October 17, 2006

 

 

 

 

TO:                 All Providers

 

FROM:           Leslie M. Clement, Administrator

 

SUBJECT:     CHANGES TO REIMBURSEMENT FOR MEDICARE PART B PSYCHIATRIC CROSSOVER CLAIMS FOR DUAL-ELIGIBLES

 

Effective for dates of service beginning July 1, 2006, Idaho Medicaid will pay providers of psychiatric services (which are subject to Medicare’s 37.5% reduction amount) the Medicaid allowable amount less any payment by Medicare and any other third-party payers.

 

If you need to adjust previously billed claims, please follow these instructions:

 

When your claim is submitted via PES or other vendor software, previously paid crossovers claims can be voided and replaced electronically. The voided claim and the new claim will appear on the same Remittance Advice.  Refer to your PES manual for instructions.

 

Complete an Adjustment Request Form asking EDS to void the original claim ICN due to non-allowance of psych reduction amounts. Be sure to attach a new claim with the matching Medicare Explanation of Benefits.

 

If you have any questions please contact Sheila Pugatch, Principal Financial Specialist for the Medicaid Office of Reimbursement Policy, at (208) 364-1817.  Thank you for your continued participation in the Idaho Medicaid program.

 

LC/sp