This information pertains to MC+ and Medicaid fee-for-service providers concerning the elimination of paper claims, adjustments and attachments for billing purposes. MC+ managed health care plans are responsible for providing information to their providers in accordance with MC+ managed care contracts.
Medicaid providers are asked to submit claims, adjustments and attachments electronically to increase quality and efficiency, and reduce cost.
Notice was given to providers that beginning July 1, 2005 all claims, adjustments and attachments must be submitted electronically. Some of the information has changed. After June 30, 2005, paper billings (stickers) and paper crossover adjustment forms will no longer be accepted for those Medicare/Medicaid claims that do not crossover automatically from Medicare. In addition, all pharmacy claims must be submitted electronically effective July 1, 2005. Electronic adjustments (other than crossovers) and attachments will be phased in over the next several months and providers will be notified by bulletins throughout the phase-in process. Once fully implemented, no paper claims, adjustments or attachments will be accepted. Until the process is complete, paper claims, adjustments and attachments can continue to be submitted except for those noted above.
The HIPAA law does not mandate that payers accept paper billing from small providers. It does require that electronic billing must comply with the HIPAA format and content requirements. Payers can decide to accept only electronic transactions. Once Medicaid has implemented all-electronic billing, providers must be prepared to use a clearinghouse, billing agent or use the Medicaid website at www.emomed.com for billing and to maintain the business relationship with the Division of Medical Services.
Once Medicaid has implemented all-electronic billing, there will be no exceptions. Providers must be prepared to use a clearinghouse, billing agent or use the Medicaid billing website at www.emomed.com for billing and to maintain a business relationship with the Division of Medical Services.
The only cost is your Internet service provider connection.
To become a registered user, providers can apply online at www.dss.mo.gov/dms. In the yellow "Quick Links" box, click on "Apply for Internet Access".
This website is not only for filing claims and attachments, but providers retrieve their Remittances, check recipient eligibility, get claim, attachment and prior authorization status, obtain check amounts and much more. Each option includes a "Help" feature that guides you step by step. Claims filed electronically are adjudicated nightly enabling you to check status the following day.
Yes. Beginning July 1, 2005, Medicaid will no longer accept the crossover stickers to collect the Medicare co-insurance and deductible amounts for those claims that do not cross over automatically from Medicare. Providers will have the ability to file the claims electronically through an 837 transaction or through the Medicaid billing website at www.emomed.com.
Yes. Missouri Medicaid will begin applying editing to the electronic claim submissions very similar to that used to review other Medicaid claims. One such edit will look at Medicare allowed procedures and compare to Medicaid coverage status. If a service covered by Medicare is not covered by Medicaid, the cost sharing amounts (coinsurance and deductibles) will not be reimbursed to providers as a crossover payment. The exception to this policy will be those Medicare/Medicaid clients who are also covered by the Qualified Medicare Beneficiary (QMB) program. Missouri Medicaid will be responsible for these charges even if Medicaid does not cover the service.
When providers verify Medicaid recipient eligibility, information will be returned if the recipient has Medicare Part A, Part B, or QMB coverage.
Paper crossover claims, crossover adjustments and pharmacy claims will be returned to the provider if received after June 30, 2005.
Any crossover claims submitted electronically between July 1 and July 8, 2005 will be held and adjudicated after July 8, 2005. As a result, providers will not have the ability to check the claim status. This allows Medicaid the time to make the system switch from paper crossover claims to electronic claims and will be the only time this delay will occur.
Yes. Beginning July 1, 2005, providers will have the ability to enter TPL denial information electronically on their claims, either through the 837 transaction or through the Medicaid Internet billing website at www.emomed.com. Providers should follow the instructions in their implementation guide for their 837 transactions or refer to the "Help" screen on the Medicaid billing website.
6/17/05