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October 17, 2006
 
 
MEDICAID INFORMATION RELEASE MA06-33
 
 
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:
 
For Electronic Crossovers Claims:
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.
 
For Paper Crossover Claims:
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.
 
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