May 8, 2009
PENDING TERMINATION OF THE IPAG-WELLNESS CONTRACT
Please click
here to read important information regarding notice of termination from WellCare of Georgia
for our participation in the Georgia Healthy Families managed care Medicaid program.
October 30, 2008
GEORGIA MEDICAID ID NUMBERS
Providers have questions about the State’s Medicaid ID Number Policy. This is a Department of Community Health Policy that has always been in effect; however, due to system limitations they were unable to enforce it.
Please be advised that this can be corrected at any time by DCH and providers can all of a sudden begin to see claims denied for lack of a Medicaid number. If a physician has multiple office locations, they will need to obtain a Medicaid ID number for each office location.
Also, if a physician treats patients while they are in the hospital, they will need to obtain a Medicaid ID number for each hospital address where they render services. Most offices do not currently follow this policy, however; all offices should obtain a number for each location where services are rendered so reimbursement will be not be interrupted or recouped.
Medicaid is currently administered by ACS; however, effective July 1, 2010, the new administer will be EDS. This does not mean that you have until July 2010 to obtain a Medicaid number for your additional location(s). This policy is, has been, and continues to be in effect and numbers should be obtained now.
For questions, or if you need to obtain a Medicaid ID number, you may enroll directly online on the
Georgia Health Partnership (GHP) web portal.
Providers may also call the ACS CIC at (404) 298-1228 or (800) 766-4456 for assistance.
July 15, 2008
IMPORTANT PROVIDER NOTICE - HOUSE BILL 1234
Dear Peach State Providers:
As you may be aware, a bill was passed during the last session of the Georgia General Assembly that will have a direct impact on the
operating procedures of Peach State Health Plan (Peach State) and the other Care Management Organizations (CMOs) serving Georgia's Medicaid
and Peach Care for Kids members. The new law, which is known as House Bill 1234, was signed by the Governor on May 13, 2008 and is scheduled
to become effective July 1, 2008.
In order to comply with the new requirements, Peach State completed an operational review of our policies and procedures and where appropriate,
we are reconfiguring our systems and revising policies and procedures to fulfill the requirements of the law. Certain aspects of the bill will be
compliant by July 1st with the remaining areas fully compliant no later than August 1, 2008.
The
attached guide contains information regarding the revised policies and procedures that are being implemented to comply with the law and the
new procedures you will need to follow as a result of the policy changes. We are also updating our Provider Manuals and other educational resource
tools and will make these documents available on our website at
www.pshp.com. In the interim, the attached guide
services as a reference tool to assist you in understanding the procedures you must follow to comply with the revised policies.
Thank you in advance for your patience while we implement these changes. We value your participation in our network and will work diligently to
ensure a smooth implementation of the new procedures. Should you have questions in the interim or need clarification regarding the policy changes,
please contact our Provider Solutions Department at 866-874-0633. We will be happy to assist you in anyway that we can to ensure a seamless transition. p>
Sincerely,
Peach State Health Plan
April 1, 2008
CHANGES TO IPAG / PEACH STATE CONTRACT
CENTRAL REGION GEORGIA
The IPA of Georgia is pleased to announce that it has entered into a new agreement with Peach State Health Plan in Georgia's Central Region.
Under the old agreement, participating primary care physicians received a capitation payment on a per member per month basis.
Under the new agreement, primary care physicians will now be paid fee-for-service for all claims submitted based on the Georgia Medicaid fee
schedule. In addition, PCPs will also receive a case management fee.
The effective date of this change is April 1, 2008. The last capitation payment for March eligibility will be mailed this month (April).
Please begin billing Peach State Health Plan directly for all services rendered to Peach State members beginning April 1st.
For more information, contact Benita Bowers, IPAG Representative at (770) 778-6832.
Thank you.
March 14, 2008
The IPA of Georgia received the following notice from Peach State Health Plan. While this particular notice only applies to Peach State,
providers should be aware that these same requirements will be coming from all health plans, as well as Medicare and Medicaid, in the coming months.
Please take the appropriate actions to get your office your applicable NPI numbers. If you have questions regarding NPI or how to obtain them,
contact Benita Bowers, IPAG Representative, at
benitabowers@aol.com.
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IPA/PHO Provider Update
Dear Peach State Health Plan Provider:
Attached is an important notice regarding a requirement change. Effective April 15, 2008, all electronic and paper claims must be submitted
with a NPI and 9-digit Zip Code of the service location of the billing provider, taxonomy code and tax identification number as outlined in the
attached document. Peach State will require that all providers submit an NPI for billing, performing, attending, ordering and referring
providers and facilities when filing claims. Atypical providers only may continue to report their Medicaid ID in field 24ja of the CMS 1500 form.
Please feel free to contact Provider Services at 1-866-874-0633 or visit our website at www.pshpgeorgia.com for additional information.
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March 13, 2008
Re-Filing Procedures for Recoupments by Medicaid CMOs
The IPA of Georgia has learned through the Georgia Chapter of the American Academy of Pediatrics that physicians are experiencing recoupments
from Medicaid CMOs for services provided – in some cases over 6 months ago. We felt this was important enough to share with
all physicians;
not just pediatricians. DCH is reminding physicians that such recoupments occur when the CMO that paid the claim was not the responsible payer,
even though that CMO did appear on either the GHP web portal or the CMO portal as the responsible party on the date the service was initially
rendered. We have also learned that DCH is working diligently to minimize this problem for the future.
When you experience such recoupments, DCH recommends that you take the following steps:
- At the time of the recoupment, check the GHP web portal and see which CMO (or FFS Medicaid) is listed as the responsible payer for the original date of service.
- Re-file the claim with the appropriate entity according to that entity’s re-filing procedures.
- Information on filing and appealing claims can be found at:
Peach State: https://www.pshpgeorgia.com/pdf/en/Provider_Manual.pdf (see pages 77 & 91)
WellCare: http://georgia.wellcare.com/Providers/ProviderManual.aspx (see sections 6 & 10)
AmeriGroup:https://www1.amerigroupcorp.com/providers/_documents/ga/ga_provider_manual.pdf (see pages 7, 51 & 104)
- If the claim is denied for a timely filing, or if the CMO or FFS Medicaid denies the claim because they state they were not the
responsible payer on that date of service, please follow that entity’s appropriate appeal policy.
- After appropriate appeals, if the CMO still upholds a past-timely filing denial, forward those cases to Leticia Mayfield,
Manager of Provider Services, DCH, at helpdesk4gf@dch.ga.gov for processing.
- Please let Benita Bowers, IPAG Representative, know if you are having any problems getting these claims paid in spite of the above steps
at benitabowers@aol.com.
- At the present time, DCH recommends that providers check the GHP web portal and the CMO website to verify that the person is covered by
that entity before filing a claim. DCH is aware that this is costly for provider staff and is working on solutions so that providers can verify
CMO eligibility with a single web visit.
Thank you all for your prompt attention to this matter.