Health Screenings of Children Enrolled in Medicaid
Managed Care Organizations |
School Divisions
|
|
March 28, 2005 |
New Billing Requirements for Non-emergency, Outpatient
MRI/CAT/PET Scans |
Providers of Non-emergency, Outpatient MRI/CAT/PET Scans
|
|
March 28, 2005 |
Patient Pay Recorded on Paper Claim Submissions for Waiver Services |
Long Term Care and Community-Based Care Waiver Service Providers
|
|
January 10, 2005 |
Services Requiring Claims Submission Through the VaMMIS |
Community Service Boards/Behavioral Health Executive Directors, Consumer-Directed Service Facilitators, MR Waiver Pre-vocational Service Providers and Agency-Directed Companion Services Providers
|
|
January 5, 2005 |
Clarification of Day Treatment Services for Children and Adolescents |
Day Treatment Services for Children and Adolescents
|
|
December 13, 2004 |
Enrollment of Licensed Marriage and Family Therapists |
Managed Care Organizations (MCOs), Physicians,
Professional Counselors, Psychologists, Clinical Psychologists, Mental Health/Mental Retardation Agencies, Substance Abuse Clinics (FAMIS),
Clinical Social Workers, Psychiatric Residential Inpatient Facilities, and Psychiatric Clinical Nurse Specialists
|
|
December 3, 2004 |
Long-Acting Narcotics Step Therapy & the Preferred Drug List |
Skilled Nursing Homes, Physicians, Nurse Practitioners, Podiatrists, Dentists, Hospices, Ambulatory Surgical Centers,
Pharmacies and MCOs
|
|
December 1, 2004 |
Medicaid Eligibility for Infants Born to Non-Medicaid-Eligible Alien Women Whose Deliveries Were Covered By Medicaid as an Emergency Medical Service |
All Providers and MCOs
|
|
December 1, 2004 |
Annual Review of Phase I of the Virginia Medicaid Preferred Drug List
Program and PDL Quicklist |
All Providers and MCOs
|
|
November 5, 2004 |
Clarification of Family Planning Waiver - Covered Services and Billing Procedures |
Physicians, Nurse Practitioners, Nurse Midwives, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Laboratories, Pharmacies, and Outpatient Clinics
|
|
November 5, 2004 |
Waiver Billing and Maintenance Issues |
All Home Health and Home-and-Community-Based Waiver Providers and all MCOs
|
|
November 5, 2004 |
Changes to the Review Process for Treatment Foster Care-Case Management Services – Effective December 15, 2004 |
All Treatment Foster Care-Case Management Service providers,
MCOs and holders of the Psychiatric Services Provider Manual
|
|
October 15, 2004 |
Maximum
Allowable Cost (MAC) Program for Virginia Medicaid
and Notification of COX-II Drug Class Changes to
Preferred Drug List (PDL) |
All Pharmacy
Providers
|
|
October 1, 2004 |
Implementation
of the New Provider Remittances for Professionals
and Facilities –
November 5, 2004 |
All
Providers, FAMIS, SLH, and MCOs
|
|
September 3, 2004 |
Changes
to the Review Process for Residential Treatment
Services |
All
Residential Treatment, MCOs, providing services to
Virginia Medicaid Recipients, and holders of the
Psychiatric Services manual
|
|
September 1, 2004 |
Threshold/Polypharmacy
Program |
All
Providers, FAMIS, MCOs
|
|
August 31, 2004 |
Clarification
of Day Treatment Services for Children and
Adolescents |
All
Providers of Day Treatment Services for Children and
Adolescents
|
|
August 20, 2004 |
Use
of Electronic Signatures |
All
Providers, FAMIS, SLH, and MCOs
|
|
August 20, 2004 |
Notice
of Sentara Family Care's Name Change to Optima
Family Care |
All
Providers, and FAMIS
|
|
August 16, 2004 |
Rate Increase for Obstetrical and Gynecological Services |
All
Providers, FAMIS, SLH and MCOs
|
|
August 15, 2004 |
Billing Information Update for
Submitting Paper UB-92 Medicare,
Crossover
Part A and B claims |
Nursing
Home Providers
|
|
August 6, 2004 |
Rate
Increase for Specific Home and Community-Based
Waiver Services |
Providers providing services under
the following waivers: AIDS, Consumer-Directed
Personal Attendant Services, Mental Retardation
Waiver and Individual & Family Developmental
Disabilities Support
|
|
August 1, 2004 |
Mandatory Generic edits, ePocrates®, Weight Loss Drugs-New Prior
Approval Procedure and Over the Counter Drugs |
All
Providers and MCOs
|
|
July 26, 2004 |
Re-Implementation of the 180-Day Outstanding Check and Claim Void
Process |
All
Providers, FAMIS, SLH and MCOs
|
|
July 19, 2004 |
Sending Attachments Related to 837 Electronic Claims Transactions
(form DMAS-3, reformatted) |
All
Providers, FAMIS, SLH and MCOs
|
|
July 1. 2004 |
Claims Edits and Extensions for Prior-Authorization
