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Serving Wyoming EqualityCare Providers

 

 

NPI News and Information

CMS-1500 (12/90) and UB-92 Claim Forms
As a reminder, EqualityCare gave providers until August 31, 2007 to transition to the new CMS-1500 (08/05) and UB-04 claim forms.  If you are still using the old CMS-1500 (12/90) and UB-92 claim forms, make sure your final submissions are mailed to ACS well before August 31, 2007.  Effective September 1, 2007, claims received on old forms will be returned unprocessed. 
 

Blackout Period

Claim Forms

Forms

EqualityCare's NPI Contingency Plan

NPI Registration Form

Revised Provider Agreement

Newsletters

Links

WINASAP Version 5.11 NPI Conversion Tutorials (Typical Providers Only)

Web Portal Tutorials

 

Blackout Period

In preparation for the May 23, 2007 NPI compliance deadline, EqualityCare has made extensive changes to its systems. Due to the nature of the changes, EqualityCare will be instituting a blackout period to allow for systems migration activities.

CLAIMS SUBMISSIONS

ACS will stop accepting claims for a period of twelve (12) days so that its staff may finish processing the current inventory. The blackout period for claims begins Thursday, May 17th and ends at 6:00 am on Tuesday, May 29th. If you have any claims you wish to have processed before the blackout period begins, EqualityCare strongly urges you to submit them well before May 17th.

During the blackout period, claims submissions will not be acceptedthe EqualityCare Web Portal will be brought down, ACS EDI Gateway will stop accepting electronic claims submissions (including WINASAP 2003 claims), and the ACS office in Cheyenne will not be processing paper claims or adjustment requests.

Paper claims and adjustment requests received during the blackout period will be held until ACS begins processing claims again on May 29th. When the held claims and adjustment requests are processed, they will be subject to new NPI and taxonomy code edits. So, if you send claims and adjustment requests during the blackout period, be sure to include your NPI and taxonomy code(s), if needed.

Attention Pharmacies: Point-of-sale pharmacy claims will not be subject to a blackout period. Pharmacies may continue to submit drug claims, but should be mindful of the NPI requirement beginning May 23rd. For more information, consult the NPI Pharmacy Billing Newsletter.

OTHER ELECTRONIC TRANSACTIONS

Whereas claims will not be accepted during the blackout period, EqualityCare will continue to accept electronic client eligibility inquiries and claim status requests until 11:59 pm on Friday, May 25th. From 12:00 am on Saturday, May 26th until 11:59 pm on Sunday, May 27th, the following services will be unavailable to providers:

  • AVRS (Automated Voice Response System)
  • Batch 270 Health Care Eligibility Benefit Inquiry
  • Batch 276 Health Care Claim Status Request
  • Eligibility Inquiries Submitted Through MEVSNET.COM and Medifax (Emdeon)
  • Claims Status Requests Submitted Through MEVSNET.COM
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    Claim Forms

    Dental Claim (489 K)

    CMS-1500 (08-/05) (137 K)
    UB-04 Claim (26K)

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    Forms

    All forms have been updated to reflect any necessary NPI changes. Please reference the forms on the Forms page.


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    EqualityCares NPI Contingency Plan

    PHARMACIES

    If you have an NPI registered with ACS, but are unable to use it because your switch vendor is not ready to generate NPI-compliant claims or other issues beyond your control, you must complete the NPI Contingency/Corrective Action Plan form . All sections of the form must be completed and on file with ACS by May 15, 2007.

    Submitting an NPI Contingency/Corrective Action Plan allows you to continue using your NCPDP ID until your switch vendor is ready to generate NPI-compliant transactions, or your other issues are resolved, whichever comes first. When you're ready to generate NPI-compliant transactions, contact the ACS NPI Unit BEFORE submitting them. ACS must first configure EqualityCare's systems to allow you to use your NPI instead of your NCPDP ID. Pharmacies that submit an NPI Contingency/Corrective Action Plan and then begin using their NPI without first informing the ACS NPI Unit will find their electronic transactions and paper forms rejected or denied. The ACS NPI unit can be reached by calling 1-800-251-1268 and selecting option 6.

    NPI Contingency/Corrective Action Plan (Pharmacies Only)

    ALL OTHER PROVIDERS

    If you registered your NPI with ACS, but are unable to use it because your system, software vendor, billing agent or clearinghouse is not ready to generate NPI-compliant claims, you must complete the NPI Contingency/Corrective Action Plan form.

