Medicaid Memos to Provider 2006
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|
Date |
Subject |
Providers |
|---|---|---|
| December 22, 2006 | Testing Electronic Transactions for the National Provider Identifier (NPI) | All Providers that Submit/Receive Electronic Transactions |
| December 22, 2006 | Rate Increase for Procedure Code S5102 (Adult Day Health Care) – Effective January 1, 2007 |
Adult Day Health Care Providers in the Elderly or Disabled with Consumer Direction Waiver |
| December 22, 2006 | False Claims Act Educational Requirements Mandated by DRA |
All Providers / Contractors and Managed Care Organizations (MCOs) |
| December 14, 2006 | Updates and Clarification of the Prior Authorization Process for Outpatient Services |
All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and MCO's Participating in the Virginia Medical Assistance Programs |
| December 14, 2006 | Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services |
All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| December 14, 2006 | Updates and Clarification of the Prior Authorization Process for Community Based Care Services |
All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| December 14, 2006 | Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management, Residential Treatment Services, and Intensive In-Home Services | All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| December 11, 2006 | Family Planning Services Program: Clarification of Eligibility, Covered Services and Billing Requirements | All Medical Doctors, Nurse Practitioners, Nurse Midwives, Hospitals, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Laboratories, Pharmacies, and Outpatient Clinics, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program |
| December 07, 2006 | Modifications to Virginia Medicaid Preferred Drug List (PDL) | All Providers Participating in the Virginia Medical Assistance Programs |
| October 23, 2006 | Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management, Residential Treatment Services, and Intensive In-Home Services | All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| October 23, 2006 | Updates and Clarification of the Prior Authorization Process for Community Based Care Services | All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| October 23, 2006 | Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services | All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| October 23, 2006 | Updates and Clarification of the Prior Authorization Process for Outpatient Services | All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| October 17, 2006 | General Billing Instructions for the New CMS-1500 (08-05) Form – Effective October 1, 2006 | All Providers Billing on the CMS-1500 (08-05) Form |
| October 12, 2006 | Clarification of School Services | All School Divisions and Managed Care Organizations Participating in the Virginia Medicaid Program |
| October 12, 2006 | Clarification of Review of Psychiatric Records | All Psychiatric Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs |
| October 4, 2006 | National Provider Identifier (NPI) Implementation Plans For the Virginia Medicaid Program: Atypical Providers | Virginia Medicaid Participating Atypical Providers and Managed Care Organizations (MCOs) |
| October 4, 2006 | National Provider Identifier (NPI) Update | Virginia Medicaid Participating Health Care Providers and Managed Care Organizations (MCOs) |
| September 20, 2006 | Updates and Clarification of the Prior Authorization Process for Community Based Care Services | All Home and Community Based Care Waiver Service Providers and Managed Care Organizations (MCOs) |
| September 20, 2006 | Updates and Clarification of the Prior Authorization Process for Outpatient Services | All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations(MCOs) |
| September 20, 2006 | Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute, Psych, and Rehab Care Services | All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations (MCOs) |
| August 30, 2006 | Revision of the DMAS-30 R 5/06 and DMAS-31 R 5/06 (Title XVIII) Medicare Part B Deductible and Coinsurance Original and Adjustment/Void Invoice Forms | All Providers and Managed Care Organizations (MCOs) |
