DOH Medicaid Update March 2005 - Special Edition Vol. 20, No. 3

Office of Medicaid Management
DOH Medicaid Update
March 2005 - Special Edition Vol. 20, No. 3

State of New York
George E. Pataki, Governor

Department of Health
Antonia C. Novello, M.D., M.P.H., Dr. P.H.
Commissioner

Medicaid Update
is a monthly publication of the
New York State Department of Health,
Office of Medicaid Management,
14th Floor, Room 1466,
Corning Tower, Albany,
New York 12237



news

SPECIAL EDITION
eMedNY PHASE II
Beginning March 24, 2005

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The eMedNY Phase II implementation is scheduled for March 24, 2005.

Understanding that some providers may have difficulty in making their required changes for eMedNY Phase II by that date, the Department of Health is offering a transition plan to assist these providers in their migration.

This transition plan will be available only for a three-month period, ending June 20, 2005, but will not be available to providers who have failed to make their conversion to HIPAA.

HIPAA compliance is absolutely required by March 21, 2005. Under the plan providers will be able to begin submitting their eMedNY Phase II HIPAA compliant claims on March 21, 2005. However, they may elect to continue sending pre-Phase II HIPAA 837 claims to Medicaid if they have not completed their conversion. Other features of the transition plan, including continued use of the 837I for ordered ambulatory claims, and the continued use of current paper forms and communication methods, were detailed in a recent letter mailed to all Medicaid providers, and are available on the eMedNY web site, www.emedny.org.

Upon final conversion to the new system, some changes will be required to the manner in which providers interact with the New York State Medicaid program.

Paper Claims and Remittances

  • New paper claim and prior approval forms will be required for processing by the eMedNY system. This change will have the following impact:
    • If you use an automated system for the completion of your claim forms and/or prior approval forms, your system will require changes to accommodate the new form layouts.
    • The new forms are required for the Phase II implementation. An initial supply of the new forms will be sent to you in advance of the implementation date. The old forms (the forms currently in use) will be rejected after the cutoff date. On a separate notification we will inform you of the date when the old forms will be discontinued and the date when the new forms will be accepted.
    • Samples of the new forms are available for viewing on our website, www.emedny.org. These forms are not for claim submissions; only original forms will be accepted.
    • Providers using the UB-92 form must be aware that CSC will not supply these forms. UB-92's are commercially available.
  • Paper remittance advices will be in a different format.
    • The claim information returned on the remittance advice will be laid out differently than on the current remittances. A sample of the new remittance format is available on our website, www.emedny.org.

Electronic Transaction Submissions and Remittances

  • Claims will not be accepted on magnetic media (tape and diskettes) following the implementation.
    • Providers using these media to send claims to Medicaid will need to switch to ePACES, eMedNY eXchange, or FTP. For information regarding these methods visit www.emedny.org.
  • The MMIS Electronic Bulletin Board will be shut down.
    • Providers using this method to submit claims will need to switch to ePACES, eMedNY eXchange, FTP, or the eMedNY Bulletin Board. Be aware that if you select the eMedNY Bulletin Board, this option will become obsolete in the future, and you will need to make another change when this occurs.
      • For active submitters who submit for only one Medicaid provider, a user ID has been established for you on the eMedNY Electronic Gateway. This user ID has been sent to you on the MMIS Electronic Gateway, and can be used at eMedNY with your existing password.
      • Submitters for more than one provider have been sent instructions on how to sign up for a user ID on the eMedNY Electronic Gateway. Simply complete this packet, and send it to the address provided in the instructions.
      • For instructions on how to test your user ID at eMedNY, visit www.emedny.org.
      • For questions regarding the eMedNY Electronic Gateway, please call Computer Sciences Corporation Provider Services at (800) 522-5518 or (518) 447-9860.
    • For information regarding signing up for ePACES or eMedNY eXchange visit www.emedny.org.

Remittance Advices (HIPAA 835 and 820) will no longer be available on magnetic media.

  • Providers now getting magnetic media remittances will need to switch to eMedNY eXchange or FTP.
  • Remittance advices will not be available on the eMedNY Electronic Gateway.

