Late Breaking News

The July issue of the MS Medicaid Provider Bulletin is now available online for read or download. Following the Mississippi Division of Medicaid’s transition to a new fiscal agent, the quarterly Provider Bulletin has shifted to a January-April-July-October publication schedule.

The Provider Bulletin aims to inform providers of Medicaid news, policy changes, and provides contact information for provider field representatives listed by county, and more.

Previous issues of the Provider Bulletin are archived online at https://medicaid.ms.gov/providers/provider-resources/provider-bulletins/.

 

 

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8/4/2023

PAD prior authorization requirements

• C9151Inj, Pegcetacoplan, 1 mg (Syfovre)
• J1440Fecal Microbiota, Live – JSLM, 1 ml (Rebyota)
• J9381Teplizumab-MZWV, 5 mcg (TZIELD) – This drug previously requires PA under C9149.

 

 

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8/2/2023

HHAeXchange (HHAX) Electronic Visit Verification Upgrade Phase 1 Go-Live effective 8/1/2023

The Mississippi Division of Medicaid (DOM) has changed over from Medikey to its upgraded EVV solution with HHAX effective Aug. 1, 2023. For more information, please visit https://medicaid.ms.gov/evv-for-personal-care-service-providers/.

 

 

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7/31/2023

Update on billing codes: EOB 1504/Edit 1946

Beginning Aug. 1, 2023, claims that have historically been placed in a PENDING status with Explanation of Benefit (EOB) Code 1504 (Performing Provider Number is Not Found) with corresponding Claim Adjustment Reason Code 206 (National Provider Identifier – missing.) and Remark Code N290 (Missing/incomplete/invalid rendering provider primary identifier.) will now be DENIED with the same EOB, Claim Adjustment Reason Code, and Remark Code combination.

The system uses the following information to assign the appropriate Mississippi Provider Medicaid ID to the claim for processing:

• NPI on provider file
• Taxonomy on provider file

The system will seek to find a unique match using the 2 data elements above submitted on your claim to a specific provider record in our system. If a unique match is not found – the edit is set, and you will receive the error code. For more details, please see: https://medicaid.ms.gov/wp-content/uploads/2023/07/Explanation-of-Benefit-Code-1504.pdf.

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Should you experience this issue and need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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7/27/2023

Pharmacy Brand and Prescription Limit Denial Resubmission

On July 20, 2023, an issue regarding the pharmacy benefit limit of 2 Brand/6 Rx per month was identified. The MESA system was denying claims for the monthly brand and prescription limit error codes when the member had not actually reached their benefit limit. This issue was corrected, and claims began processing correctly on July 21, 2023.

While some pharmacy providers obtained a prior authorization to override this error or asked the member to return the next day, there may still be members in need of monthly medications. Please be advised the MESA system is working as expected and pharmacy providers may resubmit claims that may have denied incorrectly.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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7/25/2023

“Balance Due” Letters to be Mailed

Providers with an outstanding balance owed to the Mississippi Division of Medicaid (DOM) will start receiving balance due letters. The first letter is sent at 30 days past the original balance set-up date. Additional letters are sent at 60 and 90 days past due. The letter contains a detailed listing of the amount(s) due associated with liabilities that were previously assessed against the provider or created by claims adjustments. Providers should refer to their Remittance Advice (RA) in the MESA provider portal for more information.

Current payments of claims may be used to offset this balance or providers may pay the balance by check. Checks should be made payable to the MS Division of Medicaid. A copy of the letter and the payment should be mailed to Gainwell Technologies, P.O. Box 6014, Ridgeland, MS 39158.

Questions can be directed to (800) 884-3222 – Option 2, Option 7, Option 0 to speak to a representative – or by sending an email to ms_financial@gainwelltechnologies.com.

 

 

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7/24/2023

Edit 1347 Disposition Change

Beginning Aug. 1, 2023, claims that have historically been placed in a PENDING status with Explanation of Benefit (EOB) Code 1347 (Billing Provider Number is not found or is not valid for Dates of Service) with corresponding Claim Adjustment Reason Code 208 (NPI not matched) and Remark Code N257 (Missing/incomplete/invalid billing provider/supplier primary identifier) will now be DENIED with the same EOB, Claim Adjustment Reason Code, and Remark Code combination.

The above listed code combination is set to post on a claim when the system cannot find a unique billing provider Medicaid ID to utilize when processing the claim. The system is coded to utilize the NPI, Taxonomy, Zip Code, and the 4-digit postal code to reconcile the billing provider to the appropriate Medicaid ID. In the instance that a billing provider has more than one Medicaid ID with the same NPI, Taxonomy, Zip Code, and 4-digit postal code, the claims system may be unable to reconcile the billing provider to a unique Medicaid ID, thus resulting in the claim denying and posting the above reference code combination. For more details, please see: https://medicaid.ms.gov/wp-content/uploads/2023/07/Explanation-of-Benefit-Code-1347.pdf.

Should you experience this issue and need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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7/24/2023

Excluded Taxonomies from Enrollment in MSCAN/MSCHIP

Medicaid providers, please note the following taxonomies are excluded from participation in the MississippiCAN program:

• 261QR0401X
• 252Y00000X
• 314000000X
• 311500000X
• 311Z00000X
• 315P00000X
• 310500000X
• 320600000X
• 385H00000X
• 275N00000X
• 376J00000X
• 251T00000X
• 310400000X

The following taxonomies are excluded from participation in the Children’s Health Insurance Program (CHIP):

• 373H00000X
• 251B00000X

The Mississippi Division of Medicaid (DOM) has identified that some active providers enrolled with the taxonomies listed above may have been assigned managed care contracts within the MESA provider portal during data conversion from Envision to MESA.

This may have prompted a recredentialing notice being sent to the provider. DOM is taking steps immediately to address this error. No action is required by providers. Any provider with a taxonomy excluded from participation in managed care who completed their recredentialing/revalidation application will not need to complete revalidation for another five years in accordance with federal regulations.

DOM apologizes for any inconvenience this may have caused our provider community.

 

 

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6/30/2023

IL Waiver Renewal Approved by CMS Effective 7/1/2023

CMS has approved the MS 1915(c) Independent Living (IL) Waiver effective July 1, 2023.  The approved waiver is available for review at the below link.

https://medicaid.ms.gov/wp-content/uploads/2023/06/MS-IL-Waiver-Renewal-Approved-by-CMS-eff.-7.1.2023.pdf

For dates of service on or after July 1, 2023, services under that waiver will be paid in accordance with the updated fee schedule linked below.  The appropriate procedure code and modifier combinations outlined in the table must be utilized for billing these services.

https://medicaid.ms.gov/wp-content/uploads/2023/06/ILW-FEE-SCHEDULE-7-1-2023-1.xlsx

 

TBI/SCI Waiver Renewal Approved by CMS Effective 7/1/2023

CMS has approved the MS 1915(c) Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver effective July 1, 2023.  The approved waiver is available for review at the below link.

https://medicaid.ms.gov/wp-content/uploads/2023/06/MS-TBISCI-Waiver-Renewal-Approved-by-CMS-eff.-7.1.2023.pdf

For dates of service on or after July 1, 2023, services under that waiver will be paid in accordance with the updated fee schedule linked below.  The appropriate procedure code and modifier combinations outlined in the table must be utilized for billing these services.

https://medicaid.ms.gov/wp-content/uploads/2023/06/TBI-SCI-Waiver-FEE-SCHEDULE-7-1-2023.xlsx

 

E&D Waiver Renewal Approved by CMS Effective 7/1/2023

CMS has approved the MS 1915(c) Elderly and Disabled (E&D) Waiver effective July 1, 2023.  The approved waiver is available for review at the below link.

https://medicaid.ms.gov/wp-content/uploads/2023/06/MS-ED-Waiver-Renewal-Approved-by-CMS-eff.-7.1.2023.pdf

For dates of service on or after July 1, 2023, services under that waiver will be paid in accordance with the updated fee schedule linked below.  The appropriate procedure code and modifier combinations outlined in the table must be utilized for billing these services.

https://medicaid.ms.gov/wp-content/uploads/2023/06/ED-AND-CTS-Fee-Schedule-7-1-2023.xlsx

 

AL Waiver Renewal Approved by CMS Effective 7/1/2023

CMS has approved the MS 1915(c) Assisted Living (AL) Waiver effective July 1, 2023.  The approved waiver is available for review at the below link.

https://medicaid.ms.gov/wp-content/uploads/2023/06/MS-AL-Waiver-Renewal-Approved-by-CMS-eff.-7.1.2023.pdf

For dates of service on or after July 1, 2023, services under that waiver will be paid in accordance with the updated fee schedule linked below.  The appropriate procedure code and modifier combinations outlined in the table must be utilized for billing these services.

https://medicaid.ms.gov/wp-content/uploads/2023/06/ASSISTED-LIVING-WAIVER-FEE-SCHEDULE-7-1-2023.xlsx

 

ID/DD Waiver Renewal Approved by CMS Effective 7/1/2023

CMS has approved the MS 1915(c) Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver effective July 1, 2023.  The approved waiver is available for review at the below link.

https://medicaid.ms.gov/wp-content/uploads/2023/06/MS-IDDD-Waiver-Renewal-Approved-by-CMS-eff.-7.1.2023.pdf

For dates of service on or after July 1, 2023, services under that waiver will be paid in accordance with the updated fee schedule linked below.  The appropriate procedure code and modifier combinations outlined in the table must be utilized for billing these services.

https://medicaid.ms.gov/wp-content/uploads/2023/06/Intellectual-Development-Disabilities-Waiver-Fee-Schedule-7.1.23-FORMATTED.xlsx

 

 

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6/30/2023

Mass Adjustment: LTC Inpatient Crossovers

The Mississippi Division of Medicaid (DOM) will reprocess all Long Term Care Crossover claims processed between October 3, 2022, and May 17, 2023. The claims will be reprocessed utilizing the applicable Medicare Coinsurance Cap pricing methodology and will result in the recoupment of previous overpayments.

DOM is processing the recoupment of these funds at a rate of up to 10% of the total recoupment amount for up to ten (10) weeks, or until the full balance is recouped. The mass adjustment will appear on your remittance advice dated July 3, 2023. Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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6/16/2023

Certified Behavior Analyst Providers may only be reimbursed for medically necessary ASD Services

As a reminder, Mississippi Board Certified Behavior Analysts (BCBAs) may only be reimbursed for medically necessary ASD Services. These services are provided to EPSDT-eligible Medicaid beneficiaries and rendered in accordance with their professional licensure and scope of practice. BCBA providers should reference the Autism Spectrum Disorder Services Fee Schedule for a list of reimbursable services and procedure codes. The ASD fee schedules can be found at https://medicaid.ms.gov/providers/fee-schedules-and-rates/.

