Mississippi

The Division of Medicaid continues to reprocess claims for dates of service April 1-December 19, 2011 due to the implementation of National Correct Coding Initiative (NCCI) methodology. Claims denied for NCCI edits may be adjusted by appending an appropriate modifier to the procedure code or correcting the units of service. Modifiers should only be appended to a procedure code when the clinical circumstances justify the use. Please refer to the CMS NCCI website for information on modifiers. Timely filing policies will apply to resubmitted claims.

The Patient Protection and Affordable Care Act (PPACA), enacted on March 23, 2010 require States to contract with Recovery Audit Contractors (RACs). The RACs will review Medicaid claims submitted by providers of services for which payment may be made. RACs will review the accuracy of the claims payments.

PRGX Global was awarded the contract to provide these audit services to Mississippi Medicaid. PRGX will begin performing audit functions within the next few months.

The Medicaid Provider Enrollment Division is in the planning stage for Provider Re-validation. In accordance with 42 CFR 455.414 the state Medicaid agency must revalidate enrollment of ALL providers at least every 5 years. The revalidation process allows providers the opportunity to verify and update their provider information.

Edit 0280 posts on claims when the CPT or HCPCS procedure code billed requires additional supporting documentation in order to process the claim. This documentation could include information from the beneficiary’s medical records to support the medical necessity or to support the procedure performed. Some codes billed may require that you submit an invoice in order to price the claim for payment (i.e. a physician administered drugs). Providers receiving edit 0280 on their Remittance Advice must provide the requested supporting documentation for the claim to be processed.