DMAS Incorrectly Rejects Claims

VHCA (4/4/08)

In preparation for a new mandate form the Centers for Medicare and Medicaid Services (CMS), the Department of Medical Assistance Services (DMAS) changed the edits for Medicare Crossovers to validate the revenue codes and CPT/HCPCS codes on all crossover claims received beginning March 25, 2008. 

The edits were within the range of 0990 thru 0996. DMAS has alerted VHCA that they failed to account for the fact that Medicare passes revenue code 0022 to DMAS, with the RUGS scores in the HCPCS procedure code locator, therefore nursing facility claims were incorrectly denied for these edits (majority were for edit 0990 or 0994).

These denied claims will appear on the April 4, 2008 remittance advices.  Once the error was discovered on March 31st, DMAS turned off these edits and will be preprocessing the Crossover claims that were denied.  The reprocessed claims will be reflected on the April 11, 2008 remits advice.   Please share this information with individuals within your facility or corporate office with Medicaid billing responsibilities.  Providers with questions should contact the DMAS provider helpline at 800.552.8627 or 804.786.6273 (Richmond area).