at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content.
claim jumper 1
In This Issue
Provider Fair . . . . . . . . . . . . . . . . . . 1
Publications Reminder . . . . . . . . . . 1
Provider Types Which Require a
Rendering Provider . . . . . . . . . . . . . 1
Duplicate Issue . . . . . . . . . . . . . . . . 2
Industry-Wide Enforcement of the
NPI Compliance Date . . . . . . . . . . . 2
Tamper-Resistant Prescription Pads . . 2
Passport to Health Caseloads to
Increase . . . . . . . . . . . . . . . . . . . . . . 3
Claim Attachments . . . . . . . . . . . . . 3
Use of ID Numbers . . . . . . . . . . . . . 3
NPI-Only Requirement for
Pharmacies . . . . . . . . . . . . . . . . . . . 3
Delivery of 835s . . . . . . . . . . . . . . . 3
Elimination of the Medicaid
Administrative Claiming (MAC)
for School-Based Service Providers . . 3
Recent Publications . . . . . . . . . . . . 4
Provider Fair
Spring is right around the corner
and so is Montanas Healthcare Pro-
grams Spring Provider Fair. This
two-day event will be held April
14-15 at the Best Western Great
Northern Hotel and Convention
Center in Helena.
The schedule is as follows:
Monday, April 14
8:30 a.m. - 11:30 a.m. Coding
Class
12 p.m. - 1 p.m. Registration and
Vendor Fair Opens
1 p.m. - 5 p.m. Eligibility Deter-
mination, Provider Information and
Billing ABCs
Tuesday, April 15
8 a.m. - 9 a.m. Registration and
Vendor Area Opens
9 a.m. - 9:15 a.m. Welcome
9:15 a.m. - 10:15 a.m. Hospitals/
Swing Bed, CHIP Extended Mental
Health, Durable Medical Equipment

10:15 - 10:30 a.m. Break
10:30 a.m. - 11:30 a.m. Passport to
Health/TEAM Care, School-Based
Services, Dental Programs (CHIP
and Medicaid)
11:30 a.m. - 1 p.m. Lunch With
Your Program Of cer
1 p.m. - 2 p.m. Physician-Related
Services, Childrens Mental Health
Services, Nursing Facilities
2 p.m. - 3 p.m. Third Party Liabil-
ity, Home and Community Based
Services, Transportation
3 p.m. - 3:15 p.m. Break
3:15 p.m. - 4:15 p.m. SURS, FQHC/
RHC, Adult Mental Health
Please see inserts or additional in-
formation on the web at www.
mtmedicaid.org.
Publications Reminder
It is providers responsibility to be
familiar with Medicaid manuals,
fee schedules, and notices for their
provider type, as well as other in-
formation published in the Claim
Jumper and on the Medicaid website
(mtmedicaid.org).
Provider Types Which
Require a Rendering
Provider
Prior to the NPI implementation, the
claims processing system for Mon-
tanas Healthcare Programs used
only a single provider ID to process
the claim. Since the NPI implemen-
tation, the claims processing system
uses both the billing provider and
the rendering provider so providers
must be extremely careful to use the
correct numbers in these elds to
avoid claims processing problems.
Only certain provider types are re-
quired to bill a rendering provider on
professional claims as part of the NPI
implementation. A change was re-
cently made to the claims processing
system so that only those provider
types required to submit a rendering
provider are allowed to submit a ren-
dering provider that is different from
the billing provider. If you are not one
of the provider types listed below,
you are both the billing provider and
the rendering provider. If a provider
type not listed below submits a claim
with a rendering provider that is dif-
ferent from the billing provider, the
claim will be denied.
Podiatry
Clinic
Physical Therapy Clinic
Montana
claim jumper
Medicaid
Volume XXIII, Issue 3, March 2008 Montana Medicaid Claim Jumper
March 2008
2
at least one of the following charac-
teristics beginning April 1, 2008:
One or more industry-rec-
ognized features designed to
prevent unauthorized copying
of a completed or blank pre-
scription form;
One or more industry-rec-
ognized features designed to
prevent the erasure or modi -
cation of information written
on the prescription by the pre-
scriber, or
One or more industry-rec-
ognized features designed to
prevent the use of counterfeit
prescription forms.
Beginning October 1, 2008, a
written Medicaid prescription must
be written on a tamper-resistant
prescription that contains all three
characteristics.
