Conduent



New Mexico Medicaid E-NewsNew Mexico Medicaid E-NewsNovember 29, 2022Featured Updates and Notifications:Pharmacist Enrollment Mandate and Guidance – NewPaper Claims Billing Reminders - NewImportant Notice Regarding Taxonomy FY2023 DRG Version 40 Grouper DelayTADs (Turn Around Documents) Re-verification to continue participation with New Mexico MedicaidClaims Timely Filing ReminderMonthly IHS Open ForumNew Mexico Medicaid Provider Resource ListPharmacist Enrollment Mandate and GuidancePrescribing pharmacists are reminded of an upcoming deadline for a federal requirement requiring New Mexico Medicaid to deny pharmacy claims for drugs or other items when the prescribing provider is not enrolled in NM Medicaid (either with Fee-For-Service Medicaid or with a Managed Care Organization).Both Pharmacist Clinicians and Pharmacists with prescriptive authority who bill Medicaid are required to be enrolled in Medicaid per CMS guidelines. For the time being, claims will be flagged at point of sale and Medicaid will be providing education on the enrollment process. In early 2023, if providers are not enrolled, claims will be denied.November 2022Paper Claims Billing RemindersPaper claims require a valid attachment. Clean paper claims are no longer accepted.Paper claims must be submitted on commercially printed forms from a document supplier. Printed or black and white claim forms are not accepted and will be returned.CMS claims require the service line dates to have a two-digit year – example 10/01/22. Claims with a four-digit year – example 10/01/2022 cannot be processed and will be returned.Reconsideration forms must be submitted with a completed claim form. A reconsideration form submitted by itself will be returned to the provider.The grace period for resubmitting denied claims is 90 days from the remittance date of the denial. Please remember to enter the denied TCN on the new claim for proof of timely filing.November 2022Important Notice Regarding TaxonomyEffective immediately, all MAD 012, 013, 312, and 335 applications will require a primary taxonomy. The primary taxonomy should match the taxonomy registered with the National Plan & Provider Enumeration System (NPPES) note, if the taxonomy is not listed in the dropdown list on the Web application, please select the next closest. Application taxonomies are based on provider type, not specialty.October 2022FY2023 DRG Version 40 Grouper DelayAttention Inpatient DRG Paid Providers:Because of necessary system upgrades, there will be a delay in Conduent implementing the FY2023 MS DRG Version 40 grouper software (effective October 1, 2022 through September 30, 2023) which affects hospital discharges that are paid via the diagnosis related group (DRG) methodology. We expect the v40 grouper to be implemented by the end of the calendar year.Please continue to submit your claims as appropriate and any impacted claims will be automatically reprocessed once the charges are implemented. In the meantime, your claims will continue to process under the current MS DRG version 39. Please look for future updates.October 2022TADs (Turn Around Documents): Re-verification to continue participation with New Mexico MedicaidThe purpose of the Turn Around Document (TAD) is to verify that the provider information Conduent has on file is up to date. TADs are issued every three years.A total of five TADs are issued to each provider by the following schedule:2 months prior to renewal date (first notice)1 month prior to renewal date (second notice)Renewal month (third notice)1 month after renewal date (fourth notice)2 months after renewal date (fifth notice)If a provider fails to submit a completed TAD after the fifth notice, they will be terminated in the NM Medicaid system for failure to re-verify.September 2022Claims Timely Filing ReminderThe standard timely filing period for claims is 90 days from the date of service.Exceptions:Schools (Provider type 345) – 120 days from date of serviceIHS and Tribal 638 compact facilities – 2 years from date of serviceAdjustment request – 90 days from the payment dateReconsideration request – 90 days from the denial datePrimary payer – 90 days from the date of primary payment or denial, not to exceed 210 days from the date of serviceRetroactive Client eligibility – 120 days from the date of eligibility updateProvider Enrollment – 90 days from the enrollment notification date, not to exceed 210 days from the date of service for retro-enrollmentSeptember 2022Monthly IHS Open ForumThe monthly IHS Open Forum is available for all IHS and Tribal 638 staff. The forum is on the second Wednesday of every month from 2:00 to 3:00 pm Mountain time. Microsoft TEAMS meeting - Click here to join the meeting Join by phone (audio) – 1-585-420-6781, conference ID 402 213 551#New Mexico Medicaid Provider Resource ListNew Mexico Medicaid Portal - Claim Inquiries, Eligibility verification, Electronic claim submission, Provider manuals, E-NewsMedical Assistance Division Program Rules - NMAC for programs administered by the Medical Assistance DivisionNM Human Services Department - Supplements, Memos, Provider Billing Packets and PolicyConsolidated Call Center – (800) 299 – 7304Provider Inquiries email: NMProviders@state.nm.usMember Inquiries email: NMMembers@state.nm.usHIPAA Inquiries link: HIPPAA.DeskNM@state.nm.us EDI or Portal Password ResetsDisclosure – The objective of the E-News, training, and webinars is to inform and educate. Articles reflect information at the current time and may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their content. E-News is published monthly and is available on the NM Medicaid Web Portal. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download