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2006 Memos and Bulletins

Issue Date Title To:
22-Dec-06 Testing Electronic Transactions for the National Provider Identifier (NPI) All Providers that Submit/Receive Electronic Transactions
22-Dec-06 Rate Increase for Procedure Code S5102 (Adult Day Health Care) - Effective January 1, 2007 Adult Day Health Care Providers in the Elderly or Disabled with Consumer Direction Waiver
22-Dec-06 False Claims Act Educational Requirements Mandated by DRA All Providers / Contractors and Managed Care Organizations (MCOS )
14-Dec-06 Updates and Clarification of the Prior Authorization Process for Outpatient Services -December 14, 2006 All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and MCO's Participating in the Virginia Medical Assistance Programs
14-Dec-06 Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services -December 14, 2006 All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
14-Dec-06 Updates and Clarification of the Prior Authorization Process for Community Based Care Services - December 14, 2006 All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
14-Dec-06 Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management, Residential Treatment Services, and Intensive In-Home Services -December 14, 2006 All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
11-Dec-06 Family Planning Services Program: Clarification of Eligibility, Covered Services and Billing Requirements All Medical Doctors, Nurse Practitioners, Nurse Midwives, Hospitals, Health Departments, Rural Health Clinics, Federally Qualified Health Centers, Laboratories, Pharmacies, and Outpatient Clinics, and Managed Care Organizations (MCOs) Participating in the Virginia Medical Assistance Program
7-Dec-06 Modifications to Virginia Medicaid Preferred Drug List (PDL) All Providers Participating in the Virginia Medical Assistance Programs
23-Oct-06 Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management, Residential Treatment Services, and Intensive In-Home Services -October 23, 2006 All Treatment Foster Care Case Management, Residential Treatment Service Providers, Intensive In-Home Services and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
23-Oct-06 Updates and Clarification of the Prior Authorization Process for Community Based Care Services -October 23, 2006 All Home and Community Based Care Waiver Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
23-Oct-06 Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services - October 23, 2006 All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
23-Oct-06 Updates and Clarification of the Prior Authorization Process for Outpatient Services -October 23, 2006 All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
17-Oct-06 General Billing Instructions for the New CMS-1500 (08-05) Form - Effective October 1, 2006 All Providers Billing on the CMS-1500 (08-05) Form
12-Oct-06 Clarification of School Services All School Divisions and Managed Care Organizations Participating in the Virginia Medicaid Program
12-Oct-06 Clarification of Review of Psychiatric Records All Psychiatric Service Providers and Managed Care Organizations Participating in the Virginia Medical Assistance Programs
4-Oct-06 National Provider Identifier (NPI) Update Virginia Medicaid Participating Health Care Providers and Managed Care Organizations (MCOs)
4-Oct-06 National Provider Identifier (NPI) Implementation Plans For the Virginia Medicaid Program: Atypical Providers Virginia Medicaid Participating Atypical Providers and Managed Care Organizations (MCOs)
20-Sep-06 Updates and Clarification of the Prior Authorization Process for Outpatient Services - September 20, 2006 All Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health, Physicians, and Non-Emergency MRI, PET, and CAT Scan, Service Providers, and Managed Care Organizations (MCOs)
20-Sep-06 Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute, Psych, and Rehab Care Services All Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Service Providers, and Managed Care Organizations (MCOs)
20-Sep-06 Updates and Clarification of the Prior Authorization Process for Community Based Care Services -September 20, 2006 All Home and Community Based Care Waiver Service Providers and Managed Care Organizations(MCOs)
30-Aug-06 Revision of the DMAS-30 R 5/06 and DMAS-31 R 5/06 (Title XVIII) Medicare Part B Deductible and Coinsurance Original and Adjustment/Void Invoice Forms All Providers and Managed Care Organizations (MCOs)
21-Aug-06 Updates and Clarification of the Prior Authorization Process for Treatment Foster Care Case Management and Residential Treatment Services Treatment Foster Care Case Management, Residential Treatment Service Providers and MCOs
16-Aug-06 Coverage of spacers and peak flow meters through the Durable Medical Equipment and Supply (DME) program Durable Medical Equipment and Supply (DME) Providers, Physicians, Pharmacies, FAMIS, and MCOs.