Medicaid System Enhancements

  • The New York State Medicaid program will modify several rules for claims processing in conjunction with this implementation. These modifications will require programming changes to your system.
    • The new requirements can be easily located in the CG Modification Tracking section in each Companion Guide. The Guides can be located on www.nyhipaadesk.com under the "News & Resources" tab. Please review the Phase II Companion Guides for changes that will affect your organization and make the required development changes.
    • Profession code must be used in lieu of the provider type when license numbers are submitted.
    • Locator codes expanded to 3 position fields. A locator code that is now "03" must be submitted as "003".
    • ETIN (formerly TSN) expanded to 4. Current ID's remain at 3. Newly assigned ETIN's will be 4.
    • Prior Approval number expanded to 11 characters. (See section on Prior Approval/Prior Authorization for details.)
    • Medicaid will process claims as an entire document vs. splitting multi-line claims into a new claim for each line.
    • Real-time submission and response option will be available for Professional claims (837P).
    • Visit www.nyhipaadesk.com for more details about the Medicaid systems enhancements for eMedNY Phase II.

Electronic Transactions - Phase II Testing

  • In order to help you be prepared for the new Medicaid system, CSC has provided a test system. This test system will allow you to validate your electronic transaction formats for acceptance into the new system.
    • Visit our website at www.emedny.org to get an eMedNY Phase II Testing Guide for instructions on how to use the Test System.
    • Sign up for the method you plan to use to access eMedNY Phase II. If you have questions about the available options, please visit www.emedny.org or call CSC Provider Services at (800) 522-5518 and press option 5.
    • Test your changes for Phase II.
    • If you access NY Medicaid through a switching service, contact your service provider to make arrangements for testing with Medicaid.

Phase II Deployment

  • Be prepared to implement your Phase II changes on March 24 when the new Medicaid system is implemented. Beginning in February, a weekly project status will be posted on www.emedny.org. As we get closer to the conversion date, this posting will include the exact deployment timings.
  • As is prudent with any implementation of a new system, we highly recommend you maintain the ability to roll back your changes should any unforeseeable circumstance occur.

The Department of Health and CSC are committed to working with you to achieve a smooth conversion to the new Medicaid Management System.

For questions regarding these matters, please call Computer Sciences Corporation, Provider Services at (800) 522-5518 or (518) 447-9860.


Reprint from the February 2005 edition

 

Have You Received Training?
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Major enhancements will be made to the Medicaid program on March 23 with the implementation of eMedNY (Phase II). Will you be ready?

Invitations were sent to 66,000 providers for training on the new system.
Only 4,500 providers enrolled in the training sessions!

Hopefully, you have already attended a training session, and have made the changes needed to be ready for the conversion.

If not, you may be unable to successfully submit your claims for Medicaid payments following the conversion!

If you have an interest in training sessions,
please call Computer Sciences Corporation's Provider Services at:

(800) 522-5518 or (518) 447-9860.

Because of the low volume of attendance, we are interested in identifying additional training requirements.

We also suggest that you visit our websites frequently (www.emedny.org and www.nyhipaadesk.com) for updates on the changes required for eMedNY Phase II.


New Article!

 

Be In Touch!

Look For Updates as eMedNY is Implemented!
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As we transition the Medicaid system to eMedNY on March 24, updates and alerts will be posted on Computer Sciences Corporation's website.

Go to

www.eMedNY.org

for breaking news and important updates!


Reprint from the November 2004 and January 2005 editions

 

Changes Affecting Prior Approvals/Prior Authorizations
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Upon implementation on March 24, 2005, eMedNY Phase II will introduce changes that impact the submission of prior approval/prior authorization requests and the responses to those requests.

  • The prior approval/prior authorization number format will change from 8 digits to 11 digits. After the eMedNY Phase II implementation, providers will be allowed to continue using Legacy prior approvals/prior authorizations (8-digit numbers) until they expire or the units are exhausted. However, providers must be prepared to handle 11-digit authorization numbers when they are assigned by eMedNY following the Phase II implementation.

Pharmacists: The following information pertains to other providers.
                       Please maintain your current prior authorization practice.

