Current Medicaid News
Please select the links below for complete Medicaid articles and events from the current year. View Medicaid News Archive
General
07.15.08 Peach State Health Plan issues provider notice regarding H.B. 1234
Read notice to providers
06.30.08 EDS wins state contract for Medicaid payments
EDS recently announced that has been awarded a seven-year, $391 million contract to provide Medicaid services to the state of Georgia. This will include the design, development and implementation of a new-generation Medicaid Management Information system, which the company says will go into effect in 2010. EDS assumes its Medicaid/Georgia duties from Affiliated Computer Services, which has handled the job since 2003.
The EDS Georgia Interchange system will provide the means to support delivery of fiscal agent services to Georgia's 45,000 Medicaid providers, which care for more than 1.2 million people a year. EDS says it will analyze Georgia's Medicaid population and programs. In addition, the new system will help the state identify potential fraud and abuse, the company said in a statement.
Georgia has the nation's eighth-largest Medicaid program. EDS - which serves as fiscal agent or principal information technology provider for 22 states - previously served as Georgia's fiscal agent from 1986 to 2003.
05.09.08 Third Party Payer Question & Answer: Medicaid
Q: If I sent three claims for COB consideration to Medicaid in the same envelope and two of them are processed within a couple of weeks but the third is not, where do I stand on timeliness? By the time I process the two claims that were accepted, I have run out of time for the third one – we only get 30 days from the date of denial. I am getting a lot of these and am forced to write off most of them. If I send them certified mail, can Medicaid be forced to acknowledge they made an error?
A: When the claims are received by the remote mailroom operation (RMO), they are stamped with the date in which the claim physically reached the RMO. If for some reason your claim is not processed before the time limit, the date is part of the TCN which is used to determine when the claim actually reached the RMO. Therefore, your third claim that is not yet in the system should not deny for timely filing if it was received before the last day of the timely filing date.
Unfortunately, a certified mail receipt is not justification that your claim was received in a timely manner. However, when you are running close to the timely filing date, you may submit the claim via the Web even if you need to attach a document to the claim. You can key the claim via the Web, indicate there is an attachment and mail the attachment to the RMO with the TCN on the top.
04.10.08 MAG Reminder: Medicaid Tamper-Resistant Prescription Pads Guidelines
Effective April 1, 2008, the federal government began requiring that Medicaid Fee-for-Service prescriptions include one or more industry recognized tamper-resistant features designed to:
- Prevent unauthorized copying of a completed or blank prescription form
- Prevent erasure or modification of information written on the prescription by the prescriber
- Prevent the use of counterfeit prescription forms
While the federal government has not identified the industry-recognized features, examples include, but are not limited to the following:
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Required tamper-resistant characteristics include one or more industry-recognized features designed to: 1. Prevent unauthorized copying of a completed or blank prescription form 2. Prevent erasure or modification of information written on the prescription by the prescriber 3. Prevent the use of counterfeit prescription forms |
Examples include but are not limited to: |
04.01 Pharmacists Release Detailed Tamper-Resistant Prescription Pads FAQs
"The Pharmacists Letter" gives an overview of the requirements set to go in effect today, including describing the industry standards for all three requirements.
View Update
04.01.08 MAG Reminder: Deadline for Use of Tamper-Resistant Prescription Pads under the Medicaid Program is Today - April 1st
MAG has secured an exclusive agreement with Rx Security, Inc. – a leading supplier of affordable, counterfeit-resistant prescription pads – to provide discounts to MAG members!
MAG Members, please click here or on the logo below for discounted prices and to place your orders! Through our exclusive agreement with Rx Security, MAG Members can save up to 14 percent off orders! For questions or to place an order over the phone, please call 800.667.9723.