Failure to obtain prior authorization will result in denial of payment. the Mississippi Division of Medicaid is contracted with Alliant Health Solutions as the UM/QIO vendor, responsible for determining medical necessity for fee-for-service (FFS) beneficiaries. Please refer to Alliant Health Solutions’ provider portal https://ms.allianthealth.org/ or call Alliant directly at 1-888-224-3067.

Please direct questions regarding ASD services to Penny Hall or Kimberly Sartin Holloway at 601-359-9545.

 

 

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6/12/2023

Submission of Administrative Review for Timely Filing

The Mississippi Division of Medicaid (DOM) has established a convenient and efficient way to submit a request for Administrative Review of claim denials for timely filing when attempting to resubmit or adjust the claim. This is for providers whose original claim submission was timely and resubmitted a claim during the timely processing period that was denied for timely filing. Claims are considered to comply with timely filing if they are submitted within 365 days from the date of service or 180 days from the Medicare paid date, whichever is applicable.

Providers have 365 days from the date of the original claim submission for Medicaid Fee for Service claims or 180 days from the Medicare Paid date to adjust claims, whichever is applicable. Medicaid may request additional information regarding any claims submitted for administrative review. For questions related to appeals, see https://medicaid.ms.gov/wp-content/uploads/2023/03/Title-23-Part-300-Appeals-eff.-03.01.23.pdf.

Review the Administrative Code or contact the appropriate provider representative for questions related to claims or claims billing. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

We understand the importance of streamlining administrative processes to ensure prompt reimbursement and improved provider experience. With this in mind we developed this new online submission process for timely filing requests. Effective immediately, Medicaid providers can use this user-friendly platform which eliminates the need for traditional paper-based submissions, reducing manual processing time and enhancing accuracy. By transitioning to an online system, we aim to simplify the process while optimizing efficiency for both providers and DOM staff.

Key Benefits of the Online Submission Process:

1. Time-saving: Submit your timely filing requests in a matter of minutes, eliminating the need for mailing or faxing paperwork.
2. 24/7 accessibility: Our online portal is available around the clock, allowing you to submit requests at your convenience.

To access the online submission process, please visit DOM’s website at www.medicaid.ms.gov where the Timely Filing Review Request Form is linked under “Providers,”  or access the form directly here: Timely Filing Review Request Form.

The Division of Medicaid remains committed to delivering quality service and fostering partnerships with our valued providers. Should you have any questions or need assistance regarding the new online submission process, our dedicated support team is ready to assist you. Reach out to DOM’s Provider and Beneficiary Call Center at (800) 421-2408 and ask for one of our Provider Customer Service Representatives during regular business hours.

Thank you for your ongoing commitment to providing essential healthcare services to Mississippi Medicaid beneficiaries. We appreciate your cooperation in adopting this new online submission process, which will enable us to better serve you and the community.

 

 

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6/5/2023

DOM Resumes Provider Maintenance Operations (Licensure Review)

Under 42 CFR § 455.412, the Mississippi Division of Medicaid (DOM) has resumed its regular provider maintenance operation of monthly licensure review that was suspended in September 2022 for the implementation of MESA and transfer of our fiscal agent operations from Conduent to Gainwell Technologies. DOM will be updating provider records for both our fee-for-service/MississippiCAN providers as well as our CHIP providers.

Providers identified as having an expired or expiring license will receive notification from Gainwell Technologies by letter. In addition to the notices mailed by Gainwell Technologies, providers can refer to DOM’s website where we are posting the Provider Six-Month License Due List at https://medicaid.ms.gov/. This listing will be updated weekly. Providers are required to provide their updated licensure information to Medicaid. Failure to provide Medicaid with the updated license could result in closure of the Medicaid provider number.

Providers can submit their licensure information to the Provider Enrollment Department of Gainwell Technologies via secure correspondence in the MESA Provider Portal, fax, or mail. The following information is provided:

MESA Provider Portal: https://medicaid.ms.gov/mesa-portal-for-providers

Provider Services Fax Number:
(866) 644-6148
Attention: Provider Enrollment

Provider Services Mailing Address:
Provider Enrollment/MississippiCAN/MSCHIP
PO Box 23078
Jackson, MS 39225

Please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 if you need assistance between the hours of 8 a.m. and 5 p.m. CST.

 

 

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5/26/2023

Centralized Credentialing for MSCAN/MSCHIP

During the 2021 Mississippi Legislative Session, Senate Bill 2799 was enacted into law that requires the Medicaid Coordinated Care Organizations (CCO) to follow a uniform credentialing process for provider enrollment in the Managed Care Programs. On July 1, 2022, in accordance with this new requirement, the Mississippi Division of Medicaid (DOM) amended the CCO contracts to require the CCOs to accept DOM’s provider enrollment and screening process, and not require providers be credentialed by CCOs for Medicaid or CHIP.

Beginning October 1, 2022, providers seeking participation in MississippiCAN and/or CHIP are now required to be enrolled, credentialed, and screened by DOM, and subsequently contract with their CCO of choice. As part of the implementation of the Medicaid Enterprise System Assistance (MESA), DOM implemented a new centralized credentialing process along with NCQA certified Centralized Verification Organization (CVO) that will be responsible for credentialing and recredentialing Medicaid providers seeking to enroll or currently enrolled with our coordinated care programs (MSCAN/CHIP). This new process eliminates the need for a provider to be credentialed or recredentialed multiple times.

The CVO will perform recredentialing for both current providers and new providers every three (3) years unless the provider is credentialed by a DOM-approved Delegated Credentialing Entity. Providers identified for recredentialing will receive notification from Gainwell Technologies by letter which is sent to the providers “mail to” address on their provider record. This letter is generated six months in advance of the recredentialing due date on the provider’s record in MESA and a link will be available in the portal to start the process.

Facilities with multiple service locations and provider IDs will receive a recredentialing notice for each provider ID. Only one provider ID for the same tax ID and service location address will need to submit the recredentialing application which will pick up and credential all the taxonomies at that location. If recredentialing is either denied or not completed by the recredential due date, all the facility enrollments at that location will be terminated and claims can no longer be paid. A new application for each taxonomy at that service location will be required to re-enroll in the Mississippi Medicaid program.

Individual providers with multiple provider IDs sharing the same NPI will receive a recredentialing notice for each of the provider IDs. The provider will only need to recredential one of the IDs to satisfy the requirement for all. If recredentialing is either denied or not completed by the recredential due date, all the individual provider’s enrollments will be terminated, and claims can no longer be paid. A new application for each service location will be required to re-enroll in the Mississippi Medicaid program.

In addition to the notices mailed by Gainwell Technologies, providers can refer to DOM’s website where we are posting the Provider Six Month Recredentialing Due List” at https://medicaid.ms.gov/. This listing will be updated weekly. Please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 if you need assistance between the hours of 8 a.m. and 5 p.m. CST.

 

 

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5/24/2023

Congenital Syphilis – Test, Treat, Report!

With the alarming increase in congenital syphilis cases, the Mississippi Division of Medicaid is working with the Mississippi State Department of Health (MSDH) to help raise awareness about the importance of testing for the disease, both during the pregnancy and at delivery.

Please read the attached MSDH memo about testing, treating and reporting for congenital syphilis:

https://medicaid.ms.gov/wp-content/uploads/2023/05/Congenital-Syphilis-Test-Treat-Report_MSDH-5-24-2023.pdf

 

 

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5/23/2023

Acute Psychiatric Hospital providers: Reminder about discharge/aftercare planning

The Mississippi Division of Medicaid (DOM) requires that all Acute Psychiatric Hospital providers adhere to federal and state rules and regulations.

Per 42 CFR 482.43, Condition of participation: Discharge planning is a mandated procedure that should begin immediately after admission and be updated throughout the inpatient stay.

42 CFR 482.43(b) indicates that at the time of discharge all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences be provided to the appropriate post-acute care providers responsible to the patient’s follow up or ancillary care.

Proper discharge/aftercare planning allows patients to achieve continuity and coordination of care and treatment by establishing supports in the community that correspond with their level of care.

Specific rules and regulations related to discharge planning and aftercare can be found in Subchapter 39 of the Minimum Standards of Operation for Psychiatric Hospitals located on the MS Department of Health (MSDH) website or can be accessed by clicking on the following link: https://msdh.ms.gov/msdhsite/index.cfm/30,113,83,pdf/PsychiatricHospitals_MinimumStandards.pdf.

 

 

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5/23/2023

Outpatient hospital providers of acute partial hospitalization and intensive outpatient programs:
Reminder about Alliant prior authorization requests

Going forward, please be sure to include the number of units needed when you are entering your initial prior authorization (PA) request for the following procedure codes: H0015, H0035, and S9480.

This should decrease the number of PA-related claim denials for these services in the MESA Provider Portal.

 

 

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5/22/2023

Claims Denied with Error 4371/EOB 1379

The Mississippi Division of Medicaid (DOM) is aware of a recent increase in claim denials receiving error 4371-Claim type restriction on procedure coverage rule (EOB 1379-the services are not allowed on the claim type for the member’s benefit plan.) This is primarily impacting members on the Healthier Mississippi Waiver (HMW) benefit plan who also have Medicare coverage. DOM and Gainwell are working together to address the denials. Please monitor the Late Breaking News page for future updates.

 

 

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5/18/2023

Non-Covered Current Dental Terminology Codes

Effective May 16, 2023, the fee-for-service (FFS) Utilization Management vendor, Alliant, will have new options in their prior authorization (PA) portal for submission of non-covered Current Dental Terminology (CDT) codes for members under the age of 21. Covered codes and non-covered codes cannot be entered on the same request in the Alliant portal. Detailed instructions are located on Alliant’s portal at the following link: EPSDT Dental Non-Covered Code Instructions.
In accordance with Administrative Code Title 23: Part 223, Rule 1.7, the Division of Medicaid covers any medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) diagnostic and treatment services required to correct or ameliorate physical, mental, psychosocial, and/or behavioral health conditions discovered by a screening, whether or not such services are covered under any Medicaid Administrative Rule or the State Plan for EPSDT-eligible beneficiaries when prior authorized by a Utilization Management/Quality Improvement Organization (UM/QIO).

 

 

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5/18/2023

Non-Covered Durable Medical Equipment Codes

Effective May 16, 2023, the fee-for-service (FFS) Utilization Management vendor, Alliant, will have new options in their prior authorization (PA) portal for submission of non-covered Durable Medical Equipment (DME) codes. Covered codes and non-covered codes cannot be entered on the same request in the Alliant portal. Detailed instructions are located on Alliant’s portal at the following link: DME non-covered code instructions.

