Memo Retraction: Removal of Exemption for Pregnant Women – Effective 11/1/2018
The memo entitled, "Removal of Exemption for Pregnant Women to Opt Out of Managed Care in their Third Trimester in Commonwealth Coordinated Care (CCC) Plus and Medallion 4.0 Programs" has been retracted pending further review.
More information regarding updates are forthcoming.
Medicaid Portal Upgrade
On 12/01/18, an update will be made to the Medicaid portal that could negatively impact older browsers and/or older versions of Java.
The minimum version required for IE will need to be 11 and minimum Java version will be 8. If you need help in determining your current version of IE or Java, please click here
Inpatient Co-Payment Reduction
Hospitals should be made aware that, effective with dates of service on or after December 15, 2017, DMAS is reducing the cost sharing amounts for which facilities are liable for inpatient stays from $100 to $75. This change is required pursuant to federal changes in 42 CFR 447.52(b)(2) regarding maximum allowable cost sharing.
DMAS would like to remind providers the importance of checking eligibility each time a member has services rendered. With the new CCC Plus roll out throughout the state, most members will be enrolled in one of six MCO plans. Checking eligibility will assure you bill the correct provider the first time you submit a claim, and your claims are paid promptly.
Please access the recorded session on the DMAS Website for information on verifying eligibility. https://dmastraining.adobeconnect.com/pk9bsgulxr50/?launcher=false&fcsContent=true&pbMode=normal
Attention All Providers of the Elderly or Disabled with Consumer Direction (EDCD) Waiver, and Tech Assisted (Tech) Waiver Services.
Virginia received approval from the Centers for Medicare and Medicaid Services (CMS) to combine the Elderly or Disabled with Consumer Direction (EDCD) Waiver with the Technology Assisted (Tech) Waiver, to be effective 7/1/2017. The new waiver is named the Commonwealth Coordinated Care Plus (CCC Plus) Waiver. Individuals served through the EDCD and Tech Waivers will automatically continue services through the CCC Plus Waiver. All service authorizations for the EDCD and Tech Waivers will continue; providers do not need to take any additional actions at this time. The effective date of the CCC Plus Waiver is July 1, 2017 and should not be confused with the implementation of the Commonwealth Coordinated Care Plus (CCC Plus) managed care program effective August 1, 2017. Please refer to the DMAS Provider Memo, dated 6/6/2017, Launch of Commonwealth Coordinated Care (CCC) Plus Waiver - Effective July 1, 2017 for additional details. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders
For more information contact the DMAS Helpline at 1-800-552-8627 or 804-786-6273.
To all Medicaid Providers: Provider Appeal Request form now available
There is now a form available on the DMAS website to assist providers in filing an appeal with the DMAS Appeals Division. The link to the page is http://www.dmas.virginia.gov/Content_pgs/appeal-home.aspx and the form can be accessed from there by clicking on "Click here to download a Provider Appeal Request Form." The form is in PDF format and has fillable fields. It can either be filled out online and then printed or downloaded and saved to your business computer. It is designed to save you time and money by assisting you in supplying all of the necessary information to identify your area of concern and the basic facts associated with that concern. Once you complete the form, you can simply print it and attach any supporting documentation you wish to, and send to the Appeals Division in the traditional manner.
DMAS would like to remind providers of the benefits available through Virginia's Plan First program services. The availability of family planning services allows individuals to achieve desired birth spacing and family size and contributes to improved health outcomes for infants, children and families. The following link will show you the covered services for the program:
If you have any questions please email PlanFirst@dmas.virginia.gov
Appeals Division Fax Number Change
Be advised that the DMAS Appeals Division fax number has changed. Effective September 1, 2017, the old Appeals Division fax number will no longer function, and faxes sent to the old number will not be received by the Appeals Division. The new fax number is (804) 452-5454. Please verify that the Appeals Division fax number currently programmed into your fax machine or computer and the fax number in any document sent to any client is the new Appeals Division fax number prior to the deadline.
Continuous Glucose Monitoring
Effective December 15, 2016, DMAS will CLARIFY THAT MEDICAID FEE-FOR-SERVICE COVERAGE of Continuous Glucose Monitoring (CGM) INCLUDES reimbursement for the sensor, transmitter, and receiver used with the invasive monitor. This equipment will be supplied by a Medicaid Durable Medical Equipment (DME) provider and billed as a DME item. Codes to be billed for the DME equipment are:
1) A9276 (CGM Sensor, invasive),
2)A9277 (CGM Transmitter; external) and
3) A9278 (CGM Receiver (monitor); external)
The CGM equipment requires service authorization. Providers will fax their requests on the Continuous Glucose Monitoring DME Request Form to the DMAS Medical Support Unit at 804-452-5450. The fax request form is available on the DMAS web portal in the Provider Services section. Refer to the DMAS Provider Memo, dated 11/2/2016, Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring (CGM) for members in Medicaid/FAMIS/FAMIS Fee-for-Service Programs-Effective for dates of service on or after December 15, 2016. This is available from DMAS at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders.
As of October 1, 2016 DMAS has converted to version 33 of the 3M APR-DRG grouper. Recently, DMAS has identified claims, grouped by version 31, which did not group correctly. To correct the issue, DMAS will reprocess all inpatient hospital claims grouped incorrectly with discharge dates of service on or after October 1, 2015 through September 30, 2016 using version 33 of the grouper. This reprocess may result in additional payments or recoupments of overpayments for affected claims. Any reprocessed claims that do not pend will be reflected on the remittance advice dated 11/25/2016.
WebEx Training Sessions
If you would like to view training sessions on various topics related to Medicaid, please go to dmas.webex.com and select Recorded Sessions on the left panel.