View DCH's TRPP Requirements FAQs
02.28.08 Important Information for Medicaid-PeachCare Notification: Outpatient Fee-for-Service Pharmacy Program
The Georgia Medicaid Fee-For-Service (FFS) Outpatient Pharmacy Program in accordance with Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, and in an attempt to combat fraud and abuse, will require prescribers to use tamper-resistant prescription pads for any new prescription with fill dates on and after April 1, 2008. This requirement applies to hard copy prescription orders for any drug, device or product covered through the Medicaid FFS outpatient pharmacy program whether legend or over-the-counter.
View Latest Information
02.19.08 Deadline for Medicaid Tamper-Proof Rx Pads is April 1
By now, most physicians are aware that Congress passed a law last year requiring use of tamper-resistant prescription pads for most Medicaid prescriptions (there are exceptions for Medicaid managed care and institutionalized patients). Advocacy by the AMA, state medical societies, and others, achieved a six-month delay in the implementation date. The deadline for use of tamper-resistant prescription pads for Medicaid is April 1, 2008. Orders may take up to four weeks to process, so physicians who have not yet ordered tamper-resistant prescription pads should do so now.
While this is a federal law and CMS has issued some guidance to state Medicaid programs, there is not a single national regulation. Each state Medicaid agency must implement its own requirements regarding what tamper-resistant features will be required in that state. The AMA has been working with a coalition to try to bring clarity to the situation. Some states have made good progress in reviewing the industry standards for tamper-proof pads and have informed physicians and pharmacists what pads will be accepted in their state, but many states still have not taken action. A letter from the National Council for Prescription Drug Programs provides detailed information about the new requirements, the types of tamper-resistant features that a prescription pad can have, a sample prescription, and other information that physicians who have not yet received detailed information from their state Medicaid agency may find helpful.
View Additional Information and Link to the Letter
01.14.08 Georgia to Receive Enough Funds for PeachCare for Kids in 2008
State Health Department Commissioner Dr. Rhonda Medows announced that PeachCare will have enough funding to cover the 254,820 children now enrolled and to grow by up to 40,000 children.
View DCH Information on PeachCare
Medicaid Managed Care
03.25.08 MAG's CMO Reform Update
The possibility for some long-awaited changes in Georgia’s Medicaid CMOs may have finally materialized. It has been almost two years since the Georgia’s Medicaid CMOs for children and pregnant women began in Georgia, and the state and General Assembly are finally responding to the outcries of physicians and other providers.
On January 14, 2008 the first part of the Department’s CMO audit report on hospitals was released from the Indiana CPA firm of Myers and Stauffer LC, and it was not good. The report confirmed the existence of multiple and significant issues with claim adjudication and transitional related matters including, but not limited to:
- Multiple claims adjudication and pricing issues
- Emergency room services and payment and appeal issues
- Contractual payment policies
- Issues related to timeliness edits
As a result, DCH appears to be taking the problems seriously, and has appointed a new Medical Director, and Division Chief of Georgia Families Managed Care, Dr. Winston Price, and Deputy Director, Lovey Barnes, who are actively getting involved in problem resolution.
In MAG’s recent meeting with the audit firm, for Part II on physician problems, we provided them a CMO Reform Advocacy Brief and flow chart outlining many of the difficulties that physicians have experienced over the past year and a half and the significant problems which continue to occur, as well as our recommendations for administrative and/or legislative solutions. MAG’s Third Party Payer Advocacy office also provided the company documentation of some 17 separate areas of system or contract abuses that mirrored several of those found in the hospitals’ reports.
Read Full CMO Update
Download CMO System Flowchart
Read CMO Advocacy Brief
Payment
01.16.08 NPI Claims Instructions and Tips for Implementation
DCH is gathering statistical data related to claims submitted during the dual submission period. The results indicate a high volume of claims have multiple Georgia Medicaid IDs that map to the NPI submitted on the claim. After the dual submission period has ended, any claim that does not map to a single Georgia Medicaid ID will suspend - DELAYING PAYMENT!
Also, Georgia Medicaid is implementing a contingency plan in order to avoid any potential business disruption as a result of requiring NPI as the primary identifier on X12N and NCPDP transactions.