  • Electronic prior approval/prior authorization requests and responses will be allowed only on the HIPAA 278 transaction. The Companion Guides for the HIPAA 278 are available on the www.nyhipaadesk.com website. Click on "News & Resources", then "eMedNY Phase II HIPAA Transactions".
  • Prior approval/prior authorization requests can be entered on ePACES. A reference number will be returned to your ePACES screen, which can be later used to check the approval status on ePACES. You can sign up for ePACES now to be ready for this new feature following implementation. Visit www.emedny.org for more details.
  • Paper prior approval/prior authorization request forms have been modified to comply with eMedNY requirements. Samples of the new forms are available at the eMedNY website: www.emedny.org. The layout and completion of the new forms will be discussed in training sessions, which are being offered by CSC. An initial supply of forms will be sent to providers before the eMedNY Phase II implementation. The new PA request form is a single part form, replacing the current 3-part form.
  • Providers who submit Prior Approval requests on ePACES will be able to access their final determinations over ePACES. Others will be notified of PA determinations by eMedNY eXchange messages or by mail. To sign up for eXchange, visit www.emedny.org.
  • Prior Authorizations for non-emergency transportation for New York City recipients will continue to be issued over the CSC Prior Authorization line for providers who choose that request method.

IMPORTANT CONVERSION DATES

  • For the following Prior Approval types [01-Physician, 03-Dental, 04-Nursing Home/Bed Reservation, 06-DME, 07-Eye Care, 08-Hearing Aid, and 10-Private Duty Nursing], beginning on Monday, March 14, please use the new Prior Approval forms for submission of requests, which should be sent to: Computer Sciences Corporation, PO Box 4600, Rensselaer, NY 12144-4600. NOTE: Requests mailed before March 14 must be sent on the old forms to the former addresses; the NEW forms must be used for requests sent to the new central address. Any requests submitted not following these instructions will be returned unprocessed.
  • For 05-Transportation PA Requests, the new forms should be utilized beginning March 14, Requests submitted on the old forms will be accepted up through March 18 only, as of March 21, only the new forms will be accepted.
  • For MOAS, the Threshold Override Applications will be received on the old forms up through March 18 only; as of March 21, only the new forms will be accepted.
  • For 11-Out of State Hospital prior approval requests, there is no standard form. Requests should be made in written letter format and sent to the State Health Department office based on the client's county of fiscal responsibility as follows:

NYSDOH Western Regional Office
584 Delaware Avenue
Buffalo, NY 14202-1203

Counties: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming

Bureau of Medical Review and Payment
150 Broadway, Suite 6E
Albany, NY 12204-2736

Counties: All others not listed for Western Regional Office

For questions regarding this matter, please call Computer Sciences Corporation at 800-522-5518 or 518-447-9860.


Revised and Updated!
This article is a revision to the original article printed in the October 2004 edition.

Phase II Will Not Support Blocked Data
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When you transition to eMedNY Phase II, claims will not be accepted in the 80-byte blocked format. Your HIPAA-compliant EDI X12 and NCPDP electronic claims must be submitted as Streamed Data.

You were previously notified that following eMedNY Phase II, physical media such as tape, diskette, and cartridge would no longer be accepted.

If you are sending physical media, you will need to migrate to an electronic method of sending claims, such as eMedNY Exchange or FTP.

If you are using a vendor, service bureau or clearinghouse, please contact them to verify that you will meet these requirements for eMedNY Phase II.

If you have any questions visit www.emedny.org or call CSC Provider Services at 800-522-5518 or (518) 447-9860.


Reprint from December 2004 edition

 

Non-Emergency Transportation
Electronic Claim Submission

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Transportation providers should be advised that, when you transition to eMedNY Phase II , the current Legacy electronic Claim Form A format will no longer be supported!

All non-emergency transportation services billed electronically will be required to be submitted on the HIPAA 837 Professional (837P) transaction.

This change is of particular interest to transportation providers who deliver only non-emergency transportation services and may not be currently using the HIPAA 837P transaction.

