DOH Medicaid Update September 2000 Vol.15, No.9

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This Fall, a series of license verification edits will be activated at Computer Sciences Corporation (CSC), the Medicaid program's Fiscal Intermediary. These edits will deny claims with missing or misreported servicing and referring practitioner license or MMIS numbers, as well as claims from sanctioned Medicaid providers. If your claim is denied, please verify the accuracy of the servicing practitioner number. As an alternative, contact the State Education Department online at http://www.nysed.gov/dpls/opnme.html to obtain or verify license numbers. Please check the monthly list of sanctioned providers (which is mailed to servicing providers) to assure that the servicing or referring practitioner is eligible to participate in the Medicaid program. Individuals on the sanctioned provider list are ineligible to provide or refer patients for Medicaid services.

For more information about these edits, please refer to the August 2000 Medicaid Update.

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Medicare reimburses 100% of the allowance for influenza and pneumococcal vaccinations. Skilled nursing facilities (SNFs) which provide these vaccinations should bill Medicare for Medicare-covered vaccinations. Although the Medicaid daily rate includes drugs and immunizations, if the patient has Medicare Part B, Medicare should be billed for the immunizations.

The New York State Medicaid Program encourages SNFs to provide vaccinations to appropriate patients. If you have any questions regarding the Medicaid dual rate and Medicare Part B billing, please contact Ed Dombroski at (518) 452-6826.

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On average, 70-80% of people who quit smoking initially gain between five and seven pounds. Some of these individuals lack information about methods of dealing with cravings, about the relationship between nicotine withdrawal and sugar craving, and are unaware that people often confuse the craving for a cigarette with hunger. These people may eat as a coping strategy when not hungry and consequently gain weight.

Patients may misunderstand their weight gain and may chose to resume smoking, seeing it as a better option. Below are some coping strategies that can be recommended to patients.

Coping Strategies for Controlling Weight

Don't panic if you gain a few pounds after stopping smoking, this is normal for most people.

• Avoid refined sugar. The body craves sugar during withdrawal from cigarettes.
• Fruits, vegetables and whole grain foods release sugars into the system more gradually, preventing the highs and lows in blood sugar that result from eating high sugar foods.
• Eat small well-balanced meals, dispersed through the day and avoid heavy meals.
• Eat meals slowly.
• Have enjoyable low calorie snacks available.
• Get up from the table after a meal.
• Drink water, about six extra glasses a day-this has multiple benefits.
• Be aware of the fat and calorie content of the foods you choose; be conscious of your food intake.
• Be more active, which can include simple changes, such as using stairs, parking further from your destination and walking for a few minutes after a meal. This also has benefits beyond weight control:
  • It is a good distraction;
  • It cleanses the body of nicotine and promotes better sleep;
  • You will notice benefits that come from quitting sooner;
  • It can be part of an overall lifestyle change that will help you stay smoke free.
  • Don't panic if you gain a few pounds after stopping smoking, this is normal for most people.

Adapted from NYS Smokers Quitline Manual, 2000 Roswell Park Cancer Institute, Buffalo, NY.

For further information on smoking cessation, contact or refer your patients to the NYS Smokers Quitline at
1-866-NYQUITS (1-866-697-8487).

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Many providers of Medicaid services continue to bill on tape, diskette, or paper. As a reminder, Computer Science Corporation (CSC) accepts the electronic submission of Form A, Form B, Form C, Pharmacy, HCFA Version 4, and HCFA Version 5 claims, and encounter data, through the New York State Medicaid Management Information System Electronic Gateway (NYS-MMIS-EG), and supporting Electronic Claim Submission System (ECSS).

If you have a computer and a modem, you can submit claims and encounter data electronically to CSC. Most operating systems including Windows 95, 98, and NT come packaged with the communications software (Hyperterminal) needed to transmit your file to CSC. The Windows 3.1 operating system also comes packaged with the terminal communications software.

If you currently submit on tape or diskette media, you already have a Transmission Supplier Number (TSN), which is required for electronic submission. The only other requirement is that you complete and have notarized a Certification Statement for Providers Utilizing Electronic Billing, and mail it to CSC prior to electronic claim submission. Your user ID and initial password, needed to access CSC's electronic gateway, can be assigned to you over the phone. It can be that easy, and the following benefits are well worth making the switch:

• Eliminated or reduced manual handling of claim or encounter media, and related documents - electronic claim submission greatly reduces claim preparation time for entry into a processing cycle.
• Accelerated return of submission information - information regarding the general acceptance of claims submitted through the ECSS is available for retrieval (downloading) by the submitter within a short time frame (generally within two hours of file transmission).
• Invoice level rejection for claims submitted electronically - individual claims within an electronic submission may be rejected, without causing the entire submission to reject.
• Elimination of expensive mailing costs.

If you currently bill on paper and have a computer, you can benefit from electronic claiming. Simply contact CSC's Electronic Media Claims (EMC) Control unit, at the number listed below, to obtain a TSN Application and Certification Form. A TSN is generally assigned within days of the receipt of your completed paperwork.

If you have questions regarding electronic claim submission, please call the EMC Control unit at (518) 447-9256. At the same time, you may request an ECSS User Manual. This manual was developed to facilitate the electronic submission of claims to CSC. It contains the necessary information for electronic claiming, including the required hardware and software configurations. The ECSS User Manual is also available for downloading from the NYS-MMIS-EG.

Providers making inquiries or requesting billing training by regional representatives should contact CSC by calling the appropriate number below. Please be prepared to supply your Medicaid provider ID number.

Practitioner Services     (800) 522-5518   (518) 447-9860
Institutional Services     (800) 522-1892   (518) 447-9810
Professional Services     (800) 522-5535   (518) 447-9830

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The State Department of Health welcomes your comments or suggestions regarding the Medicaid Update.

Please send suggestions to the editor, Timothy Perry-Coon:

NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
(e-mail MedicaidUpdate@health.state.ny.us )

The Medicaid Update, along with past issues of the Medicaid Update, can be accessed online at the New York State Department of Health web site: http://www.health.state.ny.us/health_care/medicaid/program/main.htm