Western Highlands Network

Friday E-Mail Newsletter

Number 95
4/27/2007

The Friday E-Mail is a weekly update for providers by the Services Management Department of Western Highlands Network. Please distribute to all your staff.

Update on New Vistas/Mountain Laurel Medical Records

Western Highlands Network will be retrieving New Vistas/Mountain Laurel records for consumers and providers beginning May 1, 2007. A procedure will be sent out next week. For questions regarding emergency situations, you may call Sandy Walker at 828 225-2800 ext. 2962.

Update on NPI

In response to the Centers for Medicare and Medicaid Services implementing an NPI contingency plan, the Division of Medical Assistance (DMA) will not require the NPI on claims effective May 18, 2007. The DMA will continue to adjudicate claims using the Medicaid Provider Number until further notice. (Reference Links: http://www.cms.hhs.gov/ and http://www.dhhs.state.nc.us/dma/NPI/NPIScript.pdf)

How does this impact claim submission to Western Highlands?
Western Highlands strongly encourages providers to continue with NPI registration and NPI billing implementation. Without specific deadlines from DMA or IPRS, Western Highlands established the following guidelines. Previously announced NPI implementation deadlines are no longer effective and future deadlines may be imposed upon notice from DMA and the State.

837 Electronic Billing:
At this point Western Highlands will process an 837 in either the legacy format or with both legacy numbers and NPI. Since DMA is unable to accept an 837 with NPI only, Western Highlands offers format and content testing in preparation of final transition.

CMS 1500:
Providers may submit claims on either the CMS-1500 (12-90) or CMS-1500 (08-05). The CMS-1500 (08-05) must include the legacy number and NPI as specified in the N.C. Medicaid Special Bulletin, December 2006, http://www.dhhs.state.nc.us/dma/NPI.htm. Western Highlands encourages providers to start utilizing the CMS-1500 (08-05) in preparation of the final transition.

Direct Data Entry (DDE):
Western Highlands will accept DDE claims submission without NPI until further notice. Western Highlands will announce in advance the DDE NPI claims entry implementation and instructions.

NPI Registration:
Western Highland will continue to accept NPI registration and strongly encourages providers to finalize NPI registration.

Technical Assistance:
Please contact a Western Highlands Claims Technician at (828) 225-2800 extension 2144, or e-mail billingquestions@westernhighlands.org for technical assistance.

State Funded Timely Filing:
State funded timely filing limits are still in effect. Dates of service July 1, 2006 through April 30, 2007 are due by close of business (5:00 P.M.) June 1, 2007.

Charlie Schoenheit
Director of Services Management
Western Highlands Network
356 Biltmore Avenue
Asheville, NC 28801
Telephone: (828)258-3511 x2219
FAX: (828) 225-2779
E-Mail: Charlie@westernhighlands.org
Website: westernhighlands.org