In order to continue submitting your claims electronically, these providers need to take action to convert to the 837P format by March 2005. Information regarding the 837P HIPAA Transactions can be found in the HIPAA Implementation Guides and the New York State Companion Guides at www.nyhipaadesk.com

Medicaid has a free internet-based billing program called ePACES through which providers can submit HIPAA-compliant electronic claims. Information about enrolling in ePACES and the minimum PC configuration requirements can be found at www.emedny.org

For questions regarding this matter, please call CSC at (800) 522-5518 or (518) 448-9860.


Revised and Updated!
This article is a revision to the original article printed in the January 2005 edition.

The Electronic Gateway
To Be Eliminated March 2005!

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The MMIS Electronic Gateway will be available through the transition period until June 20, but will not be available after you transition to Phase II.

MMIS Electronic Gateway submitters are required to select a new method for sending claims to Medicaid following the March 24 implementation of eMedNY Phase II.

If you have access to the Internet, please consider using one of our new access methods:

Computer

  • eMedNY eXchange, or
  • ePACES.
    Those providers who are enrolled in the Electronic Provider Assisted Claims Entry System (ePACES) are already enrolled to use the eMedNY eXchange with their existing user IDs, and only need to activate the Inbox by calling (800) 343-9000.

Providers who are not enrolled in ePACES will need to follow an eMedNY Exchange enrollment process during which they will be issued a user ID and an initial password.

For information regarding the eMedNY eXchange and enrollment procedures, please visit www.emedny.org

Providers who wish to continue submitting their claims using the dial-up method following the Phase II implementation may choose to use the eMedNY Electronic Gateway, which has similar features to the MMIS Electronic Gateway.

For MMIS Electronic Gateway submitters who have only one active provider number associated with their ETIN (TSN), a new user ID has been assigned to you on the eMedNY Electronic Gateway.

You have already been notified about this on the MMIS Electronic Gateway.

If you have questions about your new user ID, please call CSC Provider Services at 800-522-5518 or (518) 447-9860.

MMIS Electronic Gateway users who submit for multiple providers will need to sign up for the eMedNY Electronic Gateway. Visit the eMedNY website www.emedny.org for more details.

Although the eMedNY Electronic Gateway will remain as an access option after the Phase II implementation, this method will also be discontinued sometime in the future.

For questions regarding this matter, please call Computer Sciences Corporation at 800-522-5518 or 518-447-9860.


Reprint from
January 2005
edition

ePACES Enhancements for Phase II
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The current functionality in ePACES will continue to be available following the eMedNY Phase II implementation in March 2005. In fact, if you are a current ePACES user, your ID and password will not change for Phase II.

When eMedNY Phase II is implemented, some exciting new features will be available in ePACES.
For example:

  • Real-time processing will be available for professional claims (837P). When you select the real-time option, your claim will be processed as soon as it is received by eMedNY, and the status of your claim (including payment amount) will be available for viewing in ePACES. The actual payment will be included in your disbursement based on Medicaid's payment cycle. When using the real-time option, a maximum of four lines can be included on a claim.
  • You will be able to enter your requests for prior approval on ePACES. A reference number will be returned to your ePACES screen, which can be later used to check the approval status on ePACES.
  • When submitting a batch of claims in ePACES, if some of the claims in the batch are rejected, they will not preclude all other claims in the batch from being accepted for processing. A list will be provided to identify the rejected claim, so it can be corrected and resubmitted.

You can sign up for ePACES now. Signing up for ePACES will also give you access to eMedNY eXchange.

To find out more visit our website at www.emedny.org, or contact CSC Provider Services at 800-522-5518 or (518) 447-9860.


Revised and Updated!
This article is a revision to the original article printed in the December 2004 and February 2005 editions.

Paper Claim Forms
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Paper forms will undergo significant changes with the implementation of Phase II in March 2005. The new forms are required to accommodate systems changes, and to comply with the Centers for Medicare and Medicaid Services (CMS) regulations.

  • NYS Form A, HCFA-1500, and Pharmacy forms will be accepted with modifications in format and provider-type users.
  • NYS Form B and Form C will be discontinued.
  • The standard CMS UB-92 Form will be adopted for rate-based providers.
  • The current Prior Authorization/Prior Approval forms will be modified.
  • The current Threshold Override Application (TOA) form will be modified.