In accordance with Administrative Code Title 23: Part 223, Rule 1.7, the Division of Medicaid covers any medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) diagnostic and treatment services required to correct or ameliorate physical, mental, psychosocial, and/or behavioral health conditions discovered by a screening, whether or not such services are covered under any Medicaid Administrative Rule or the State Plan for EPSDT-eligible beneficiaries when prior authorized by a Utilization Management/Quality Improvement Organization (UM/QIO).

 

 

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5/16/2023

AVRS No Longer Requires PIN Access

It has now become easier to use the Gainwell Technologies’ Automated Voice Recognition System (AVRS). The requirement to use a Personal Identification Number (PIN) for validation when using the AVRS has been removed. Providers will now be able to retrieve claims, eligibility, payment, and service limit information without needing to supply a PIN.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative.

The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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5/15/2023

Attention All Providers: Physician Administered Drug State Fiscal Year 2023 Fee Updates

The Mississippi Division of Medicaid has updated Physician Administered Drug (PAD) fees for dates of service during state fiscal year 2023 (July 1, 2022 through June 30, 2023). PAD claims during these dates will be adjusted. The mass adjustment will appear on remittance advice at a future date. No further action on the part of the provider is needed.

If you have any questions, please contact Gainwell Provider and Beneficiary Services at 800-884-3222 or your designated provider field representative at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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5/4/2023

Attention All Providers: Prior Authorization Reminder

The Mississippi Division of Medicaid has seen a recent increase in denied claims posting edit 3100- PA REQUIRED -PA MISSING OR INVALID. Providers are reminded to obtain prior authorization (PA) for all codes and services that require PA from the appropriate Utilization Management vendor and ensure this information is included in the appropriate location on their claim submissions.

• MESA electronic claims submitted via 837I 5010 X12 transaction files should include the prior authorization number in Loop 2300 (Claim Information Loop: Data Element REF02).

• MESA electronic claims submitted via 837P & 837D 5010 X12 transaction files should include the prior authorization number applicable to the entire claim in Loop 2300 (Claim Information Loop: Data Element REF02, whereas the prior authorization number applicable to the detail lines should be included in Loop 2400 (Service Line Information Loop: Data Element REF02).

Alliant Health Solutions is responsible for authorization requests for fee-for-service (FFS) Medicaid members. Please refer to Alliant Health Solutions’ provider portal at: https://ms.allianthealth.org/ or call Alliant directly at 1-888-224-3067 for assistance.

Kepro (formerly eQHealth Solutions) is responsible for advanced imaging authorization requests for FFS Medicaid members. Please refer to Kepro’s website at https://msadi.kepro.com/ or call Kepro directly at 866-740-2221 for assistance.

 

 

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5/4/2023

Claims Denied/Posting Edit 798

The Mississippi Division of Medicaid advises providers to resubmit secondary claims, which previously denied for Edit 798 “TPL AMOUNT LESS THAN % SPECIFIED”, via the MESA Provider Portal or paper submission to assure these claims process accordingly.

If there is no EOB attachment and the TPL amount is less than 20%, the claim will deny with Edit 798.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or your designated provider field representative at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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5/4/2023

Providers and Member Registered Users: Portal Password Policy Updates

We would like to inform you that the Portal password policy has been updated for enhanced security. As part of this update, we now require all passwords to be at least 14 characters long. This means that your current password may no longer be compliant with our policy, and you will need to update it accordingly.

Follow the password policy requirements outlined below.

1. A password cannot be reset more than once in a 24-hour period.
2. Passwords will expire every 60 days.
3. The minimum password length is 14.
4. The password cannot repeat any of the previous 24.
5. Passwords must be complex, containing 3 of the following 4 items:

• Upper case letters (A, B, C…)
• Lower case letters (a, b, c…)
• Numbers (1, 2, 3…)
• Special characters (!, $, *…)

6. User ID cannot be part of your password.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative.

The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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5/4/2023

Mass Adjustment for Claims Affected by Clinic Home Health Agency Rate Updates

The Mississippi Division of Medicaid will mass adjust claims affected by the Clinic Home Health Agency Rate Updates with Taxonomy 251E00000X, processed on or after October 3, 2022. The adjustments will appear on your Remittance Advice dated May 5, 2023.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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5/4/2023

Inpatient Hospital: Mass Adjustment for Claims Denied with Incorrect DRG Version

The Mississippi Division of Medicaid will mass adjust claims originally processed using the incorrect DRG version. The adjustments will appear on your Remittance Advice dated May 5, 2023.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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4/28/2023

ATTENTION: Hospice and Long-Term Care Providers

After very productive conversations with Hospice and Long-Term Care providers, the Mississippi Division of Medicaid (DOM) is working diligently with our Fiscal Agent, Gainwell Technologies, and our Utilization Management/Quality Improvement Organization (UM/QIO) Alliant Health Solutions, to address the following three issues related to Hospice Lock-ins and Claims:

• Hospice Transfers
  When members transfer from once hospice provider to another hospice provider on the same date of service, and the new Hospice provider submits a claim, Error Code 2603 (Lock-in Violation Billing Prov – Deny) is posting because of the one-day overlap in the lock-in segments. Gainwell Technologies is working to develop a process to allow the one-day overlap for hospice lock-ins.

• Hospice Providers with New Medicaid Enterprise System Assistance (MESA) ID Numbers
  Hospice claims submitted with the new MESA ID number are denying with Error Code 2603 (Lock-in Violation Billing Prov – Deny) and EOB Code 0631 (Member Assigned to Lock-in Program), if the approval was issued prior to the MESA transition. Gainwell Technologies is working to develop a process to address this issue. DOM advises providers not to request Alliant Health Solutions to update prior approvals to the new MESA ID.

• Hospice Members with the Healthier MS Waiver Benefit Plan
  Hospice claims submitted for members with the Healthier MS Waiver Benefit Plan are denying with Error Code 4262 (Lock-In Restriction on Rev Code Billing Rule). Gainwell Technologies is working to develop a process to address this issue.

Currently, DOM does not have an anticipated date of completion for the system updates. Please continue to monitor DOM’s Late Breaking News (LBN) page and provider remittance advice messages to find out when these system updates have been completed.

Please continue to submit all new Hospice elections and recertifications timely to Alliant and retain all documents on file.

Questions concerning claims impacted for these reasons can be directed to the Office of Medical Services at (601) 359-6150.

 

 

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4/28/2023

April Provider Bulletin now available

The April issue of the MS Medicaid Provider Bulletin is now available online for read or download. Following the Mississippi Division of Medicaid’s transition to a new fiscal agent, the quarterly Provider Bulletin is shifting to a January-April-July-October publication schedule.

The Provider Bulletin aims to inform providers of Medicaid news, policy changes, a way to connect with our executive director and provides contact information for provider field representatives listed by county, and more.

Previous issues of the Provider Bulletin are archived online at https://medicaid.ms.gov/providers/provider-resources/provider-bulletins/.

 

 

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4/27/2023

Mississippi Medicaid to remove all Medicaid copayments effective May 1, 2023

Effective May 1, 2023, the Mississippi Division of Medicaid (DOM) is eliminating all Medicaid copayments for pharmacy and health care services.

DOM plans to submit MS State Plan Amendment (SPA) 23-0011 to allow the agency to remove copays from Medicaid services. While DOM will continue to pay providers for their services, providers will no longer be able to collect copays from beneficiaries beginning Monday, May 1, 2023.

Pharmacy point-of-sale paid claims will reflect a $0.00 amount in the copayment field. This change will apply to both fee-for-service and MississippiCAN claims.

 

 

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4/27/2023

Claim Filing Indicator “16” Should be Used if member has a Medicare Part C Policy

ATTENTION: Providers Submitting Portal Claims

MESA-submitted Medicare Part C electronic claims submitted via 837 5010 X12 transaction files should include “16” as the Claim Filing Indicator in the 2320 (Other Subscriber Loop: Data Element SBR09).

The value of “16” indicates that the member has a Medicare Part C policy. MESA will process the claim as a crossover claim. Failure to use Claim Filing Indicator 16 will result in incorrect processing/payment of a claim.

Additional assistance can be found in the 837 Companion Guides available at: https://medicaid.ms.gov/edi-technical-documents/.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative.

The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

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4/12/2023

Pay/Deny Date Updates After Submission of Portal Claims

When providers submit a portal claim, they will see a Pay/Deny Date of 01/01/1900. This date will be updated to the correct Pay/Deny Date once the claim finalizes through the financial cycle. The updated date will also be the Pay/Deny Date that appears on the provider’s Remittance and Status.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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4/11/2023

Prescription Billing Instructions During State of Emergency

Prescription billing directions for beneficiaries adversely affected by tornados during the State of Emergency declared on March 25, 2023, by Governor Reeves.

 

Payer and Contact Information:	Pharmacy Claim Billing Directions for Beneficiaries adversely affected by tornados
Medicaid Fee For Service (FFS) (Gainwell) Help Desk: 1-833-660-2402	Enter a value of ’13-Payor Recognized Emergency’ in SCC field (NCPDP Field ‘420-DK’) to override: • Two (2) Brand / Six (6) Prescription Limit • Refill Too Soon
Magnolia (Rx Advance) Help Desk: 1-800-460-8988	Enter a value of ’13-Payor Recognized Emergency’ in SCC field (NCPDP Field ‘420-DK’) to override: • Two (2) Brand / Six (6) Prescription Limit • Refill Too Soon
Molina (CVS Caremark) Help Desk: 1-844-286-1899	Enter a value of ’13-Payor Recognized Emergency’ in SCC field (NCPDP Field ‘420-DK’) to override: • Two (2) Brand / Six (6) Prescription Limit • Refill Too Soon Beneficiary’s zip code must be entered in NCPDP field ‘325-CP’
UnitedHealthcare (Optum Rx) Help Desk: 1-877-305-8952	A one-time override of the following edits will process at the point of sale (without the need for submission clarification codes or call to the pharmacy help desk) for any member with an address on file with UnitedHealthcare within Carroll, Humphreys, Monroe, and Sharkey counties: • Two (2) Brand / Six (6) Prescription Limit • Refill Too Soon • Pharmacy Lock-In Restriction For members needing override of the above edits due to being impacted by the tornado, who have addresses on file outside of the impacted counties, a one-time override is available by calling the Pharmacy Help Desk.

