Independent Providers Rule16.03.09.706

DDA Rules 16.03.10.704

Dockets no. 16-0309-0706 and 16-0310-0704    

Implementation procedures for independent providers of occupational therapy to bill Medicaid directly

Important Dates

April 1, 2008:  Provider enrollment will begin

June 1, 2008:  Providers may bill and be paid

July 1, 2008:   Provider Handbook will be accessible online

Steps to becoming a Idaho Medicaid Provider

Medicaid Provider Handbook

Ask a question of an IOTA Reimbursement Representative

Click to send your question

Questions will be answered by the IOTA Office

or forwarded to Reimbursement

Chair AJ Jaques, OTR/L.

1)  Apply and receive an NPI (National Provider Identification) number.

The NPI is a unique identifier for providers that was established by HIPPA Title II in an effort to improve the efficiency and effectiveness of the electronic transmission of health information. Medicare providers must use this number when submitting claims.  Full compliance is required by May 23, 2008. 

 

Learn more about the NPI here:

https://nppes.cms.hhs.gov/NPPES/Welcome.do

 

Apply for the NPI here: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart

2)  Apply and receive a Medicare Provider number.

Overview of the Medicare Provider enrollment process:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/01_Overview.asp#TopOfPage

 

Enrollment Applications:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_EnrollmentApplications.asp#TopOfPage

 

Form CMS 855I -Medicare Enrollment Application for Physicians and Non-Physician Practitioners:

http://www.cms.hhs.gov/CMSForms/CMSForms/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS019477&intNumPerPage=10

 

Special Note:  There is a question on the Medicare application that asks when you will begin seeing Medicare patients.  Please answer as of June 1, 2008 because that is the earliest date that you can bill and receive payment from Idaho Medicaid.  Everything in your application should be geared to be in place as of June 1, 2008.

On April 1, access an enrollment package here: http://www.healthandwelfare.idaho.gov/site/3437/default.aspx    CHOOSE HEALING ARTS from the menu on the right of the screen.  You must receive your INDIVIDUAL number before applying for a group number.

EDS and provider relations consultant contact information will be available online April 1.

The Therapy Services Rule allows  25 medically necessary occupational therapy visits per calendar year without prior authorization.  Once a participant reaches the 26th visit, prior authorization must be received from Medicaid. 

Additionally, the following codes require prior authorization:

• 97039 - Unlisted modality (specify type and time if constant attendance)

• 97139 - Unlisted therapeutic procedure (specify)

• 97537 - Community/work reintegration training (e.g. shopping, transportation, money, management, avocational activities and/or work environment modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact by provider, each 15 minutes

Click here for the documentation and submission process for prior authorization. 

The reimbursement rates may be found in numerical order here: http://www.healthandwelfare.idaho.gov/site/3502/default.aspx

Therapy Services Rule Provider Q&A

Additional Resources

          MedicAide Newsletters - find important provider information releases by month

          http://www.healthandwelfare.idaho.gov/portal/alias__Rainbow/lang__en-  US/tabID__3439/DesktopDefault.aspx

           Medicaid Provider Handbook - find Occupational Therapy under Healing Arts

           http://www.healthandwelfare.idaho.gov/site/3438/default.aspx

           Fee Schedule

           http://www.healthandwelfare.idaho.gov/site/3502/default.aspx

These guidelines represent  information received from the Medicaid Division of Idaho Health and Welfare on March 7, 2008.  The application procedures outlined herein are subject to approval through Medicare and Medicaid.  Specific questions should be directed to the agencies using the contact information included in the enrollment packages.