Samples of the new paper forms for Phase II are available at www.emedny.org in the ”Phase II Paper Forms“ section.

  • You may begin using the new form when eMedNY Phase II is implemented on March 24, 2005.
  • However, those providers who are not ready for the new forms can continue to use the old ones through May 31, 2005.

Claim Form A

This form will be required, with modifications, only for dental billing (categories of service 0180, 0200, and (0287 or 0160 with specialty 912) and transportation billing (categories of service 0601, 0602, 0603, 0605, 0606).

HCFA-1500

The modified version of this form will be required for the current users and for the fee-for-service provider types currently using Form A and Form C.

Provider categories of service that are expected to use the modified NYS HCFA-1500 under eMedNY Phase II
Service Category
Code
Service Category
Name
Current FormeMedNY Form
(modified)
0140QMB Chiropractor & Portable X-rayNYS-HCFA 1500NYS-HCFA 1500
0162Clinic-based Ordered AmbulatoryClaim Form ANYS-HCFA 1500
0163, 0389Ordered Ambulatory Part A & B (other than Lab)Claim Form ANYS-HCFA 1500
0164, 0261, 0262, 0283, 0321-0325, 0386,
0387, 0442, 0443, 0604
DME and Hearing AidClaim Form CNYS-HCFA 1500
0281Hospital-based Ordered Ambulatory LabNYS-HCFA 1500NYS-HCFA 1500
0282Hospital-based Ordered Ambulatory (Other than Lab)NYS-HCFA 1500NYS-HCFA 1500
0401, 0402, 0404, 0405, 0407, 0408,
0422, 0423
Vision CareNYS-HCFA 1500NYS-HCFA 1500
0460PhysicianNYS-HCFA 1500NYS-HCFA 1500
0469Nurse PractitionerNYS-HCFA 1500NYS-HCFA 1500
0500PodiatristNYS-HCFA 1500NYS-HCFA 1500
0521Nurse LPNClaim Form ANYS-HCFA 1500
0522Nurse RNClaim Form ANYS-HCFA 1500
0523Hospital Registry LPNClaim Form ANYS-HCFA 1500
0524Hospital Registry RNClaim Form ANYS-HCFA 1500
0525MidwifeClaim Form ANYS-HCFA 1500
0560Clinical Social WorkerNYS-HCFA 1500NYS-HCFA 1500
580Clinical PsychologistClaim Form ANYS-HCFA 1500
0621Occupational TherapistClaim Form ANYS-HCFA 1500
0622Physical TherapistClaim Form ANYS-HCFA 1500
0623Speech Pathologist / Speech TherapistClaim Form ANYS-HCFA 1500
1000Free Standing LaboratoryNYS-HCFA 1500NYS-HCFA 1500

NYS Pharmacy Claim

The modified Pharmacy form will be accepted for categories of service 0161, 0288, and 0441.

UB-92

All rate-based providers that currently bill on Form A or on Form B will be required to use the Centers for Medicare and Medicaid Services (CMS) standard UB-92 form.

Provider categories that are expected to use the UB-92
Service Category CodeService
Category Name
Current Form eMedNY Form (modified)
0121Child Care Claim Form BUB-92
0123Residential Treatment FacilityClaim Form AUB-92
0160Diagnostic and Treatment CenterClaim Form BUB-92
0164School Supportive Health ServicesClaim Form AUB-92
0165HospiceClaim Form BUB-92
0220Managed Care CapitationClaim Form AUB-92
0260, 0260 with specialty 798Free-standing Home Health Care and
Long and Long Term Home Health Care
Claim Form AUB-92
0263TBI WaiverClaim Form AUB-92
0264Personal Care Agency; Limited Licensed Home CareClaim Form AUB-92
0265Case Management ServicesClaim Form AUB-92
0266Personal Emergency Response ServicesClaim Form AUB-92
0267Assisted Living Program (ALP)Claim Form BUB-92
0268OMH Rehabilitative ServicesClaim Form AUB-92
0269OMRDD HCBS WaiverClaim Form AUB-92
0284, 0284 with specialty 798Hospital-based Home Health Care and
Long Term Home Health Care
Claim Form AUB-92
0286Skilled Nursing Facility (Inpatient)Claim Form BUB-92
0287Hospital-based Day Treatment CenterClaim Form BUB-92
0381Long Term Care (LTC) Skilled Nursing FacilityClaim Form BUB-92
0383LTC Day CareClaim Form BUB-92
0384Intermediate Care Facility (ICF-DD)Claim Form BUB-92
0385OMRDD State Operated Clinic and Day TreatmentClaim Form BUB-92
0386NH-based Home Health CareClaim Form AUB-92
0388 w/specialty 798NH-based Long Term Home Health CareClaim Form AUB-92

