By Jackie Lucas, Billing Manager
ePACES TO ADD NEW FEATURE EFFECTIVE JUNE 1, 2016
In an effort to make user data more secure and to improve system performance, eMedNY will be installing a new feature that will impact ePACES users when signing on to the ePACES application. This new feature, commonly called CAPTCHA, is a program that can distinguish whether the user attempting to sign on is a human or a computer.
EFFECTIVE June 1, 2016: When users attempt to sign on to ePACES from the eMedNY website, the user will be asked to verify that he/she is a person and not a computer by selecting specific images. Once the user has successfully verified the correct images, he/she will be allowed to sign into the ePACES account. If the incorrect images are selected, the user will be asked to verify another set of images before being allowed access to ePACES.
This new feature is widely utilized by other secure websites. Many people are familiar with it and have probably had to use it to gain access to those secure websites. The NYS Department of Health is adding this feature to help secure your data, and to prevent unauthorized computer-automated access to ePACES that could adversely impact ePACES performance.
IMPORTANT NOTE: All users will need to have installed Internet Explorer (IE) version 10 or greater or any alternative browsers including Google Chrome, Mozilla Firefox, or Apple Safari. IE versions 9 and below will NOT be supported. Please be sure to coordinate with your IT department to upgrade your internet browser, if necessary, before the effective date shown above.
Questions about ePACES can be directed to the eMedNY Call Center at 800-343-9000.
NATIONAL DRUG CODES (NDC) REQUIRED FOR ALL PHYSICIAN ADMINISTERED MEDICATION
In accordance with the New York State Medicaid Program, Independent Health requires a valid 11-digit NDC number on claims when billing for all physician administered drugs that use J codes for its state products (MediSource, Child Health Plus, Essential Plan). The New York State Medicaid Program addressed this requirement in its April 2015 update (link below).
To participate properly in New York State’s All Payer Database, Independent Health is expanding this reporting requirement to all other fully-insured lines of business (Commercial plans and Medicare Managed Care plans) for dates of service beginning June 1, 2016.
The NDC is maintained by the U.S. Food and Drug Administration (FDA) and contains identifying information regarding the labeler/manufacturer, strength, dosage form and formulation of a drug product. The code is located on drug invoices, inserts and/or product packages.
Beginning for dates of service June 1, 2016, Independent Health will require the following when providers submit claims for physician administered drugs that use J-codes (J0000-J9999):
- Valid NDC number
- Quantity and measurement
Please note, Independent Health will deny claims submitted without this information for dates of service June 1, 2016 or after.
The use of NDC codes follows similar efforts for improved specificity in health care operations, similar to the recent move to ICD-10 coding.
Link to April 2015 Medicaid Update Addressing NDC Requirement:
Link to New York State All Payer Database Program:
If you have questions, please contact Independent Health’s Provider Services Department at firstname.lastname@example.org or call (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.
PF WILL BE CONTACTING YOU FOR YOUR UPDATED NDC CODES
NEW ESSENTIAL PLAN FOR UNINSURED PATIENTS AND THEIR FAMILIES
You may have patients who are currently uninsured – or who could potentially lose their health insurance coverage this coming year as a result of loss of employment or a change in benefits.
Per Univera, the Essential Plan, a new health plan for 2016, costs much less than what other health plans offer but at the same essential benefits. Those who qualify can enroll any time of the year.
Plans for as low as $0 or $20 per month are available to eligible individuals who meet household size and income guidelines. The Essential Plan has NO deductible and covers the same services covered by other quality insurance plans:
- office visits (including specialists) and ordered tests
- prescription drugs
- inpatient and outpatient care
- free preventive care (routine exams and screenings)
Important Note: Essential Plan is only available in the eight counties of our Western New York service area (Erie, Niagara, Cattaraugus, Chautauqua, Allegany, Orleans, Wyoming and Genesee), and only practitioners located within those counties are eligible to provide services to Essential Plan members. Uninsured patients can go online or call Univera for help determining if they qualify. The Essential Plan is only available
through the New York State of Health Marketplace, but they offer an online calculator at ChooseUnivera.com to help determine eligibility.
ROUTINE TETANUS VACCINES
For claims received on or after 6/1/2016, tetanus vaccines will be subject to denial when a routine non-covered diagnosis code is linked to the CPT code. Providers must be aware that if the tetanus vaccine is medically necessary, the appropriate ICD-10 diagnosis code must be linked to the CPT code. For routine vaccines, which are expected to be denied, procedure codes including the administration need to be submitted with modifier GY for correct denial.
NGS is aware that not all providers have been using modifier GY to obtain a denial for supplemental insurance processing. Claims paid in error with a routine non-covered diagnosis code will be adjusted for refunds.
NON-COVERED ICD-10 DIAGNOSIS CODES
National Government Services (NGS) has seen an increase in claims for CPT 90471/90472 using ICD-10 code Z23 (Encounter for immunization), that were paid even though the provider was expecting the service to deny.
NGS advised that effective for claims received 1/1/2016 with dates of service 10/1/2015 and after, claims submitted with a combination of non-covered routine diagnosis codes and payable diagnosis codes would be considered for payment. Providers that submit claims with the intent of denial for supplemental insurance will no longer be able to submit a routine diagnosis for denial unless all of the reported diagnosis codes are routine non-covered. A combination of the routine diagnosis and the use of the GY modifier will be required for denial.
For Billing questions, please contact Jackie Lucas at 716-348-3923 or email@example.com.