The Department of Public Welfare (DPW) Office of Medical Assistance Programs (OMAP) has posted new information that may be of interest to PCPA members on its web site (www.dpw.state.pa.us/omap/news/omapnews.asp).
RFP No. 10-05, Claim Validation and Recoupment Project has been added to the RFP and Standards (www.dpw.state.pa.us/omap/rfp/omaprfp.asp) section of site. This RFP is to select a vendor to enhance Bureau of Program Integrity (BPI) efforts, identify patterns and trends in billing errors, and improve health care management decisions for MA recipients. The selected vendor will augment BPI’s provider reviews for the Fee-for-Service rogram for the following provider types: 1) inpatient hospital to include Diagnosis Related Group (DRG) validation (inpatient psychiatric reviews may be included at a later date); 2) inpatient/outpatient radiology services; 3) inpatient/outpatient laboratory services; 4) short procedure unit to inpatient admissions; 5) physician services relating to these hospital areas; and 6) ambulatory surgical centers. In addition, DPW may include other types of provider reviews.
Meeting Minutes have been added to the Medical Assistance Advisory Committee (MAAC) Information Section (www.dpw.state.pa.us/omap/geninf/maac/omapmaacmin.asp):
- March 10 Managed Care Delivery System Subcommittee Meeting
- April 27 Consumer Subcommittee Meeting
- May 26 MAAC Meeting
Medical Assistance Bulletins
- MA Bulletin 99-05-12, Revised Maximum Participation Project Consent for Release of Information Form (PA 1723)
- MA Bulletin 99-05-13, Announcement of the National Provider Identifier Number
- MA Bulletin 08-05-03, Non-Coverage of Drugs for the Treatment of Erectile Dysfunction for Sex Offenders
- MA Bulletin 07-05-01, Psychological/ Psychiatric/Clinical Re-Evaluations and Re-Authorizations for Behavioral Health Rehabilitation (BHR) Services for Children and Adolescents with Behavioral Health Needs Compounded by Developmental Disorders
Remittance Advice Alerts
- RA Banner Message For Special Cycle 78 - This cycle was run as a supplement to the normal cycle 51, which is scheduled to pay on or around June 15. (www.dpw.state.pa.us/omap/provinf/RA060705.asp)
- Eligibility Verification System (EVS) - Effective September 3, 2005 at midnight, the Eligibility Verification System will be returning a "6" meaning "Inactive" in place of an "I" which means "Non-Covered" in the EB01 element in the EB Segment in Loop 2110C of the 271 response if the recipient is found on our system but not eligible during the dates of service returned. (www.dpw.state.pa.us/omap/provinf/RA052305a.asp)
- TPL Recovery of Certain MA Payments – Certain providers were notified in December 2003 of claims that should have been paid by a resource other than Medical Assistance and that recovery would occur after March 2004. Due to PROMISe™ implementation the claims were not recovered. The Division of Third Party Liability will now begin this recovery. (www.dpw.state.pa.us/omap/provinf/RA052305b.asp)
- RA Banner Message For Med B 34 – Certain providers were notified on November 18, 2003, of claims that should have been paid by a source other than Medical assistance. Recovery was to have begun after March 1, 2004. Due to PROMISe implementation, recovery was not accomplished then but will begin now. (www.dpw.state.pa.us/omap/provinf/RA060605.asp)
Information about the Medicare Modernization Act, Medicare Prescription Drug Benefits (www.dpw.state.pa.us/omap/geninf/MMA/omapMMAmain.asp)
PA Medicaid Managed Care Organization Directory – Update for June (www.dpw.state.pa.us/omap/hcmc/omapmcodir.pdf)
Information about the Pharmacy and Therapeutics Committee for the Medicaid Preferred Drug List (www.dpw.state.pa.us/omap/geninf/PTC/omapPTCmain.asp)
Information, including client notices, about possible Medical Assistance benefit changes in the 2005-2006 fiscal year commonwealth budget. (www.dpw.state.pa.us/omap/geninf/budget/omapbudgetmain.asp)