Providers who file paper claims using a software program will need to modify their software to accommodate the changes.

If you have any questions about the contents of this article, please call CSC Provider Services at (800) 522-5518 or (518) 447-9860.


Revised and Updated!
This article is a revision to the original article printed in the October 2004, November 2004 and January 2005 editions.

Dental Prior Approvals and Claims
Change in Oral Cavity Reporting

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Your transition to eMedNY Phase II will require a change in the reporting of ORAL CAVITY designations on all prior approvals and claim forms where required. This will include the HIPAA 837 transaction, as explained below.

Currently, Medicaid recognizes two ORAL CAVITY designations, which do not have a mapping in the HIPAA 837D:

  • Upper Anterior Sextant; and,
  • Lower Anterior Sextant.

eMedNY will NOT recognize these two Oral Cavity designations.

Only the Oral Cavity values and definitions for quadrants (UR, UL, LL, LR) listed in the HIPAA Implementation Guides will be recognized and accepted as valid for those procedures where a quadrant indication is required.

The Companion Guides for the 837D, which can be found at www.nyhipaadesk.com, will be updated accordingly.

For questions regarding this matter, please call Computer Sciences Corporation at (800) 522-5518 or (518) 447-9860.


Revised and Updated!
This article is a revision to the original article printed in the October 2004, December 2004 and February 2005 editions.

Remittance Advices
eMedNY Transactions 820 and 835

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When you transition to eMedNY Phase II:

  • eMedNY will not produce remittance advices on tape or cartridges.
  • HIPAA remittance advices (835 and 820 transactions) will be delivered as electronic response files through the eMedNY eXchange.

Providers will still have the alternate choice of receiving paper remittance advices; however, those who choose the electronic transactions 835 or 820 will not receive paper remittance advices.

This means that, even if you submit certain claims on paper forms, these will be included in the electronic 835/820.

Providers who submit claims under multiple Electronic Transmitter Identification Numbers (ETIN) will receive multiple 835/820 transactions and multiple checks; i.e., one advice and one check for each ETIN.

This will eliminate the current requirement of a separate check remittance. Additionally, remittance advices (electronic or paper) will contain a maximum of 10,000 claim lines. Any excess will be carried over to additional remittance advice(s). Each remittance advice will have a corresponding check.

Providers who submit claims under multiple ETINs, and receive the 835 or the 820, must choose a primary ETIN for the purpose of receiving retroactive adjustment advices (rate-based providers) and claims submitted on paper forms (any provider).

Providers who do not choose a primary ETIN will not be able to receive information regarding retroactive adjustments or claims submitted on paper, since eMedNY will not be able to link this information to any specific ETIN.

For questions regarding this matter, please call CSC at (800) 522-5518 or (518) 447-9860.


Revised and Updated!
This article is a revision to the original article printed in the January 2005 editions.

Electronic Billing Changes for
Ambulatory Services

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Do you bill Medicaid for ambulatory services, such as laboratory and radiology services (Categories of Service 0281, 0282, 0162 or 0163)?

Urgent

If so, here is important information that will affect you!

When you transition to eMedNY Phase II , the new system will not be ready to accept electronic bills for ordered ambulatory services on the Institutional Health Care Claim (837I) transaction. However, you may continue to send 837I claims for these services to the Legacy MMIS system using your existing method, which includes magnetic media (tape or diskette) or the MMIS Electronic Gateway.