of Home and Community Based Waiver Services and Off-Line Billing
for MR Waiver Claims |
All Home and Community
Based Providers providing services under AIDS Waiver,
Consumer-Directed Personal Assistance Services Waiver,
Elderly & Disabled Waiver, Mental Retardation Waiver,
Technology Assisted Waiver and Individual & Family
Developmental Disabilities Support Waiver
|
|
June 1. 2004 |
Cox-2 Clinical Edits, Phase III of the Virginia Medicaid Preferred Drug List
(PDL) Program, and PDA Download for PDL Quick List- July 2004 |
All
Providers and MCOs
|
|
May 25, 2004 |
Billing Alert – Processing of Certain Community Mental Health
Services covered under FAMIS |
Mental Health Providers and
MCOs participating in the FAMIS Program
|
|
May 17, 2004 |
Prospective Drug Review Program (ProDUR) Changes to Early Refill
(ER) edits and Update on Home Infusion Billing |
All Pharmacy
Providers
|
|
April 15, 2004 |
Durable
Medical Equipment (DME) Appendix B Information |
DME,
Supplies Providers and MCOs
|
|
April 13, 2004 |
Claim Repayments Due To ClaimCheck |
Hospitals
and Physicians
|
|
April 1, 2004 |
Processing
and Payment of Emergency Room Claims |
Hospitals,
Physicians and MCOs
|
|
March 22, 2004 |
Update of Medicaid, FAMIS, and FAMIS Plus ID Cards and Eligibility Verification Systems Information |
All
Providers, MCOs and FAMIS,
|
|
March 18, 2004 |
Billing Information Correction for Submitting Paper UB-92 Medicare Part A and B Claims |
Nursing Home Providers
|
|
March 1, 2004 |
Phase
II of the Virginia Medicaid Preferred Drug List
(PDL) Program for Pharmacy Services – April 2004
(Revised) |
All
Providers and MCOs
|
|
February 6, 2004 |
Request Required by Providers Receiving ASC X12 835 Transactions
for the Continued Receipt of Paper Remittances Advices Past 30 Days |
All
Providers, FAMIS, SLH and MCOs
|
|
January 23, 2004 |
Prospective Drug Review Program Changes for Pharmacy Claims, and
other Pharmacy Program Changes |
All
Pharmacy providers
|
|
December 1, 2003 |
Prescriber
ID for Pharmacy Claims |
All
Pharmacy providers
|
|
November 25, 2003 |
Introduction
of Virginia Medicaid Preferred Drug List (PDL
Program for Pharmacy Services |
All
Providers and MCOs
|
|
November 20, 2003 |
Mandatory Use of ASC X12 Formats for Electronic Transactions |
All
Providers, FAMIS, SLH and MCOs
|
|
October 28, 2003 |
Changes in Billing for Medicare “Crossover” Claims |
All
Providers
|
|
October 8, 2003 |
VAMMIS
Issues Resolution |
All
Providers, FAMIS and SLH
|
|
September 16, 2003 |
Trading Partner Contingency Plan for HIPAA
Transactions and Code Sets - NSF electronic
transaction claim formats and Local Codes accepted
in MMIS after October 16, 2003 deadline through
December 31, 2003 |
All
Providers, FAMIS, SLH and MCOs
|
|
September 12, 2003 |
Changes to Billing for EPSDT Services and Summary of Blood Lead Screening Requirements |
EPSDT
Providers and MCOs
|
|
August 15, 2003 |
Implementation of the New Virginia Medicaid Management Information System (MMIS) |
All
Pharmacy Providers, and FAMIS
|
|
August 1, 2003 |
Medicaid and FAMIS New ID Cards and Eligibility Verification |
All Providers, and FAMIS
|
|
July 10, 2003 |
Telemedicine Services |
Physicians, nurse practitioners, nurse midwives, clinical nurse specialists-psychiatric, clinical psychologists, clinical social workers, licensed professional counselors and MCOs
|
|
July 1, 2003 |
Revised Effective Date for Prior Authorization of Non-Emergency, Outpatient MRI, PET and CAT scans |
All Providers and FAMIS
|
|
June 1, 2003 |
Prior
Authorization of Non-emergency, Outpatient MRI, PET
and CAT scans |
All Providers and FAMIS
|
|
May 1, 2003 |
All Providers:
Implementation of the New Virginia Medicaid
Management Information System (MMIS) |
All Providers, FAMIS,
SLH and MCOs
|
|
May 1, 2003 |
All Pharmacy
Providers: Implementation of the New Virginia
Medicaid Management Information System (MMIS) |
All Pharmacy Providers
and FAMIS
|
|
May 1, 2003 |
All TDO Providers:
Implementation of the New Virginia Medicaid
Management Information System (MMIS) |
All TDO Providers
|
|
April 16, 2003 |
Revision
to the Paper Pharmacy Claim Form and Introduction of
Pharmacy Compound Claim Form |
All Pharmacy services
providers
|
|
October 18, 2002 |
Implementation
of the New Virginia Medicaid Management Information
System |
All
Providers and MCOs
|
|
December 1, 1999 |
Billing Instructions and Reimbursement of Claims by
Diagnosis Related Groups (DRG) |
All
Providers and MCOs |