 

 

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3/31/2023

Reprocessing Claims Using Incorrect HAC Version

The Mississippi Division of Medicaid will Mass Adjust claims and resubmit any denied claims originally processed using the incorrect HAC version. The adjustments will appear on your Remittance Advice dated March 31, 2023.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/31/2023

Mass Adjust Claims Affected by PAD SFY22 Retro Rate

The Mississippi Division of Medicaid will Mass Adjust claims affected by the PAD SFY22 Retro Rate for claims processed on or after Oct. 3, 2022. The adjustments will appear on your Remittance Advice dated March 31, 2023. Claims processed prior to Oct. 3, 2022, will be mass adjusted at a later date.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/31/2023

Reprocessing of Claims Affected by Appendix K HCBS Rate Increases

The Mississippi Division of Medicaid (DOM) will reprocess claims affected by the Appendix K HCBS Rate Increases for dates of service after Oct. 1, 2022. Affected claims submitted from Oct. 1, 2022, through Nov. 10, 2022, that have not already been adjusted by providers, will be included in the reprocessing. The mass adjustment will appear on your remittance advice dated March 31, 2023.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on DOM’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/27/2023

Professional and Outpatient Crossover Claim Submissions

All Medicare Professional and Outpatient Crossover claims require the Medicare information to be submitted at the detail level. If your Medicaid Crossover claim denied with EOB message 4502, “Medicare EOMB information is missing at the claim detail,” resubmit the claim with the Medicare EOMB information submitted at the detail level. Each of the lines billed, including the HCPCS Code, Revenue Code and units must match.

The requirement to submit detail claim information began on October 3, 2022, and allows DOM to ensure proper payment and reporting of paid claim information.

Please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative should you need assistance. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/27/2023

Enhanced Functionality for Delegate Accounts

Providers often use delegates to manage their claims and other clerical functions via the portal for legitimate business reasons. Effective March 26, 2023, additional functionality was added that now allows delegates to perform recredentialing, revalidation and add program functionalities when given permissions by the Provider/Provider Administrators.

Instructions related to delegate accounts can be found at https://medicaid.ms.gov/wp-content/uploads/2022/10/PRP-100-Job-Aid-Delegate-Accounts.pdf.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/25/2023

Medicaid lifts prescription limits in response to State of Emergency

The Mississippi Division of Medicaid has enacted its State of Emergency provision which allows fee-for-service beneficiaries affected by the tornadoes to receive early refills and additional prescriptions above the 2brand/6prescription monthly limit.

Pharmacy providers should follow the billing guidelines found at this link: https://medicaid.ms.gov/disaster-billing-directions/.

Medicaid is directing its Coordinated Care Organizations’ pharmacy directors to enact their emergency procedures.

 

 

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3/24/2023

Dental claims must be submitted with a valid dental-related ICD-10 code

Dental claims submitted for dates of service on and after April 1, 2023, must be submitted with a valid dental-related ICD-10 diagnosis code.

In December 2022, the Division of Medicaid (DOM) advised Dental Providers to resubmit previously denied dental claims when the claim denied for edit 257-Primary Diagnosis Code Missing – Detail. DOM made temporary modifications to edit 257 to allow Dental Providers more time to update their software to include ICD-10 diagnosis codes.

Since that time, dental claims submitted without a valid dental related ICD-10 diagnosis code have still received edit 257, but the claim would pay. However, claims submitted for dates of service on and after April 1, 2023, will begin to deny when submitted without a valid dental-related ICD-10 diagnosis code.

 

 

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3/24/2023

MESA MOVEit Transfer Password Expiration Guidelines

For security reasons, Gainwell Technologies requires users to change their MOVEit Transfer passwords every 60 days.

Prior to expiration, users will receive Password Age Warning notifications sent to the contact email address associated with the MOVEit user profile. If you are a user of the MOVEit Transfer web application, please use the following instructions to change your password when you receive password expiration notices.

Click on the image or link at the bottom to open or download the MESA MOVEit Transfer Password Expiration Guidelines.

 

 

 Link: https://medicaid.ms.gov/wp-content/uploads/2023/03/MOVEit-Transfer-Password-Expiration-Guidelines.pdf

 

 

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3/24/2023

Provider Maintenance Operations (Licensure Review)

Under 42 CFR § 455.412, the Mississippi Division of Medicaid (DOM) is resuming its regular provider maintenance operation of monthly licensure review that was suspended in September 2022 for the implementation of MESA and transfer of our fiscal agent operations from Conduent to Gainwell Technologies. DOM will be updating provider records for both our fee-for-service/MississippiCAN providers as well as our CHIP providers.

Providers identified as having an expired or expiring license will receive notification from Gainwell Technologies by letter. Providers are required to provide their updated licensure information to Medicaid. Failure to provide Medicaid with the updated license could result in closure of the Medicaid provider number.

Providers can submit their licensure information to the Provider Enrollment Department of Gainwell Technologies via secure correspondence in the MESA Provider Portal, fax, or mail. The following information is provided:

MESA Provider Portal: https://medicaid.ms.gov/mesa-portal-for-providers

Provider Services Fax Number:
(866) 644-6148
Attention: Provider Enrollment

Provider Services Mailing Address:
Provider Enrollment/MississippiCAN/MSCHIP
PO Box 23078
Jackson, MS 39225

Providers can utilize the Provider Search Tool located on DOM’s website at http://dom-azure-app.medicaid.ms.gov/ to validate if they have an expired license on their Medicaid provider record along with other data elements.

Please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 if you need assistance between the hours of 8 a.m. and 5 p.m. CST.

 

 

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3/17/2023

Attention All Providers: Additional Physician Administered Drugs to Require Prior Authorization

The Division of Medicaid (DOM) will require prior authorization (PA) of the following physician administered drugs (PADs) for services rendered on or after the dates indicated.

Effective April 1, 2023:	Effective April 15, 2023:	Effective June 1, 2023:
Q5129 Vegzelma	Q5108 Fulphila	Q5118 Zirabev
J1411 Hemgenix	Q5122 Nyvepria	J9304 Pemfexy
C9148 Tzield	Q5111 Udenyca
	Q5127 Stimufend
	Q5120 Ziextendo

 

Alliant Health Solutions is responsible for authorization requests for fee-for-service (FFS) Medicaid beneficiaries. Please refer to Alliant Health Solutions’ provider portal at: https://ms.allianthealth.org/, or call Alliant directly at 1-888-224-3067 for assistance. Providers are encouraged to register with Alliant to submit authorization requests via the Alliant web-portal https://ms.allianthealth.org/.

 

 

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3/17/2023

Providers: Web Portal Errors Related to Uploading/Downloading 837 & 835 Files

Over the last several weeks, some providers may have experienced intermittent error messages when attempting to upload 837 files or download 835 files in the MESA provider portal. At that time, providers were encouraged to utilize MOVEit SFTP accounts to transfer files until the issue was resolved. The defect was resolved with the March 12, 2023, system release.

Should affected providers continue to experience upload/download errors, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/16/2023

How to Help Members Update Their Information

Coverage Champions, providers, and community organizations wishing to partner with individuals and families covered by Mississippi Medicaid who may need to update their contact information can help in two ways.

The Mississippi Division of Medicaid (DOM) can accept notification of a change of address or updated contact information from Medicaid members, as well as from designated Heads of Household, or authorized representatives. An online form is located at www.medicaid.ms.gov/staycovered, and this information can also be provided by calling 1-800-421-2408.

If a patient or client needs assistance filling out the form or placing a call, please feel free to help facilitate entering information into the web form or calling DOM. However, please be sure that the member, Head of Household, or authorized representative is present to participate in completing the form or making the call. Please Note: If you assist in entering form information, please indicate this by entering your name and organizational affiliation “on behalf of” the Medicaid member.

If Medicaid members have questions or need assistance maintaining information on file with the Division of Medicaid, please call 1-800-421-2408.

Sign up to be a Coverage Champion and help us share important information and resources, including the Stay Covered Flyer.

 

 

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3/14/2023

Providers Can Submit Affiliation Requests Via Portal, Fax or Mail

Currently during the individual enrollment process, the provider is not given the option to add a group affiliation. The Mississippi Division of Medicaid is working on a resolution through a change request (CR), but until the CR is implemented the following steps should be taken to request that an affiliation be added.

Providers needing to submit affiliation requests to the Provider Enrollment Department of Gainwell Technologies may do so via secure correspondence in the MESA Provider Portal, fax, or mail. Additional information is noted below. Please note the requested effective date for the affiliation within your communication request, otherwise the provider affiliation will be effective the date of processing.

MESA Provider Portal:
https://medicaid.ms.gov/mesa-portal-for-providers/

 

Provider Services Fax Number:
Attention: Provider Enrollment
(866) 644-6148

Provider Services Mailing Address:
Provider Enrollment/MississippiCAN/MSCHIP
PO Box 23078
Jackson, MS 39225

 

Delegates for the group that this provider needs to be affiliated with can send in a request through the Secure Correspondence link located on the right side of the Home Page. A delegate of the group can also check the Affiliated Providers link on the Home Page to see a list of all individuals affiliated with the provider.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/13/2023

Provider Enrollment Application Fee Increased for 2023
(Updated from 2/28/23)

The enrollment application fee for institutional providers for the 2023 calendar year has increased from $631 to $688. This application fee will be required in the following instances:

• • • • Initial enrollment, reactivation, revalidation or reenrollment of providers in Medicaid and the Children’s Health Insurance Program (CHIP)
      • Addition of New Owners – Change of Ownership
      • Providers adding a new Medicaid practice location

Note: Simple changes to the provider enrollment information, that is, new phone numbers, new bank account information, new billing address, change in the name of the provider or other such updates are not subject to the fee.

Providers required to submit a fee are:

Taxonomy	Description
251E00000X	Home Health
251G00000X	Hospice Care, Community Based
261QA1903X	Clinic/Center – Ambulatory Surgical
261QE0700X	Clinic/Center – End-Stage Renal Disease (ESRD) Treatment
261QF0400X	Clinic/Center – Federally Qualified Health Center (FQHC)
261QM0801X	Clinic/Center – Mental Health (Including Community Mental Health Center)
261QR0401X	Clinic/Center – Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
261QR1300X	Clinic/Center – Rural Health
282N00000X	General Acute Care Hospital
283Q00000X	Psychiatric Hospital
291U00000X	Clinical Medical Laboratory
293D00000X	Physiological Laboratory
314000000X	Skilled Nursing Facility
314000000X	Skilled Nursing Facility
3140N1450X	Skilled Nursing Facility – Nursing Care, Pediatric
332B00000X	Durable Medical Equipment and Medical Supplies
333600000X	Pharmacy
341600000X	Ambulance

 

Providers submitting their application fee should make their check out to the Mississippi Division of Medicaid, annotating on the check the application tracking number (ATN) and mail to Gainwell Technologies, PO Box 6014, Ridgeland, MS 39158. Providers who have already paid the application fee to Medicare or another state’s CHIP or Medicaid program have fulfilled the requirement and do not have to pay the fee to Mississippi Medicaid.

For more information, call the Provider and Beneficiary Services Call Center at 1-800-884-3222 or your designated field representative: https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf if you need assistance.