Upon implementation of eMedNY Phase II, electronically billing ordered ambulatory services will be allowed only on the Professional Health Care Claim format (837P).

You certainly may program the 837P format if you wish. But this will not be necessary, because the New York State Department of Health and CSC will conduct a high priority project to support ordered ambulatory claims on the 837I format following the eMedNY Phase II implementation.

As soon as support for the 837I is available on eMedNY, you will be encouraged to make your transition of these claims to eMedNY as soon as possible.

The ability to continue sending claims to the Legacy MMIS system will be discontinued on June 24, 2005.

It is important to remember that these claims will need to be sent to eMedNY using one of the eMedNY access methods:

  • eXchange,
  • FTP,
  • a service provider,
  • PC to host dial-up, or
  • ePACES.

For questions regarding this matter, please call Computer Sciences Corporation at 800-522-5518 or 518-447-9860.


Reprint from
December 2004
edition

 

Encounter Data Submission

March 2005 Changes Affect
Managed Care Providers

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The current Medicaid Encounter Data System (MEDS) was redesigned in an effort to:

computers

  • enhance specificity;
  • take advantage of and be consistent with national health care transaction standards; and,
  • support financial analysis and rate setting.

Encounter data elements will be submitted to the department for:

  • professional services;
  • institutional services (hospital and clinic);
  • pharmacy services; and,
  • dental services.

A MEDS II Data Element Dictionary has been developed by OMC, and has been shared with managed care plans that submit encounter data.

For more information on encounter data or new MEDS II requirements, please call Mary Beth Conroy in OMC's Bureau of Quality Management and Outcomes Research at (518) 486-9012.


Reprint from
September and November 2004 and January 2005
editions

Magnetic Media Processing Will
Change in March 2005

Return to Table of Contents

Magnetic media processing will be available through the transition period until June 20, but will not be available after you transition to Phase II. When you transition eMedNY Phase II will not accept magnetic media such as:

  • tape,
  • diskette, and
  • cartridge

Trading partners who currently use this type of media for claim submission will need to migrate to CPU-to-CPU, FTP, or eMedNY eXchange and will need to obtain user IDs and passwords.

As with the inbound submissions, physical media (tape and cartridge) will no longer be used to produce remittance advices.

  • Individual providers and managed care plans who choose to receive the HIPAA 835 or the 820 transactions will receive these as electronic transmissions.
  • Providers and managed care plans will still have the option of receiving paper remittance advices instead of the 835 or 820 transactions.

For questions regarding this article, please call Computer Sciences Corporation at (800) 522-5518 or (518) 447-9860.


Revised and Updated!
This article is a revision to the original article printed in the October 2004 and December 2004 editions.

Introducing the eMedNY eXchange!

Communicating Electronic Transactions
Return to Table of Contents

The implementation of eMedNY Phase II in March of 2005 will introduce a new electronic file submission method:

Computer

eMedNY eXchange

The eMedNY eXchange works like email:

Users are assigned an "inbox."
Through this inbox, the user is able to send and receive transaction files in an email-like fashion.
Transaction files are "attached" by the user and sent to eMedNY for processing.
Responses are delivered to the user's inbox. They can be "detached" and saved on the user's computer.

For security reasons, the eMedNY eXchange will be accessible only through the eMedNY website www.emedny.org.

If you are already enrolled in ePACES, you are also enrolled for eXchange, and can activate your inbox by calling 1-800-343-9000. If you are not enrolled in ePACES, you must first enroll in ePACES/eXchange via https://www.emedny.org/enroll/. You will be issued a user ID and an initial password. Then call eMedNY Provider Services at 1-800-343-9000 to activate your Inbox.

Following the implementation of eMedNY Phase II on March 24, 2005, eMedNY eXchange will accept additional types of HIPAA compliant transactions, including the following:

837 - Dental, Professional and Institutional Claims
835 - Claim Remittance Advice
820 - Claim Remittance Advice (Managed Care Plans only)
270/271 - Eligibility Benefit Inquiry and Response
276/277 - Claim Status Request and Response
278 - Prior Approval/Prior Authorization/Service Authorization Request and Response (except for DVS requests)
NCPDP Version 5.1 - National Council for Prescription Drug Programs
MEDS - Medicaid Managed Care Encounter Data

After the implementation of Phase II, eMedNY eXchange will be a convenient method for providers who are now submitting claims on magnetic media (tape, diskette, cartridge), since these media will not be supported by eMedNY. It will also be an effective way to receive your remittance advices (835 and 820).