| August 21, 2006 | Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management and Residential Treatment Services | Treatment Foster Care Case Management, Residential Treatment Service Providers and MCOs |
| August 16, 2006 | Coverage of spacers and peak flow meters through the Durable Medical Equipment and Supply (DME) program | Durable Medical Equipment and Supply (DME) Providers, Physicians, Pharmacies, FAMIS, and MCOs. |
| August 15, 2006 | Intensity of Treatment Criteria for Acute Inpatient Hospital Psychiatric Services | Providers of Acute Inpatient Hospital Psychiatric Services |
| August 4, 2006 | Updates and Clarification of the Outpatient Prior Authorization Process for Outpatient Services | Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health and Non-Emergency MRI, PET, CAT Scan Providers and MCOs |
| August 4, 2006 | Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services | Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Providers, and MCOs |
| August 4, 2006 | Updates and Clarification of the Prior Authorization Process for Community Based Care Services | Home and Community Based Care Waiver Providers and MCOs |
| July 26, 2006 | Request to Calculate and Report the Estimated Glomerular Filtration Rate (eGFR) Value for Medicaid Recipients | In-State General Hospitals, Independent Laboratories, Out-of-State Hospitals, Out-of-State Laboratories, and MCOs |
| July 14, 2006 | BabyCare Covered Service Changes and mileage rate increase | Maternal Infant Care Coordination (MICC) providers and high risk maternity and infant program managers of MCOs. |
| July 13, 2006 | Rate Increase for Private Duty Nursing and Services that are Unique to the MR and DD Waivers – July 1st 2006 | Private Duty Nursing, Mental Retardation Waiver and Individual & Family Developmental Disabilities Support Waiver providers |
| July 7, 2006 | Expansion of Medallion II & FAMIS Programs in Danville – September 2006 | All Providers and MCOs |
| June 26, 2006 | Update Regarding Behavioral Therapeutic Consultation Provider Qualifications | Behavioral Therapeutic Consultation Services and Mental Retardation Case Managers |
| June 16, 2006 |
National Provider Identifier (NPI) Implementation
Plans For the Virginia Medicaid Program: Health Care Providers |
Health care providers and MCOs |
| June 13, 2006 | Update to the Physician Provider Manual | Physicians |
| June 9, 2006 | Expansion of Medallion II & FAMIS Programs in Culpeper – Summer 2006 | All Providers and MCOs |
| June 7, 2006 | Program Updates for Virginia’s Medicaid, FAMIS and FAMIS Plus Children Dental Program (Smiles For Children) – Spring 2006 | Dental Providers |
| June 6, 2006 | Update to the Community Mental Health Rehabilitative Services Provider Manual and changes to the Prior authorization process for extensions to Intensive In Home Services (H2012) | Community Mental Health Rehabilitative Services |
| June 2, 2006 | Update to the IFDDS Waiver Services Provider Manual | IFDDS Waiver Services providers, Case Managers and MCOs |
| June 2, 2006 | Update to the Elderly Case Management Services Provider Manual | Elderly Case Management Services providers |
| June 2, 2006 | Update to the EDCD Waiver Services Provider Manual | EDCD Waiver service providers and MCOs |
| June 2, 2006 | Update to the AIDS Waiver Case Management Services Provider Manual | HIV/AIDS Waiver Services Organization providers and MCOs |
| June 2, 2006 | Changes to the Preauthorization of Treatment Foster Care Case Management and changes to the Psychiatric Services Manual | Treatment Foster Care Case Management Providers MCOs |
| June 2, 2006 | Changes to the Preauthorization of Inpatient Psychiatric Residential Treatment and changes to the Psychiatric Services Manual | Inpatient Psychiatric Residential Treatment Providers and MCOs |
| June 1, 2006 | Update to the Technology Assisted Waiver Services (TAWS) Provider Manual | Technology Assisted Waiver Services Providers and MCOs |
| June 1, 2006 | Modifications to the Virginia Medicaid Preferred Drug List (PDL) Program and PDL Quicklist & Termination of Automatic PDL Prior Authorizations for Long-Acting Narcotics: Effective July 1, 2006 | All Providers |
| May 26, 2006 | Update to the Hospital Provider Manuals and New Prior Authorization Contractor: Effective June 12, 2006 | Hospital and Non-emergency, Outpatient MRI/CAT/PET Scan and MCOs |
