Please use the following tips to help resolve some of the billing problems you may be encountering.
All Providers: If you are getting denials pertaining to:
NPI – Claims may be billed with an NPI or Medicaid ID number between 05/23/07 and 05/23/08. The CMS1500 (08/05), UB-04 and ADA (2006) claim forms must be utilized for paper billing. Providers that have one NPI for more than one Medicaid ID must bill with a taxonomy code, provider name and 9-digit zip code as it appears in the Unisys claims processing system.
Managed Care – Always check the patient's medical card to see if an HMO is listed. When an HMO is listed on the medical card, services must be billed to the HMO. The HMO is also listed on the remittance advice after the patient's name.
Modifiers – Physicians’ assistants, nurse practitioners and first nurse assistants must bill with modifier AS using the surgeon's NPI (or Medicaid ID until 05/23/08) when assisting in surgery. Modifiers are QK, QX, and QY are required for supervised anesthesia services. Modifiers such as 50, 59, right and left, toes, fingers, eyelids, etc. are required for correct claims processing when applicable by the claims processing system for dates of service on or after July 1, 2007.
QMB (Qualified Medicare Beneficiary) – The medical card indicates services are limited to Medicare cost sharing Part A and Part B deductible and coinsurance amounts and any service that does not have Medicare deductible or coinsurance will be denied.
Procedure Codes – Please check the code you are billing. The current CPT, HCPCS or CDT-4 codes must be billed.
Diagnosis Codes – Must use ICD-9 diagnosis codes with the 4th and 5th digits where indicated. Zero filling to make all codes 5 digits creates an invalid diagnosis code and will cause your claim to deny. If you are using E diagnosis codes, the ICD-9 rules indicate that E codes are additional information codes and should never be in the primary position on a claim.
Revenue Codes – This is now a four-digit field. Revenue codes are listed in the UB-04 manual.
Timely Filing – Dates of service greater than 1 year, but not more than 2 years, in which an original claim met timely filing guidelines must be billed on paper with the remittance advice attached and mailed to: Molina Provider Services, PO Box 2002, Charleston, WV 25327-2002.
For more specific answers to your billing problems, please contact Provider Services at 888-483-0793 or 304-348-3360.
If you are experiencing problems with the Web Portal, please e-mail the EDI helpdesk at firstname.lastname@example.org.