For more information about eMedNY eXchange, visit www.emedny.org or call CSC Provider Services at 800-522-5518 or (518) 447-9860.


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New Article!

 

New CSC Mailing Addresses
Follows Phase II
Implementation

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Following the implementation of Phase II, CSC's office will be consolidated at the 1 CSC Way location in Rensselaer, NY.

Please use the following PO boxes after March 23, 2005, and mail to:

Computer Sciences Corporation
PO Box ____
Rensselaer, NY 12144-4601

 

Mailbox/SourceDescription of ContentsForm Types
Mailbox 4601ClaimsEMEDNY-1500 (HCFA)
EMDENY-0002 (Form A)
EMEDNY-0003 (Pharmacy)
UB-92
Mailbox 4602Threshold Override AuthorizationsEMEDNY-0001 (TOA)
Mailbox 4600Prior AuthorizationsEMEDNY-3614 (Dental)
EMEDNY-3615 (Drugs...Physician)
EMEDNY-2832 (Hearing Aid)
EMEDNY-1260 (Level of Care)
EMEDNY-3897 (Transportation)
EMEDNY-4106 (Group Transportation)
EMEDNY-0004 (PA 278 Electronic Attachment)
PA Additional Information
Mailbox 4603Provider EnrollmentsAll Fee-For-Service and Rate-Based Enrollment Packets
Mailbox 4606Additional InformationProvider Enrollment Additional Information form with attachments
Mailbox 4610Provider MaintenanceProvider related correspondence and maintenance forms
Mailbox 4605Remittance RetrievalRequests from Providers for copies of remittance statements.
Mailbox 4604Edit ReviewProvider submitted documentation to adjudicate claims.

All other correspondence (not listed above), should be sent to:

Computer Sciences Corporation
1 CSC Way
Rensselaer, NY 12144

If you have any questions, please call the CSC Provider Services at (800) 522-5518 or (518) 447-9860.


Info

PROVIDER SERVICES
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Missing Issues?
The Medicaid Update, now indexed by subject area, can be accessed online at the New York State Department of Health website: http://www.health.state.ny.us/health_care/medicaid/program/main.htm
Hard copies can be obtained upon request by calling (518) 474-9219.

Would You Like Future Updates Emailed To You?
Email your request to our mailbox, MedicaidUpdate@health.state.ny.us
Let us know if you want to continue receiving the hard copy in the mail in addition to the emailed copy.

Do You Suspect Fraud?
If you suspect that a recipient or a provider has engaged in fraudulent activities, please call the fraud hotline at: 1-877-87FRAUD. Your call will remain confidential.

As a Pharmacist, Where Can I Access the List of Medicaid Reimbursable Drugs?
The list of Medicaid reimbursable drugs is available at: http://www.eMedNY.org/info/formfile.html

Questions About an Article?
For your convenience each article contains a contact number for further information, questions or comments.

Do You Want Information On Patient Educational Tools and Medicaid's Disease Management Initiatives?
Contact Department staff at (518) 474-9219.

Questions About HIPAA?
Please contact the HIPAA Support Helpline at (800) 522-5518 or (518) 447-9860.

Address Change?
Please contact the Bureau of Medical Review and Payment at:
Fee-for-Service Provider Enrollment Unit, (518) 486-9440
Rate Based Provider Unit, (518) 474-8161

Billing Question? Call Computer Sciences Corporation:
Provider Services (800) 522-5518 or (518) 447-9860.

Comments and Suggestions Regarding This Publication?
Please contact the editor, Timothy Perry-Coon at MedicaidUpdate@health.state.ny.us or via telephone at (518) 474-9219 with your concerns.


The Medicaid Update: Your Window Into The Medicaid Program

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