Medicaid Patient Pay Update

VHCA (6/26/09)

The Department of Medical Assistance Services (DMAS) recently notified VHCA that they will be modifying an existing report (AS-O-317) to include patient pay information for all Medicaid residents receiving care in nursing facilities.  The report modifications will be completed no later than July 31st.  Once complete, the report will list all residents along with the applicable patient pay for the month then ended as well as the projected patient pay for the following month.  For example, the July 31st report will contain patient pay information for both July and August.

Additional information about the new report will be forwarded to members once available.  We would like to acknowledge the efforts of Cindy Olson, Cindi Jones and others at DMAS for their efforts in addressing provider concerns related to the Medicaid patient pay issue.  A large group of provider representatives have been working with VHCA and DMAS for several months to address the lack of timely and accurate Medicaid patient pay information.

While the AS-O-317 report modification represents a very practical solution for providing Medicaid patient pay information to facilities, another option being pursued by a number of providers is the automatic exchange of information between the DMAS fiscal agent, First Health Services (FH) and facilities.  DMAS and FH have provided some information that may be helpful to providers pursuing the electronic data interchange (EDI) option.

The 270/271 Companion Guides outlining the EDI provisions can be found here.  The use of this guide is solely for the purpose of clarification and is a companion guide to the HIPAA ANSI X12N implementation guides. The information describes specific requirements to be used for processing data. This companion guide supplements, but does not contradict any requirements in the X12N implementation guide.  Additional information on the Final Rule for Standards for Electronic Transactions can be found here.  The HIPAA Implementation Guides may be obtained here.

As stated in the Companion Guide, ‘The Health Insurance Portability and Accountability Act (HIPAA) requires that Medicaid, and all other health insurance payers in the United States, comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The ANSI X12N implementation guides have been established as the standards of compliance for claim transactions.’ These are national mandated standards. FH has created a set of test files (under Payment & Financial for Nursing Facilities) for the 270 and 271. Patient information has been de-identified and in the word version comments have been added as well. For the text version, it is recommended that users open them in WordPad or Word so that the files remain parsed.

Instructions for becoming a trading partner with Virginia Medicaid can be found here. If there is an interest, FH can provide facilities with contact information on the eligibility vendors that currently do business with First Health.  For technical support related to EDI, please contact Diane Goldberg, EDI Manager with First Health Services by email or by telephone at 804.965.7477.