 

 

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3/10/2023

Medicaid Pharmacy point of sale claims system outage

The Gainwell pharmacy point-of-sale claims system will be down for hardware maintenance starting at 5:00 a.m. on Sunday, March 12, 2023, for up to 1 hour. This downtime will impact beneficiaries with fee-for-service coverage. MississippiCAN/MSCHIP beneficiaries will not be affected. If Medicaid fee-for-service beneficiaries require new/urgent prescriptions during this temporary outage, beneficiary eligibility may be checked by calling the Gainwell Provider Help Desk at 1-833-660-2402.

 

 

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3/10/2023

Long Term Care Providers: Outpatient Crossover Claim Denials Related to Audit 5518 (Home Health Visit Limit for Fiscal Year)

The Mississippi Division of Medicaid (DOM) encourages providers to resubmit claims that previously denied with Audit 5518 (Home Health Visit Limit for Fiscal Year). For process dates on or after 2/15/2023, this issue is fixed. As a result, long term care therapy revenue codes billed on outpatient crossover claims will no longer deny with audit 5518.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/8/2023

TPL Denials on Dental Claims

Effective Feb. 24, 2023, the Mississippi Division of Medicaid (DOM) has updated Third Party Liability (TPL) coverage rules in MESA to correct an issue where Dental claims were incorrectly denying for Edit 2504 – TPL for Member Resubmit with TPL EOB. This occurred when the member had TPL Medical coverage on file but no TPL Dental coverage.

Providers are advised to either resubmit or adjust impacted dental claims as follows:

• • • • Resubmit denied dental claims that denied prior to Feb. 24, 2023 with Edit 2504
      • Adjust partially paid dental claims that processed prior to Feb. 24, 2023 and contained denied details with Edit 2504

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or your designated provider field representative at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/7/2023

Paper Claims Converted to Electronic Claims

Paper claims submitted prior to Oct. 3, 2022, and remaining unprocessed as of Oct. 3, 2022, were converted and processed as electronic claims. The paper claim and any attachments will be scanned and linked to the processed electronic claim.

Until the linking process is complete, the claims will appear on the submitting provider’s Remittance Advice (RA) with a status of Suspend with EOB 1084 – CLAIM SUSPENDED BECAUSE AN ATTACHMENT WAS INDICATED, BUT NOT RECEIVED. No action from the provider is required.

Once the linking process is completed, the claim will be processed and released. The claim will then appear on the RA with a status of Paid or Denied.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or the provider field representative (rep) designated for your county. To identify the provider field rep for your county, go to https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/6/2023

Medicaid urges members to update their contact information before renewals begin April 1

With the federal government ending the continuous Medicaid coverage requirement on March 31, the Mississippi Division of Medicaid (DOM) is notifying Medicaid members that eligibility renewals will begin on April 1. DOM urges all Medicaid members to make sure their contact information is correct by visiting www.medicaid.ms.gov/staycovered.

During the COVID-19 public emergency, states and territories have continued to cover every person who has been eligible for Medicaid on or after March 18, 2020, even if their income or circumstances have changed and otherwise would no longer be eligible.

Under the Consolidated Appropriations Act (CAA) passed in December, Congress has now required states to begin the process of redetermining the eligibility of all Medicaid members. The Centers for Medicare and Medicaid Services (CMS) has instructed all states to begin normal redetermination operations by April 1, 2023, at the latest.

To prepare for the return to annual renewals, DOM is sending notices to recipients alerting them to the change in federal requirements and to look for renewal forms in the mail in the months ahead.

Members can update their information online at www.medicaid.ms.gov/staycovered, or by calling DOM at 1-800-421-2408 or 601-359-6050.

DOM has been actively increasing its eligibility workforce through various recruitment and retention efforts, including hiring temporary staff to help with the caseload and streamlining training requirements.

In January, DOM also launched a Stay Covered campaign, which includes a Coverage Champions program for community partners, advocates and providers to support Medicaid members and prepare for the end of the continuous coverage requirement. The Stay Covered webpage (www.medicaid.ms.gov/staycovered) includes a media toolkit, a link for members to update their contact information, and more important information about the unwinding process.

Following federal guidance, renewals for all current Medicaid members must be initiated within 12 months following April 1, and all renewals must be completed within 14 months.

When DOM begins redeterminations, electronic verification sources will first be used to try to renew a member’s benefits.

If more information is needed to complete a renewal, the member will be mailed a renewal form, and they will have 30 days to fill it out and return it. DOM is also reaching out to members via email and text messages.

Find more information and frequently asked questions (FAQs) online at www.medicaid.ms.gov/staycovered.

 

 

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3/3/2023

Professional Claim TPL Denials for Procedure Code A4554

Effective Feb. 23, 2023, the Mississippi Division of Medicaid (DOM) updated TPL coverage rules for Procedure Code A4554 causing inappropriate denials impacting Professional claims. Providers are advised to resubmit impacted Professional claims that denied or adjust Professional claims that were partially paid but contained denied details for Procedure Code A4554 with Edit 2504 — TPL for Member Resubmit with TPL EOB.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or your designated provider field representative at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/3/2023

Secondary Claims with EOB (Clarification)

The Mississippi Division of Medicaid (DOM) would like to clarify that providers are not limited to sending secondary claims on paper only. All secondary claims can be submitted using the EDI claim transactions, Provider Claim Portal, or paper claims. As a reminder, DOM has temporarily discontinued the requirement that an explanation of Medicare benefits (EOMB) be attached for all secondary Medicare claims when submitted via EDI, in order to include Medicare Part C (Medicare Advantage). Please note, an EOMB will continue to be required for all claims submitted via the portal or paper submission.

Additionally, during the webinars, providers were instructed that all claims that have TPL should include an attachment. If there is no EOB attachment and the TPL amount is less than 20%, the claim will deny with Edit 798. If there is an EOB attachment, the claim will process accordingly.

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or your designated provider field representative at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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3/3/2023

Reprocess Claims Posting Edit 452

The Mississippi Division of Medicaid (DOM) will reprocess paper crossover claims that erroneously denied with the EOB message “Resubmit charges for Medicaid covered service(s) denied by Medicare on Medicaid claims.” The reprocessed claims should begin to appear on your Remittance Advice dated March 10, 2023. No further action from provider is needed. Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or your designated provider field representative at https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

 

 

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2/28/2023

Provider Enrollment Application Fee Increased for 2023
(Updated on 3/13/23)

The enrollment application fee for institutional providers for the 2023 calendar year has increased from $631 to $688. This application fee will be required in the following instances:

• • • • Providers initially enrolling in Medicaid and the Children’s Health Insurance Program (CHIP)
      • Providers revalidating their Medicaid or CHIP enrollment
      • Providers adding a new Medicaid practice location

Providers required to submit a fee are:

Taxonomy	Description
251E00000X	Home Health3
251G00000X	Hospice Care, Community Based
261QA1903X	Clinic/Center – Ambulatory Surgical
261QE0700X	Clinic/Center – End-Stage Renal Disease (ESRD) Treatment
261QF0400X	Clinic/Center – Federally Qualified Health Center (FQHC)
261QM0801X	Clinic/Center – Mental Health (Including Community Mental Health Center)
261QR0401X	Clinic/Center – Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
261QR1300X	Clinic/Center – Rural Health
282N00000X	General Acute Care Hospital
283Q00000X	Psychiatric Hospital
291U00000X	Clinical Medical Laboratory
293D00000X	Physiological Laboratory
314000000X	Skilled Nursing Facility
3140N1450X	Skilled Nursing Facility – Nursing Care, Pediatric
332B00000X	Durable Medical Equipment and Medical Supplies
333600000X	Pharmacy
341600000X	Ambulance

 

Providers that have already paid the application fee to Medicare or another state’s CHIP or Medicaid program have fulfilled the requirement and do not have to pay the fee to Mississippi Medicaid. Proof of payment should be submitted with the application.

For more information, call the Provider and Beneficiary Services Call Center at 1-800-884-3222 or your designated field representative: https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf if you need assistance.

 

 

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2/24/2023

Inpatient Hospitals: MESA Issues Impacting Inpatient Claims Payment

MESA does not use the DRG/SOI values that may be submitted by providers on inpatient claims. MESA utilizes 3M APR-DRG assignment software to assign the DRG/SOI to the claims. APR-DRG assignment depends chiefly on the ICD-10-CM/PCS codes, age, gender, and other C specific information. The 3M assigned DRG/SOI is then used in the pricing of the claims. If providers are using the APR-DRG desktop grouper from 3M, confirm that MS Medicaid state-specific information is used in conjunction with the same grouper settings as documented in the grouper settings document (Microsoft Word – MSI22005 MS Medicaid Grouper Settings 2022-09-28.docx).  Providers that are licensing the APR-DRG grouper directly from 3M can contact 3M HIS Customer Support to help ensure they are set up properly.

MESA DRG/SOI ASSIGNMENT ERROR IMPACTING CLAIMS PRICING:
Between 10/1/2022 and 2/12/2023 an incorrect version of the 3M software was used to assign the DRG/SOI on the claims. This may have resulted in an incorrect assignment of the DRG/SOI and pricing of the claims during this timeframe.

MESA INPATIENT CLAIM PRICING CALCULATION ERROR:
Between 10/1/2022 and 2/12/2023 there was an error in the pricing calculation in the situation where the number of DRG days are less than the Length of Stay days on the claim. This error resulted in the underpayment of claims during this timeframe.

RESOLUTION:
Gainwell and DOM will identify claims paid incorrectly due to both situations described above, and perform mass adjustments on the impacted claims to correct the paid amounts. There is no timeframe determined yet for the mass adjustments of these claims. A notification will go out to providers prior to the execution of the mass adjustments.

In lieu of waiting on the mass adjustment process, providers have the option of submitting claims adjustments to expedite the correction of their claims payments.

 

 

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2/23/2023

Inpatient Hospital Claim Denials Related to Edit 4032

The Mississippi Division of Medicaid (DOM) advises providers to resubmit inpatient hospital claims which previously denied for Edit 4032 – PROCEDURE CODE NOT ON FILE. When procedure codes are submitted on inpatient hospital claims, providers must use a valid procedure code. Providers may also need to check billing software settings to ensure that only valid values are submitted on these fields. Please contact the Provider and Beneficiary Services Call Center at 1-800-884-3222 or your designated field representative: https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf if you need assistance.

 

 

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2/21/2023

1099s for Tax Year 2022

1099 tax forms generated by the Mississippi Division of Medicaid are reflective of the claims that have processed during that tax year. Providers will get one 1099 for each Tax ID number/Social Security Number. If they have more than one provider number associated to one Tax ID number/SSN, the 1099 will have the combined 1099 earnings for all the Medicaid provider numbers.

Providers who have not received their 1099 for Tax Year 2022 can submit their request to ms_financial@gainwelltechnologies.com (Please note that there is an underscore between ms and financial).

Please contact the Provider and Beneficiary Services Call Center at 1-800-884-3222 or your designated field representative: https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf if you need assistance.

