July 22, 2016  |  Issue 23  |  Volume 1
Medicaid e-News
Important Billing Reminders:
Billing: Top 10
The Iowa Medicaid Enterprise (IME) understands how important it is for providers to be paid in a timely manner. Below are the top 10 questions to ask when filling out claims to ensure prompt payment.

1. Am I enrolled with Iowa Medicaid?
 
2.  Where does my provider number (National Provider Identity (NPI) or atypical provider number) go on the claim form?
 
3.  Do I have my  taxonomy code on the claim?
 
4.  Am I billing the right payor for these dates of service?

5. Have I verified eligibility for this member for these dates of service?
 
6.  Are these services covered under my NPI?
 
7.  Is the procedure code payable for my provider type?
 
8.  Does the claim match the prior authorization?
 
9.  Do I have all the necessary signatures?
 
10.  Is there a primary carrier which should be billed first?

Claims Definitions:
Clean Claims: All information required for processing is present.   

Denied: Claim is received and services are not covered benefits, are duplicate, or have other substantial issues that prevent payment. 
 
Suspended: Claim is pending internal review for medical necessity and/or may need additional information to be submitted for processing.
 
Rejected: Claims that don't meet minimum data requirements or basic format are rejected and not sent through processing. 

Timely Claims Processing Requirements:
The Managed Care Organization (MCO) must pay or deny
  • 90 percent of clean claims within 14 calendar days of receipt,
  • 99.5 percent of clean claims within 21 calendar days of receipt and
  • 100 percent of all claims within 90 calendar days of receipt.
Provider Resource Pages
Comprehensive provider resource pages are available for each Managed Care Organization (MCO), featuring provider training manuals, webinars and important updates. View them below:


Tools and Resources:
Verify Eligibility
The Eligibility and Verification Information System (ELVS) line is very busy during the first of the month. The ELVS web portal  is another option for providers in lieu of calling the ELVS line but each provider must enroll through the Electronic Data Interchange Support Services (EDISS). The ELVS web portal allows for multiple eligibility checks and batch submission, where as the ELVS phone system only allows for one at a time.

Login ID and password may be obtained through EDISS by submitting the following Access Request Form to EDISS or calling EDISS at 1-800-967-7902. 

For more information, please see Informational Letter 1650-MC available here.
 
Resource Guide for Providers' Front Desk Staff
The Iowa Medicaid Enterprise (IME) has put together a useful tool for administrative staff which includes important phone numbers, claims submission information and more.

Download and print the Managed Care Quick Reference Guide here.

Looking for an Old Issue of the Medicaid e-News?
Each edition features useful tools and important updates. Now you can quickly access old issues to find what your looking for. Visit the Iowa Medicaid newsletter page 
where you'll find links to each issue.

Provider Services

Non-Emergency Medical Transportation
Members may contact their assigned non-emergency medical transportation (NEMT) broker at the numbers below to schedule their  NEMT services:

Amerigroup Iowa Inc.
Logisiticare
1-844-544-1389

AmeriHealth Caritas, Iowa Inc.
Access2Care
1-855-346-9760

UnitedHealthcare Plan of the River Valley, Inc.
MTM
1-888-513-1613
_________________

Medicaid 
Fee-for-Service 
Access2Care/TMS
1-866-572-7662


New Provider Informational Letters
Informational letters are posted through the Iowa Medicaid Portal Application (IMPA) system and are available on the DHS website  here .  These letters communicate important policies and procedures for providers and their administrative staff. 

Iowa Medicaid Enterprise | IMECommunications@dhs.state.ia.us | dhs.iowa.gov
100 Army Post Rd., Des Moines, IA 50315

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