| May 26, 2006 | Changes to the Preauthorization of Inpatient Psychiatric Services and and changes to the Psychiatric Services Manual: Effective June 12, 2006 | Inpatient Psychiatric Services Providers and MCO |
| May 22, 2006 | Prior Authorization transition information – change in Hospital Service Transition Date to KePRO - June 12th; one-time change in PA number for certain types of requests; Clarification of Outpatient Psychiatric Service Limits | All Pharmacies and MCO |
| May 11, 2006 | Update to the Rehabilitation Provider Manual and New Prior Authorization Contractor Effective June 5, 2006 | Rehabilitative Services providers |
| May 5, 2006 | Update to the Home Health Provider Manual and New Prior Authorization Contractor Effective June 5, 2006 | Home Health providers and MCOs |
| May 5, 2006 | Update to the Durable Medical Equipment and Supplies Provider Manual and New Prior Authorization Contractor Effective June 5, 2006 | DME providers and MCOs |
| May 3, 2006 | Correction to March 31, 2006 Medicaid Memo regarding Rate Increase for Personal Care and Related Services and Adult Day Health Care – May 1, 2006 | Mental Health and Mental Retardation Agencies, Providers of Case Management Waiver Services, Enrolled Service Facilitators under Medicaid Waivers, and Medicaid Recipients Receiving Consumer-Directed (CD) Services |
| April 26, 2006 | Changes to the Preauthorization of Outpatient Psychiatric Services and changes to the Psychiatric Services Manual | Outpatient Psychiatric Services and MCOs |
| April 26, 2006 | Changes to the Preauthorization of Outpatient Psychiatric Services and Changes to the Mental Health Clinic Provider Manual | Mental Health Clinics and MCOs |
| April 13 2006 | Updates and Changes in the Processing of Medicare “Crossover” Claims | All Pharmacies and MCO |
| April 3, 2006 | Contracting of Services to a Qualified Fiscal Agent for Consumer-Directed Fiscal Agent Services – Summer 2006 | Mental Health and Mental Retardation Agencies, Providers of Case Management Waiver Services, Enrolled Service Facilitators under Medicaid Waivers, and Medicaid Recipients Receiving Consumer-Directed (CD) Services |
| April 1, 2006 | Increased Dispensing Fee for Brand Name Drug Products – May 1, 2006 | All Providers |
| March 31, 2006 | Rate Increase for Personal Care and Related Services and Adult Day Health Care – May 1, 2006 | Personal Care, Mental Health/Mental Retardation, Consumer-Directed, Respite Care, Private Duty Nursing, Adult Day Health, who provide Personal Care and Related Services and Adult Day Health Care Services |
| March 24, 2006 | EPSDT Blood Lead Testing Requirements, Lead-Safe Virginia, & the Discontinued Usage of the Division of Consolidated Laboratories | All EPSDT Providers and all MCOs |
| March 20, 2006 | Notification of Contract Award and New Prior Authorization and Utilization Review Process – Spring 2006 | All Providers and all MCOs |
| March 1, 2006 | Discontinuation of Virginia Medicaid Interim Reimbursement for Medicare Part D Drugs for Dual Eligibles – March 8, 2006 | All Pharmacies and MCO |
| February 27, 2006 |
Implementation of the National Provider
Identification Number (NPI): Typical Anticipated Initial Implementation Date: January 1, 2007 |
Health Care Providers and MCOs |
| February 27, 2006 |
Implementation of the National Provider
Identification Number: Atypical Anticipated Initial Implementation Date: January 1, 2007 |
Treatment Foster Care, Case
Management, Respite Care, Personal Care, Adult Day
Health Care, Family Caregiver Training, Education
Services (Schools), Assisted Living, Non-Emergency
Transportation, and Mental Retardation Waiver and/or
Developmental Disabilities Waiver Service Providers
who are not eligible to obtain a National Provider
Identifier (NPI) |
| February 1, 2006 | Changes to Virginia Medicaid Billing Instructions for HIPAA Compliance – Utilization of Interim Bill Types | Hospitals, Intermediate Care Facilities, Residential Treatment Facilities, Nursing Facilities, Hospice, and Temporary Detention Order providers |
| January 30, 2006 | New Virginia Medicaid Interim Reimbursement for Medicare Part D Drugs for Dual Eligibles – Effective January 31, 2006 | All Pharmacies and MCO |
| January 12, 2006 | Changes to Processing of Medicare “Crossover” Claims -Addendum | All Pharmacies and MCO |