 

 

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2/17/2023

Pharmacy Changes to Ease Provider Burden

The Mississippi Division of Medicaid is implementing the following changes to ease provider burden:

• • • • Universal Preferred Drug List (PDL) changes for fee-for-service, MississippiCAN and CHIP claims will be implemented no later than February 22 , 2023: All Adderall XR and Concerta brand name products will be moving to preferred status to ease provider burden due to the stimulant medication shortage issues.
      • The reimbursement rate for HCPCS Code J0561, penicillin G benzathine 100,000 units (Bicillin LA) has been updated to $22.0505, with an effective date of 1/1/2023. Providers may reverse and resubmit claims, with dates of service 1/1/2023 and forward, on which reimbursement was below the ingredient cost. The fee-for-service system has been updated and the MississippiCAN systems will be updated no later than February 27, 2023.

 

 

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2/14/2023

Frequently Denied Edits

Billing providers can find a list of frequently denied edits that have been posting on Remittance Advices recently in the MESA Provider Portal, as well as helpful hints to resolve those issues at: https://medicaid.ms.gov/frequently-denied-edits/.

 

 

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2/14/2023

Providers Can Submit Updated Licenses Via Portal, Fax or Mail

Providers needing to submit updated licenses to the Provider Enrollment Department of Gainwell Technologies may do so via secure correspondence in the MESA Provider Portal, fax, or mail. The following information is provided:

MESA Provider Portal:
https://medicaid.ms.gov/mesa-portal-for-providers/

Provider Services Fax Number:
Attention: Provider Enrollment
(866) 644-6148

Provider Services Mailing Address:
Provider Enrollment/MississippiCAN/MSCHIP
PO Box 23078
Jackson, MS 39225

Please contact the Provider and Beneficiary Services Call Center at 1-800-884-3222 or your designated provider field representative: https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf if you need assistance.

 

 

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2/13/2023

Attention All Providers: Physician Administered Drug State Fiscal Year Fee Updates

The Mississippi Division of Medicaid has updated Physician Administered Drug (PAD) fees for dates of service during State Fiscal Year 2022. PAD claims during these dates will be adjusted. The mass adjustment will appear on remittance advice at a future date. No further action on the part of the provider is needed. If you have any questions, please contact Gainwell Provider and Beneficiary Services at 800-884-3222.

 

 

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2/10/2023

Verisys Serves as Credentials Verification Organization (CVO) for Mississippi Division of Medicaid

With the implementation of a centralized credentialing process for providers enrolling with any MississippiCAN or Children’s Health Insurance Program (CHIP) for our Coordinated Care Organizations, providers will choose during the MESA application process for both credentialing and recredentialing, if they are currently credentialed through a MIssissippi Division of Medicaid-approved delegated credentialing entity or if they will credential through the state’s Credentials Verification Organization (CVO). Verisys is contracted to perform credentialing for DOM’s Fiscal Agent, Gainwell Technologies.

The below screenshot is an example of an email notification a provider will receive from Verisys if additional information is required. Please contact Verisys directly if you have any questions pertaining to the information being requested at 855-743-6161, Monday-Friday, 8 a.m. to 8 p.m. ET, or via email at outreachsupport@verisys.com.

 

 

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2/6/2023

Physician Administered Drug PA Requirement: Q5126 – Alymsys to require Prior Authorization

Effective Jan. 1, 2023, the Mississippi Division of Medicaid will require prior authorization (PA) of the following physician administered drug (PAD): Alymsys – Q5126, Injection, bevacizumab-maly, 10 mg.

Alliant Health Solutions is responsible for authorization requests for fee-for-service (FFS) Medicaid beneficiaries. Please refer to Alliant Health Solutions’ provider portal at: https://ms.allianthealth.org/, or call Alliant directly at 1-888-224-3067 for assistance.

Providers are encouraged to register with Alliant to submit authorization requests via the Alliant web portal: https://ms.allianthealth.org/.

For billing issues, call Gainwell Provider and Beneficiary Services at 800-884-3222.

 

 

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2/2/2023

January Provider Bulletin now available

The January issue of the MS Medicaid Provider Bulletin is now available online for read or download. Following the Mississippi Division of Medicaid’s transition to a new fiscal agent, the quarterly Provider Bulletin is shifting to a January-April-July-October publication schedule.

The Provider Bulletin aims to inform providers of Medicaid news, policy changes, a way to connect with our executive director and provides contact information for provider field representatives listed by county, and more.

Previous issues of the Provider Bulletin are archived online at https://medicaid.ms.gov/providers/provider-resources/provider-bulletins/.

 

 

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1/31/2023

Medicaid members urged to update contact information before return to routine eligibility operations

Following the passage of the Consolidated Appropriations Act (CAA), states will soon return to routine eligibility operations, and the Mississippi Division of Medicaid (DOM) will begin re-qualifying all Medicaid members this spring.

It is very important for Medicaid members to update their contact information by visiting www.medicaid.ms.gov/update-contact-info/ or calling DOM at 1-800-421-2408 or 601-359-6050.

To keep Medicaid members – as well as providers and advocacy groups – informed of the latest information, FAQs, alerts and other resources, DOM has launched a “Stay Covered” website at www.medicaid.ms.gov/staycovered/.

Help DOM spread the word by sharing the attached flyer (click on the image to open) and looking for additional resources as they become available at www.medicaid.ms.gov/staycovered/.

 

 

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1/25/2023

Temporary Discontinuance of EOMB Attachments on Secondary Medicare Claims

Effective immediately, the Mississippi Division of Medicaid (DOM) has temporarily discontinued the requirement that an explanation of Medicare benefits (EOMB) be attached for all secondary Medicare claims submitted via EDI to include Medicare Part C (Medicare Advantage). Please note, an EOMB will continue to be required for all claims submitted via portal or paper submission. DOM will provide advanced notice to providers before reinstating this requirement for EDI submitted claims.

 

 

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1/25/2023

Claim denials related to Edit 2505 (Member over 65 Medicare)

The Mississippi Division of Medicaid (DOM) advises providers to resubmit claims which previously denied for Edit 2505 – Member over 65 Bill Medicare.  Please contact the Provider and Beneficiary Services Call Center at 1-800-884-3222 or your designated field representative: https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf if you need assistance.

 

 

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1/24/2023

Comprehensive Fee Schedule now available for download

As of Jan. 23, 2023, the Mississippi Division of Medicaid (DOM) has updated its online Fee Schedules format and added a downloadable Comprehensive Fee Schedule that provides detailed information.

The Comprehensive Fee Schedule can be found of DOM’s external website at: https://medicaid.ms.gov/providers/fee-schedules-and-rates/.

Additionally, Fee Schedules are now available on the MESA Provider Portal: https://portal.ms-medicaid-mesa.com/ms/provider/Home/tabid/135/Default.aspx.  Once the link opens, scroll down, and click on Resources.  Once the Resources link opens, click on Fee Schedules and Rates.

 

 

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1/24/2023

Updated Sterilization Consent Form

In accordance with Title 42 Code of Federal Regulations (CFR) 441 Subpart F, all sterilizations require a valid consent form. Providers are responsible for using the most current form published on the date the consent is obtained. Effective Feb. 1, 2023, the Mississippi Division of Medicaid (DOM) will no longer accept sterilization consent forms with the expiration date of April 30, 2022. The current sterilization consent form has an updated expiration date of July 31, 2025, and is available on DOM’s website at Forms – Mississippi Division of Medicaid under Provider Forms.

Additional information regarding policy and procedures for sterilizations can be found in the Mississippi Administrative Code Title 23 Part 202 at https://medicaid.ms.gov/wp-content/uploads/2022/05/Title-23-Part-202-Hospital-Services-05.01.22.pdf.

 

 

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1/6/2023

Updated Paper Claims Billing Manual

If you are a provider that uses the paper UB-04 Claim Form to bill institutional, outpatient, institutional crossover and outpatient crossover claims, please be advised that the billing provider taxonomy on the paper UB-04 Claim Form is required to be entered in FL 81cc (a-d) as well as the B3 qualifier. The previous instruction for entry of the billing provider taxonomy in FL 57 with qualifier ZZ is no longer valid. The Paper Claims Billing Manual has been updated to reflect this change. Please contact the Gainwell Technologies Provider and Member Services at 1-800-884-3222 with any questions.

 

 

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12/22/2022

Targeted Case Management (TCM) and HCBS Services

Please be advised that individuals receiving Home and Community Based Services (HCBS) case management/support coordination (CM/SC) cannot also receive Community Mental Health Services Targeted Case Management (T2017). This is considered a duplicative service by the Centers for Medicare and Medicaid Services (CMS). If an individual is locked-in to a waiver or Community Support Program (CSP), the HCBS agency is the case management service provider.  Should the Community Mental Health Center/Private Mental Health Center become aware of a beneficiary’s need normally handled through Targeted Case Management, they should contact the beneficiary’s support coordinator or CSP Targeted Case Manager.

As a reminder, providers should check beneficiary eligibility for each date of service. To determine if a beneficiary is enrolled in a HCBS program, go to your MESA provider portal:

• • • • Select the “Eligibility” tab at the top of the screen, then select “Eligibility Verification”.
      • Enter the “Member ID” or other requested information if Member ID is unknown. Enter an effective from and effective to date (no more than a 30-day span) and click the blue “Submit” button at the bottom left of the screen.
      • Click on “Medicaid State Plan” located at the bottom of the screen under “Benefit Details” and “Coverage”.
      • Click on “Expand All” option above the “Effective/End Dates”.
      • The “Lock-in Details” and “Benefit Plan” are displayed for the date range selected.
      • HCBS Lock-ins are identified in MESA as follows: Assisted Living (WAL), Elderly and Disabled (WED), Independent Living (WIL), Intellectual Disabilities/Developmental Disabilities (WID), Traumatic Brain Injury/Spinal Cord Injury (WTB), or Community Support Program (CSP).

Please refer to Mississippi Division of Medicaid Administrative Code and State Plan references as follows:

Part 206: Mental Health Services

Chapter 1, Rule 1.2.X and Chapter 1, Rule 1.3.D

Part 208: Home and Community Based Long Term Care Services

Assisted Living (WAL) Waiver – Chapter 3, Rule 3.6

Elderly and Disabled (WED) Waiver – Chapter 1, Rule 1.6

Independent Living (WIL) Waiver – Chapter 2, Rule 2.6

Intellectual Disabilities/Developmental Disabilities (WID) Waiver – Chapter 5, Rule 5.5

Traumatic Brain Injury/Spinal Cord Injury (WTB) Waiver – Chapter 4, Rule 4.5

MS Medicaid State Plan

Community Support Program (CSP) Attachment 3.1-A, Exhibit 19b, Page 1 Supplement 1C to Attachment 3.1-A, Pages 1-4

If you have any further questions, please contact Tamatha Creel at 601-359-2056.

