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Information regarding increased payments for physician primary care services effective January 1, 2013 through December 31, 2014 are below:

Web Announcements

Continuous Glucose Monitoring

Effective December 15, 2016, DMAS will CLARIFY THAT MEDICAID FEE-FOR-SERVICE COVERAGE of Continuous Glucose Monitoring (CGM) INCLUDES reimbursement for the sensor, transmitter, and receiver used with the invasive monitor. This equipment will be supplied by a Medicaid Durable Medical Equipment (DME) provider and billed as a DME item. Codes to be billed for the DME equipment are:
1) A9276 (CGM Sensor, invasive),
2) A9277 (CGM Transmitter; external) and
3) A9278 (CGM Receiver (monitor); external)
The CGM equipment requires service authorization. Providers will fax their requests on the Continuous Glucose Monitoring DME Request Form to the DMAS Medical Support Unit at 804-452-5450. The fax request form is available on the DMAS web portal in the Provider Services section. Refer to the DMAS Provider Memo, dated 11/2/2016, Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring (CGM) for members in Medicaid/FAMIS/FAMIS Fee-for-Service Programs-Effective for dates of service on or after December 15, 2016. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders.

As of October 1, 2016 DMAS has converted to version 33 of the 3M APR-DRG grouper. Recently, DMAS has identified claims, grouped by version 31, which did not group correctly. To correct the issue, DMAS will reprocess all inpatient hospital claims grouped incorrectly with discharge dates of service on or after October 1, 2015 through September 30, 2016 using version 33 of the grouper. This reprocess may result in additional payments or recoupments of overpayments for affected claims. Any reprocessed claims that do not pend will be reflected on the remittance advice dated 11/25/2016.

Change to the Service Authorization of Organ and Stem Cell Transplants and non-emergent, out-patient, out of state MRI, PET and CAT scans

Effective with request date of November 1, 2016, all physician requests of organ and bone marrow transplants and non-emergent, outpatient, out of state MRI, PET and CAT scans will be completed by the DMAS Medical Support Unit. Out of state is defined as any facility or provider not within the State of Virginia.
Providers who submit requests to KEPRO on or before October 31, 2016 will receive a final determination from KEPRO; providers are not to submit the same request to DMAS if the request was submitted to KEPRO.
This change only applies to members in the Medicaid and FAMIS Fee-for-Service programs and GAP. Members enrolled in Managed Care will follow the Prior Authorization process determined by the Managed Care plan. All requests as well as all pertinent medical information must be received at least 30 days prior to the date of the transplant procedure and/or diagnostic imaging. Providers will fax their requests to the DMAS Medicaid Support Unit, fax number 804-452-5450.

Hospitals will continue to submit to KEPRO their request for the in-patient hospitalization for the transplant. An approved physician authorization is required and must accompany the hospital request.
Please refer to the DMAS Provider Memo, dated 10/19/2016, Change to the Service Authorization of Organ and Stem Cell Transplants and non-emergent, out-patient, out of state MRI, PET and CAT scans - effective November 1, 2016 for additional details. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders.

Attention All Individual and Family Developmental Disabilities Support Waiver (DD Waiver) Case Managers:
Effective July 1, 2016, Keystone Peer Review Organization (KEPRO) will no longer process service authorization requests for DD Waiver services. All service authorization requests on or after July 1, 2016, must be submitted to the Department of Behavioral Health and Developmental Services (DBHDS). For more information contact the DBHDS Helpline at 804-663-7290 or access the DBHDS website: http://www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities

Ambulatory Surgical Center and Outpatient Hospital Claim
This is to notify providers that Ambulatory Surgery Center (ASC) and Outpatient Hospital claims with dates of service on or after January 1, 2016 that were adjudicated prior to May 1, 2016 will be reprocessed the week of May 30, 2016 with a remittance date of June 10, 2016.

Delayed Remittance
The 2016 Appropriation Act requires that the remittance that normally would be paid on Friday, June 24, 2016 will instead be paid on Friday, July 1, 2016. This annual delay was originally communicated in our Medicaid Memo of May 14, 2010. All claims will be processed as usual based on the date they are received. Furthermore, providers should plan accordingly and prepare for this delay in claims payment. DMAS will not issue advance pays associated with this delay.

Patient Pay Reprocess
For providers submitting Crossover claims incorrectly subjected to patient pay deductions, DMAS will void and reprocess the identified claims.

For providers submitting claims that were subject to patient pay deductions and the incorrect deduction of the patient pay resulted in claims processing with a smaller patient pay amount being deducted for NF, waiver or other LTC services, DMAS will void and reprocess the identified claims.

All corrected claims will show on the remittance dated April 22, 2016. Providers are responsible for reviewing the remittance advice associated with the patient pay reprocess.

For the List of top 10 commonly occurring X12 compliance issues, use the following URL:

https://www.virginiamedicaid.dmas.virginia.gov/ECMPdfWeb/ECMServlet?memospdf=X12Compliance.pdf

Outpatient Emergency Room Claims Spanning 9/30/15-10/01/15 Dates of Service
DMAS is requiring providers billing only Outpatient emergency room and observation claims that span 9/30/15 - 10/01/15 to keep those charges on one claim and bill with the ICD-9 diagnosis code(s). These claims will suspend for review and be adjudicated by DMAS.

ICD-10
Effective with dates of service October 1, 2015, ICD-10 coding goes into effect. Our system is tested and ready to accept properly coded ICD-10 claims. In order to prevent a denial, claims with dates of service prior to the ICD-10 compliance date must be coded with ICD-9. Claims with dates of service on or after the compliance date must be coded with ICD-10. For those providers billing in-patient hospital charges, DMAS will be using the ICD-10 diagnoses for all UB claims with a discharge date on or after October 1, 2015. Claims must be coded with either ICD-9 or ICD-10 codes but not with both. For more information, please see the Medicaid Memo dated August 25, 2015. It can be found on the Virginia Medicaid Web Portal under the Provider Services tab. Please select Medicaid Memos and then select the Medicaid Memo dated August 25, 2015. DMAS will not be issuing advance payments due to lack of provider readiness.

NEW - Managed Long Term Services and Supports (MLTSS) Stakeholder Notice
Please read the following important announcement regarding Virginia's proposed managed long-term services and supports (MLTSS) initiatives. Consistent with Virginia General Assembly directives, over the next couple of years, the Department of Medical Assistance Services (DMAS) will transition the majority of the remaining Medicaid fee-for-service populations into coordinated and integrated managed care models. Additional information on DMAS proposed initiatives is available at the following link:
http://www.dmas.virginia.gov/Content_pgs/mltss-home.aspx

Online Enrollment Access

To enroll online you must be logged in as a registered provider. To register, please follow the instructions below.

How to register:

In the Login box click the Provider link. In the First Time User Registration box click the Web Registration link. Enter the requested information and click Continue.
After you are registered and logged into the web portal, click on the Provider Enrollment tab to proceed to the online enrollment applications.

WebEx Training Sessions

If you would like to view training sessions on various topics related to Medicaid, please go to dmas.webex.com and select Recorded Sessions on the left panel.

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