    Submitting an NPI Contingency/Corrective Action Plan allows you to continue using your EqualityCare number until August 31, 2007 or your system, software vendor, billing agent or clearinghouse is ready to generate NPI-compliant transactions, whichever comes first . When you're ready to generate NPI-compliant transactions, contact the ACS NPI Unit BEFORE submitting them. ACS must first configure EqualityCare's systems to allow you to use your NPI instead of your EqualityCare number. Providers who submit an NPI Contingency/Corrective Action Plan and then begin using their NPI without first informing the ACS NPI Unit will find their electronic transactions and paper forms rejected or denied. The ACS NPI unit can be reached by calling 1-800-251-1268 and selecting option 6.

    Do not submit an NPI Contingency/Corrective Action Plan because you have not obtained an NPI. Unless you are a pharmacy, you have until August 31, 2007 to obtain an NPI AND register it with ACS. Continue using your EqualityCare number until then.

    NPI Contingency/Corrective Action Plan (All Other Providers)

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    NPI Registration Form

    Simply obtaining an NPI is not enough. You must register your NPI with ACS.

    Using an NPI without registering it first will result in your claims being rejected or denied. If you have an NPI, but have not registered it, complete the NPI Registration Form and return it to ACS. The registration form must be completed for each EqualityCare number even if one NPI replaces several EqualityCare numbers. Failure to submit an NPI Registration Form for each EqualityCare number may result in your claims being rejected or denied .

    NPI Registration Form

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    Revised Provider Agreement

    In January 2007, EqualityCare mailed a revised Provider Agreement to all its active providers. This version of the agreement supersedes all previous versions. If you have not returned a signed Provider Agreement by August 31, 2007, your provider number will be voluntarily terminated until one is received.

    If you did not receive a revised Provider Agreement, you may print a copy by clicking on the link below. The agreement must be signed in ink and a ll four pages returned to ACS. When completing the agreement, be sure to write your EqualityCare provider number in the top right corner of each page to expedite processing.

    Revised Provider Agreement

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    Newsletters

    ALL PROVIDERS

    NPI Sharing - Letter from State Medicaid Medical Officer (May 2007)

     

    NPI Billing Newsletter (May 2007)

    Blackout Period
    EqualityCare Contingency Plan
    Registering Your NPI with ACS
    Using Your NPI After the Blackout Period Ends
    Taxonomy Code Requirement
    How to Complete Paper Claim Forms Using an NPI
    837 Health Care Claims: Professional, Institutional and Dental
    WINASAP 2003
    EqualityCare Web Portal
    Paper Remittance Advice
    835 Health Care Claim Payment/Advice
    Revised Provider Agreement
    Sharing NPIs

     

    NPI Newsletter (September 2006)

    National Provider Identifier
    Affected Providers
    EqualityCare Requirements
    Preparation
    How to Apply
    Resources

     

    PHARMACIES

    NPI Billing Newsletter for Pharmacies (May 2007)

    EqualityCare Contingency Plan
    Registering Your NPI with ACS
    Submitting NPI-Compliant POS Claims
    Paper Remittance Advice
    835 Health Care Claim Payment/Advice
    Revised Provider Agreement
    Sharing NPIs

     

    Pharmacy NPI Newsletter (November 2006)

    National Provider Identifier
    Affected Providers
    NPI and Paper Transactions
    EqualityCare Requirements
    EqualityCare Provider Verification Form
    Preparation
    How to Apply
    Resources

     

    DENTAL

    Letter to Dentists from Dr. Grant Christensen (January 2007)

    Sample ADA 2006 Claim Form

     

    WAIVER

    DD Waiver NPI Newsletter (January 2007)

    National Provider Identifier
    Affected Waiver Providers
    Taxonomy Code Requirement
    EqualityCare Provider Verification Form and Updated Provider Agreement
    More Information
    How to Apply for an NPI

     

    LTC Waiver NPI Newsletter (January 2007)

    National Provider Identifier
    Affected Waiver Providers
    Taxonomy Code Requirement
    EqualityCare Provider Verification Form and Updated Provider Agreement
    Revised CMS-1500 Claim Form
    More Information
    How to Apply for an NPI

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    Links

    Centers for Medicare & Medicaid Services (CMS)

     

    National Provider and Plan Enumeration System

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    WINASAP Version 5.11 NPI Conversion Tutorials (Typical Providers Only)

    On May 29, 2007 ACS will begin accepting HIPAA compliant claims containing the NPI number for billing.  In order to update the WINASAP software to bill with a compliant transaction, you will need to follow the steps provided in the tutorial to update your taxonomy and NPI information. 

    These tutorials are to be used only if you are currently using WINASAP Version 5.11 and are a Typical Provider.  This tutorial is NOT for Atypical (Waiver) Providers or if your software version is NOT 5.11.  The tutorial will provide you with the instructions to determine the WINASAP version you are currently using.

    WINASAP Tutorial

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    Web Portal Tutorials

    Effective May 29, 2007 Claims can begin being submitted through the web portal for updated web tutorials click here.


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