The Department advises prescribers
to take this time to obtain supplies of
tamper-resistant prescription pads
for their Medicaid prescriptions. The
Department will continue to update
the list of tamper-resistant prescrip-
tion pad vendors on its website at
http://medicaidprovider.hhs.mt.gov/
providerpages/prescriptions.shtml.
For providers who elect to seek out
their own vendors, the Department
is available to evaluate these tamper-
resistant prescription pads upon
request to ensure compliance with
published guidelines.
Please direct any questions regard-
ing this notice to the following
personnel: Physician and Mid-Level
Providers: Denise Brunett at (406)
444-5778; Dentists: Jan Paulsen at
(406) 444-3182; Pharmacy Provid-
ers: Wendy Blackwood at (406)
444-2738; Hospitals: Debra Stipcich
at (406) 444-4834.
Submitted by Wendy Blackwood, DPHHS
Speech Therapy Clinic
Occupational Therapy Clinic
Dental
Clinic
Physician
Clinic
Dedicated
Emergency
Department
General Group or Clinic
Provider Based Clinics
Hospitals
Duplicate Issue
Please be sure to submit claims only
once under either the PID or NPI.
An extensive review of paid claims
will be done to verify whether ser-
vices were billed and paid for the
same service under different pro-
vider numbers. The Department
will complete adjustments to take
back inappropriate duplicate funds
paid for services that have been
billed more than once to the Mon-
tanas Healthcare Programs.
ACS has identi ed that some clinic
providers have been paid twice for the
same service since the contingency
period began. The NPI contingency
plan currently in place allows provid-
ers to bill with either their old provider
number (PID) or NPI until January 1,
2008, for institutional providers and
March 1, 2008, for professional pro-
viders. The contingency was adopted
to allow providers the additional
time they may have needed to obtain
their NPI and to follow guidelines
as set forth by Medicare. As part of
the NPI implementation effective
October 1, 2007, providers have the
option of using their NPI or old PID.
Montanas Healthcare Programs now
allow clinics to enroll and submit
claims as the billing/pay-to provid-
ers but must include the rendering
provider(s) as well.
Submitted by Michelle Gillespie, DPHHS
Industry-Wide
Enforcement of the NPI
Compliance Date
The compliance date for the NPI
for all HIPAA covered entities
except small health plans was May
23, 2007. (Small health plans have
until May 23, 2008, to comply.) In
guidance provided on April 2, 2007,
CMS announced that, through May
23, 2008, it would not impose penal-
ties on covered entities that deploy
contingency plans to facilitate the
compliance of their trading partners.
On May 24, 2008, CMS will lift its
enforcement-leniency policy. Com-
plaints will be investigated as they
are today, but penalties will be a le-
gitimate resolution if the entity does
not demonstrate compliance or cor-
rective action. CMS will continue
to employ a complaint-driven ap-
proach to enforcement. For example,
if a complaint is received alleging a
failure to comply with the NPI re-
quirements, CMS will contact the
entity to secure evidence of compli-
ance and the contingency plan that
had been in place. If violations are
identi ed, enforcement actions will
take place.
This notice does not prohibit covered
entities from lifting contingency
plans prior to May 24, 2008. As
you are aware, Montanas Health-
care Programs required NPI only
on paper UB and 837I claims on
January 1, 2008. Effective March 1,
2008, health care professionals must
submit NPI only on paper profes-
sional and 837P formats. Atypical
providers do not bill with an NPI and
will bill with their new Montanas
Healthcare Programs ID number.
In sum, no later than May 24, 2008,
all covered entities are expected
to be using the NPI in a compliant
manner, and all contingency plans
should be lifted.
Submitted by Michelle Gillespie, DPHHS
Tamper-Resistant
Prescription Pads
The federal law requiring written
Medicaid prescriptions to be on
tamper-resistant pads will be imple-
mented on April 1, 2008, by H.R.
3668, the TMA, Abstinence Edu-
cation, and QI Programs Extension
Act of 2007.
The Department, in accordance with
CMS guidance, will require that a
Medicaid prescription pad contain
14,250 copies of this newsletter were printed at
an estimated cost of $.60 per copy, for a total
cost of $8,610.93, which includes $5633 for
printing and $2,977.93 for distribution.
Alternative