 

 

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12/20/2022

Attention inpatient hospital providers

Gainwell Technologies identified a claim-processing issue related to inpatient hospital claims: Hospital Acquired Condition/Present on Admission (POA) and the External Cause of Injury Diagnosis. For institutional claims, the system required a POA value on the External Cause of Injury when it was submitted in the External Cause of Injury (ECI) field.  An update to the system was made on December 18, 2022, to no longer require a POA on the diagnosis entered in the External Cause of Injury field. Claims received on or after December 19, 2022, will no longer deny for Explanation of Benefits (EOB) 1531 – INDICATOR FOR PRESENT ON ADMISSION (POA) IS NOT A VALID VALUE for diagnosis codes entered in the External Cause of Injury field. Providers may resubmit impacted claims to Gainwell Technologies at this time.

 

 

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12/19/2022

Claim denials related to TPL amount is less than % specified

The Mississippi Division of Medicaid (DOM) advises providers to resubmit previously denied claims with TPL attachments—when the claim was denied for Edit 798 – TPL Amount Less than % Specified. Effective December 15, 2022, any claim with a TPL payment greater than zero and  a TPL attachment will process without denying for this edit. Claims submitted with TPL attachments will still receive Edit 798; however, the claims will process.

 

 

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12/16/2022

2023 Home Health Agency rates to be corrected

The Mississippi Division of Medicaid (DOM) must rescind the 2023 Home Health Agency (HHA) rates issued with an effective date of October 1, 2022. The State Plan currently in effect does not allow for this rate increase. DOM will correct the rate in our system and adjust any claims with dates of service after September 30, 2022.  The managed care organizations will also be notified of the rate correction.

DOM will request a State Plan Amendment (SPA) to allow a rate update effective February 1, 2023.

If you have any questions or comments, please contact Requests For Information at RFI@Medicaid.ms.gov.

 

 

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12/12/2022

Attention All Providers: General Claims Submission Information

The process for reconsideration of claims has changed with the transfer of Fiscal Agent operations from Conduent to Gainwell Technologies effective October 3, 2022. This was shared through a Late Breaking News post in October and posted on the Division’s website.

Denied claims should be submitted as new day claims with appropriate supporting documents via the Provider Web Portal at https://medicaid.ms.gov/mesa-portal-for-providers/, or paper submission to P.O. Box 23076, Jackson, MS 39225.

Electronically submitted claims with attachments must include the new Claim Attachment Form which can be found at https://medicaid.ms.gov/wp-content/uploads/2022/12/Claim-Attachment-Form.pdf. Examples of appropriate supporting documentation may include, but is not limited to consent forms, third-party insurance EOBs, operative reports, physician notes, prior authorization information, MSRPs, invoices, and certificates of medical necessity (CMNs).

Providers receive a Remittance Advice (RA) which provides Detail EOBs (explanation of benefits) for each line on a claim. The corresponding EOB Code and Description are located at the end of the RA and provide guidance to address denied services. A comprehensive list of EOBs may be located at https://medicaid.ms.gov/wp-content/uploads/2022/11/Mississippi-Medicaid-Explanation-of-Benefits_112822.pdf.

The Fiscal Agent is unable to void or adjust medical claims on behalf of the provider. This process must be completed by the provider. Effective November 21, 2022, providers can now void and adjust legacy claims on the MESA Provider Web Portal. The issue affecting providers when attempting to void or adjust legacy claims has now been resolved. Providers should no longer receive an error message.

Claims submitted for services that require a prior authorization (PA) must include the authorization number on the claim. Retroactive authorization of fee-for-service (FFS) medical services will only be granted in cases of retroactive eligibility. Claims lacking a PA number will be denied. Contact the appropriate Utilization Management/Quality Improvement Organization (UM/QIO) to obtain a PA. Providers should contact Magnolia Health, Molina Healthcare or United Healthcare Community Plan for specific prior authorization and documentation requirements for members enrolled in Mississippi Coordinated Access Network (MSCAN).

Timely Filing rules may be found on the Division of Medicaid website at https://medicaid.ms.gov/providers/administrative-code/  (Administrative code Part 200; Chapter 1; Rules 1.6, 1.7 and 1.8). Providers may submit an Administrative Review of a claim when:

• • • • A beneficiary’s retroactive eligibility prevents the provider from filing the claim timely and the provider submits the claim within ninety (90) days of the system’s add date of the beneficiary’s eligibility determination
      • The Division of Medicaid adjusts claims after timely filing and timely processing deadlines have expired, or
      • The provider has submitted a Medicare crossover claim within one-hundred and eighty (180) days of the Medicare paid date and the provider is dissatisfied with the disposition of the claim.
      • The request should include a new day claim, supporting documentation, and a cover letter containing specific details of why the claim denied and actions taken to file timely.

Requests for Administrative Reviews must be submitted to the Office of Appeals at the Division of Medicaid and must include:

• • • • Documentation of timely filing or documentation that the provider was unable to file the claim timely due to the beneficiary’s retroactive eligibility,
      • Documentation supporting the reason for the Administrative Review, and
      • Other documentation as required or requested by the Division of Medicaid.

Submit Administrative Reviews to:

Division of Medicaid
Attention: Office of Appeals
550 High Street, Suite 1000
Phone: 601-359-6050
Fax: 601-359-9153

If you need assistance, please contact the Provider and Beneficiary Services Call Center at 1-800-884-3222 or your designated field representative: https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf

 

 

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12/8/2022

Attention: Dental Providers

The Division of Medicaid (DOM) requires dental claims be submitted on the 2012 American Dental Association (ADA) claim form. As a reminder, claims must be submitted with appropriate Current Dental Terminology procedure codes (CDT). DOM accepts both electronic and paper dental claims. Dental providers are strongly encouraged to bill electronic claims.

 

 

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12/8/2022

Attention Ambulance Providers: Denial related to Mileage and Base Rate

DOM’s new fiscal agent, Gainwell Technologies, completed work on a recent system update to address issues related to claims denying with error code 6402-Mileage charge must have emergency base rate paid. As part of this system update, Providers will need to resubmit denied claims.

Effective for dates of service on and after January 1, 2023, procedure codes A0380 and A0390 will no longer be covered for fee-for-service (FFS) Medicaid. Providers should use existing procedure code A0425 beginning with the twenty-sixth (26th) patient loaded mile of ground ambulance transportation.

 

 

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12/7/2022

Attention COBA Crossover Providers

The Mississippi Division of Medicaid will reprocess COBA-submitted crossover claims that denied in error for Medicare EOMB is Missing or Does not Match the Services on the Claim. The resubmitted COBA claims will appear on the December 9, 2022, Remittance Advice. No further action is required from the provider.

 

 

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12/1/2022

Hospice Prior Authorization Information

Effective December 1, 2022, Hospice Prior Authorization information will not be available to view in the Medicaid Enterprise System Assistance (MESA) System. All Hospice Prior Authorization information will be viewed on the Alliant Health Solutions web portal. Providers that do not access the Alliant web portal may contact the Alliant Utilization Management team at MSAlliant@allianthealth.org or 1-888-224-3067 for Hospice Prior Authorization assistance.

 

 

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12/1/2022

Claims Impacted by Explanation of Benefit (EOB) code 0503

Gainwell Technologies identified a claim processing error related to Hospice claims billed with revenue code, ‘659 – Hospice Service-Other Hospice Service’, and members enrolled in Medicare Part C Hospice claims processed between October 3, 2022, and November 22, 2022, erroneously denied for Explanation of Benefit (EOB) code, ‘0503 – Member is Enrolled in Medicare Part C on the Date(s) of Service’. MESA has been updated and impacted claims may be resubmitted to Gainwell Technologies at this time.

 

 

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12/1/2022

Claim Denials Related to Diagnosis Codes

The Division of Medicaid (DOM) advises Dental Providers to resubmit previously denied dental claims when the claim denied for edit 257-Primary Diagnosis Code Missing – Detail. DOM will make temporary modifications to edit 257 to allow Dental Providers more time to update their software to include ICD-10 diagnosis codes. Dental claims submitted without a valid dental related ICD-10 diagnosis code will still receive edit 257; however, the claim will pay. Claims submitted for dates of service on and after April 1, 2023, will begin to deny when submitted without a valid dental-related ICD-10 diagnosis code.

 

 

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11/28/2022

Update: Processing Medicare Crossover Claims

On 11/8/2022, Gainwell published a Late Breaking News article related to improvement processes for Medicare Crossover operations. Please review the following new updates.

• • • 1. The functionality of the Web Portal regarding submission of Medicare Part A, B and C Crossover claims (including Dental Part C) was enhanced. The enhanced functionality is available on the Web Portal November 28, 2022. Gainwell Technologies will provide training on Web Portal Crossover Submission during the November 29 and December 1 Webinars. In addition, the Job Aids (training materials) for Inpatient and Professional services associated with Web Portal Crossover Claim submission (including Dental with Medicare Part C) will be updated and posted by November 29, and the Outpatient Job Aid will be posted by December 1, under MESA Tips on the provider portal resource page: https://medicaid.ms.gov/mesa-portal-for-providers/.

 

Please go to https://medicaid.ms.gov/mesa-provider-workshop-webinars/ for upcoming webinar details.

 

• • • 2. Gainwell Technologies began processing Medicare COBA files in the new MESA system on November 10, 2022, that included a backlog of files from Medicare based on the last file that was processed by the former Division of Medicaid’s Fiscal Agent, Conduent. These are claims that cross directly from Medicare to Medicaid. The claims began appearing on the November 13, 2022, Remittance Advice (RA)/835.

 

Contact the Provider/Beneficiary Services call center at 1-800-884-3222 if you have questions regarding crossover claims that have processed. Please have your Claim ID available for the call center representative to assist with research.

 

• • • 3. Gainwell Technologies is implementing a process that will allow providers to submit a paper EOMB attachment with claims which have been submitted via an EDI 837 transaction. This will improve the claims submission experience for providers related to Medicare Crossover Claims utilizing EDI 837 transactions.

 

Providers are required to submit the Explanation of Medicare Benefits (EOMB) with all Medicare Crossover claims. For Medicare Crossover claims submitted via the EDI X12 (electronic submission), the provider must create a unique Attachment Control Number (ACN) for each claim. The ACN must be entered in the ‘PWK06’ segment of the transaction. Also, a value of ‘BM’ (for By Mail) must be entered in the ‘PWK02’ segment. A Claim Attachment Form must accompany each EOMB and must identify the Provider NPI, Attachment Control Number (ACN) as it was entered in the PWK segment, Claim ID/ICN and Member ID Number.  The Claim Attachment Form is located at: https://medicaid.ms.gov/resources/forms/

The updated 837 Companion Guides are located at: https://medicaid.ms.gov/edi-technical-documents/

Once GWT receives the 837 electronic claim transaction with the PWK segments completed as instructed, the claim will suspend for 21 days awaiting the attachment. Suspended claims will appear on the Remittance Advice with an EOB 1084 – CLAIM SUSPENDED BECAUSE AN ATTACHMENT WAS INDICATED, BUT NOT RECEIVED. CLAIM WILL SUSPEND FOR UP TO 21 DAYS, UNTIL ATTACHMENT IS RECEIVED, OR AFTER 21 DAYS YOUR CLAIM WILL DENY. This EOB message will not show on the 835 Health Care Payment/Advice Transaction. If the Claim Attachment Form and EOB are not received within 21 days from the claim ID Julian date, the claim will deny with EOB 0989 – CLAIM DENIED.  ATTACHMENT WAS NOT RECEIVED WITHIN 21 DAYS OF A CLAIM RECEIPT.

Mail the Claim Attachment Cover Sheet along with the supporting documentation to:

Gainwell Technologies
PO Box 23076
Jackson, MS 39225

 

 

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11/22/2022

Voiding/Adjusting Claims

Effective November 21, 2022, Providers can now void and adjust legacy claims on the MESA Provider Web Portal. There was an issue affecting providers when attempting to void or adjust legacy claims. This issue has now been resolved. Providers should no longer receive an error message.

 

 

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11/21/2022

Prior Authorization Related Issues in MESA

Prior Authorization numbers issued by Alliant or Kepro are case sensitive – The new MESA claims-processing system requires prior authorization (PA) numbers containing an uppercase letter “A” when issued by Alliant or an uppercase letter “K” when issued by Kepro.  Providers who submitted a claim with a PA number containing a lowercase “a” or “k” must resubmit denied claims.

PA updates by Alliant – The Mississippi Division of Medicaid (DOM) is aware of an issue related to updated PA information being transmitted to the new MESA system.  This appears to be occurring when a PA is changed or updated by Alliant and the update must be transmitted to MESA.

 

 

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11/8/2022

Medicare Crossover Claims

 After very productive conversations with providers, the Mississippi Division of Medicaid is working diligently with our Fiscal Agent, Gainwell Technologies, to address the following three issues related to Crossover Claims:

• • • 1. The functionality of the Web Portal regarding submission of Medicare Crossover claims in being enhanced. In an effort to reduce provider burden when submitting Medicare Crossover Claims, the Web Portal is being modified to reduce the amount of information required at the detail level for professional crossover and institutional outpatient crossover claims. The Gainwell Technologies team anticipates this being available in Web Portal by week of November 28, 2022.
      2. As you may be aware, Gainwell Technologies has not processed any Medicare COBA files in the new MESA system. These are claims that cross directly from Medicare to Medicaid. While the request for COBA files to be sent to Gainwell from the Medicare contractor was made prior to go-live, Gainwell has not received any of these files in production. Gainwell Technologies received the first ‘COBA test files’ on October 31, 2022 and is diligently working to ensure they are processing as expected. Once the testing is complete, COBA files will begin to process in the MESA production environment. It is anticipated that Gainwell Technologies will receive a backlog of files from Medicare based on the last file that was processed by the former Division of Medicaid’s Fiscal Agent, Conduent. Gainwell Technologies anticipates processing the first of the COBA files the week of November 14, 2022. Please monitor forthcoming communication regarding the status of processing COBA files and when providers can anticipate seeing them on the Remittance Advice (RA)/835.
      3. Gainwell Technologies is working to develop a process that will allow providers to submit a paper EOMB attachment with claims which have been submitted via an EDI 837 transaction. This will improve the claims submission experience for providers related to Medicare Crossover Claims utilizing EDI 837 transactions. Testing is currently in progress and it is anticipated this process will be communicated to providers by November 30, 2022.

We want to thank our provider community for working closely with us as we seek to improve our operations.

 

 

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10/31/2022

 Community/Private Mental Health Centers, LPC/LMFT and BCBA Provider Update

 Temporary Fix for Medicare Crossover Claim Errors in MESA

The disposition for Medicare-related claim errors 2502, 2503, and 2505 have been updated for providers in the 261QM0801X Clinic/Center – Mental Health (Including Community Mental Health Center), 101Y00000X Licensed Professional Counselor (includes Marriage and Family Therapist providers) and 103K00000X Board Certified Behavior Analyst (BCBA) taxonomies who were previously receiving denials.  While the errors may still post on claims for those providers, they should not result in claim denials.  DOM will continue to work with Gainwell to make updates to the Medicare crossover logic for mental health services in the coming weeks and will provide additional provider education to ensure that crossover claims are submitted and adjudicated appropriately.

 

 

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10/24/2022

Denial Code related to PA/Procedure Conflict

The Mississippi Division of Medicaid’s (DOM) new fiscal agent, Gainwell Technologies, completed work on a recent system update to address issues related to claims denying with error code 3106-PA/Procedure Conflict.  Providers that have had claims deny for this reason since October 1, 2022 and know that prior authorization had been obtained will need to resubmit claims that denied for error code 3106-PA/Procedure Conflict.

 

 

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10/24/2022

Taxonomy Related Claim Denials

As part of the Mississippi Division of Medicaid’s (DOM) transition to a new system, Medicaid Enterprise System Assistance (MESA), important changes were implemented that involve Medicaid Provider IDs.  All actively enrolled Medicaid Providers received letters in June 2022 that detailed the changes made to their Provider IDs.

The letter included the taxonomy code that was assigned which was derived from your current provider type and specialty information.  A taxonomy code was issued for each specialty. MESA requires that each service location and taxonomy combination have its own unique provider ID to correctly process claims. Providers must submit claims with the appropriate taxonomy code to avoid taxonomy related claim denial error codes.

If you or your clearinghouse submitted claims to MESA via Electronic Data Interchange (EDI) that were not reflected on your remittance advice (RA) or in your portal claims search, the issues you are experiencing may be caused by the incorrect taxonomy being submitted on the claim.  Since your claim did not have a taxonomy that matched your provider ID on file, the system could not accurately associate the claim with your account.  In these instances, please verify the taxonomy on your provider record as it may have been updated in conversion from the Conduent system to the MESA system.  If you determine that the claims were submitted with the incorrect taxonomy originally, please resubmit them with the correct information.

There are also multiple ways to find the assigned taxonomy code. It can be found on the top of the web portal screen after signing in. Additionally, resources are available on DOM’s website to help lookup the new MESA Provider ID.  Access the lookup tool using this link dom-azure-app.medicaid.ms.gov, or by following the instructions in the images below. The MMIS Replacement Project webpage contains the Provider ID Search Tool.

 

 

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10/21/2022

Claim Reconsideration Form Updates

Effective October 3, 2022, the Claim Reconsideration Form will no longer be available for providers to submit to the new fiscal agent, Gainwell Technologies.  Providers are encouraged to submit electronic claims to reduce the potential for error.  Resources are available to providers to assist with learning more about how to use the new Medicaid Enterprise System Assistance (MESA) portal (Resource Information – MESA Portal for Providers).  Providers who submit electronic claims should adjust claims electronically, which allows for attachments for medical review.  Additionally, providers who submit paper claims should refer to their return to provider (RTP) letter and follow instructions in the letter.

Appeal claim reconsideration options are reserved for instances when a claim is denied based on medical necessity.  Should an appeal be necessary, please follow the requirements in the Administrative Code, Title 23, Part 300: Appeals.

 

 

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10/19/2022

Waiving copay on COVID-19 claims

COVID-19 related claims that should bypass the copayment requirement must include the CS modifier, as the “V” suffix will not be recognized in the new MESA system.

 

Directions for waiving $3 copay on COVID-19-related prescriptions

Effective 10/1/2022 and through the end of the Public Health Emergency, the directions for waiving the $3 copay on COVID-19-related prescriptions when:

• • • • The prescriber has indicated a diagnosis of COVID-19 on the prescription,
      • The prescriber notates the beneficiary may have COVID-19 illness on the prescription, or
      • The beneficiary states that they may have COVID-19 or are being treated for COVID-19

The V suffix on the member ID will no longer be accepted.

In Field # 461-EU (Prior Authorization Type Code) enter a value of “4” (exempt from copay and/or coinsurance)

In Field # 462-EV (Prior Authorization Number) enter a value of “19”

 

 

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10/19/2022

Dental Claims Require Valid Diagnosis Codes

Effective October 3, 2022, the Division of Medicaid (DOM) transitioned to a new fiscal agent, Gainwell Technologies. The new provider-enrollment and claims-processing solution is called MESA: Medicaid Enterprise System Assistance.  Dental claims submitted on or after October 3, 2022, to the new MESA system, require both the Current Dental Terminology (CDT) code and valid International Classification of Diseases-10^th Edition (ICD-10) diagnosis codes.  Failure to use valid ICD-10 diagnosis codes will result in denied claims.  Dental related ICD-10 diagnosis codes are in the range of K000-K1379.

 

 

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10/5/2022

MESA does not accept copay exception codes

Effective October 3, 2022, the Division of Medicaid (DOM) transitioned to a new fiscal agent, Gainwell Technologies. The new provider-enrollment and claims-processing solution is called MESA: Medicaid Enterprise System Assistance.  DOM claims processing policy removed the need for the submittal of the copay exception codes to bypass copayment.  Providers who used a copay exception code in the beneficiary identification number field of their claim received and will continue to receive claim denial edit 2001-MEMBER ID NUMBER NOT ON FILE.  Providers should submit new claims without the copay exception code.

 

 

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10/5/2022

Prior Authorization update for Physician Administered Drugs

Effective October 1, 2022, the Division of Medicaid (DOM) will require prior authorization (PA) of 4 additional physician administered drugs (PADs).  The chart below reflects the PADs that will require PA.  Alliant Health Solutions is responsible for authorization requests for fee-for-service (FFS) Medicaid beneficiaries.  Please call Alliant directly at 1-888-224-3067 for assistance with the PA process for these 4 PADs.

 

Q2053 brexucabtagene autoleucel (Tecartus)

Indication	Infusion Bag NDC	Metal Cassette NDC
MCL	71287-0219-01	71287-0219-02
ALL	71287-0220-01	71287-0220-02

 

Q2054   lisocabtagene maraleucel (Breyanzi)

Product	NDC
Vial	73153-0900-01
CD8 Component	73153-0901-08
CD4 Component	73153-0902-04

 

Q2055   Idecabtagene vivleucel (Abecma)

Product	NDC
50 ml infusion bag and metal cassette	59572-0515-01
250 ml infusion bag and metal cassette	59572-0515-02
500 ml infusion bag and metal cassette	59572-0515-03

 

Q2056   ciltacabtagene autoleucel (Carvykti)

Product	NDC
70 ml infusion bag and metal cassette	57894-0111-01
30 ml infusion bag and metal cassette	57894-0111-02