15-Aug-06 Intensity of Treatment Criteria for Acute Inpatient Hospital Psychiatric Services Providers of Acute Inpatient Hospital Psychiatric Services
4-Aug-06 Updates and Clarification of the Inpatient Prior Authorization Process for Inpatient Acute Care Services -August 4, 2006 Inpatient Acute, Inpatient Psychiatric, and Inpatient Rehabilitation Providers, and MCOs
4-Aug-06 Updates and Clarification of the Outpatient Prior Authorization Process for Outpatient Services Outpatient Psychiatric, Outpatient Rehabilitation [including Comprehensive Outpatient Rehabilitation (CORF)], Durable Medical Equipment (DME), Orthotic, Home Health and Non-Emergency MRI, PET, CAT Scan Providers and MCOs
4-Aug-06 Updates and Clarification of the Prior Authorization Process for Community Based Care Services -August 4, 2006 Home and Community Based Care Waiver Providers and MCOs
26-Jul-06 Request to Calculate and Report the Estimated Glomerular Filtration Rate (eGFR) Value for Medicaid Recipients In-State General Hospitals, Independent Laboratories, Out-of-State Hospitals, Out-of-State Laboratories, and MCOs
14-Jul-06 BabyCare Covered Service Changes and mileage rate increase Maternal Infant Care Coordination (MICC) providers and high risk maternity and infant program managers of MCOs.
13-Jul-06 Rate Increase for Private Duty Nursing and Services that are Unique to the MR and DD Waivers - July 1st 2006 Private Duty Nursing, Mental Retardation Waiver and Individual and Family Developmental Disabilities Support Waiver providers
7-Jul-06 Expansion of Medallion II and FAMIS Programs in Danville - September 2006 All Providers and MCOs
26-Jun-06 Update Regarding Behavioral Therapeutic Consultation Provider Qualifications Behavioral Therapeutic Consultation Services and Mental Retardation Case Managers
16-Jun-06 National Provider Identifier (NPI) Implementation Plans For the Virginia Medicaid Program: Health Care Providers Health care providers and MCOs
13-Jun-06 Update to the Physician Provider Manual Physicians
9-Jun-06 Expansion of Medallion II and FAMIS Programs in Culpeper - Summer 2006 All Providers and MCOs
7-Jun-06 Program Updates for Virginia's Medicaid, FAMIS and FAMIS Plus Children Dental Program (Smiles For Children) - Spring 2006 Dental Providers
6-Jun-06 Update to the Community Mental Health Rehabilitative Services Provider Manual and changes to the Prior authorization process for extensions to Intensive In Home Services (H2012) Community Mental Health Rehabilitative Services
2-Jun-06 Update to the EDCD Waiver Services Provider Manual EDCD Waiver service providers and MCOs
2-Jun-06 Update to the Elderly Case Management Services Provider Manual Elderly Case Management Services providers
2-Jun-06 Update to the IFDDS Waiver Services Provider Manual IFDDS Waiver Services providers, Case Managers and MCOs
2-Jun-06 Update to the AIDS Waiver Case Management Services Provider Manual HIV/AIDS Waiver Services Organization providers and MCOs
2-Jun-06 Changes to the Preauthorization of Inpatient Psychiatric Residential Treatment and changes to the Psychiatric Services Manual Inpatient Psychiatric Residential Treatment Providers and MCOs
2-Jun-06 Changes to the Preauthorization of Treatment Foster Care Case Management and changes to the Psychiatric Services Manual Treatment Foster Care Case Management Providers MCOs
1-Jun-06 Update to the Technology Assisted Waiver Services (TAWS) Provider Manual Technology Assisted Waiver Services Providers and MCOs
1-Jun-06 Modifications to the Virginia Medicaid Preferred Drug List (PDL) Program and PDL Quicklist and Termination of Automatic PDL Prior Authorizations for Long-Acting Narcotics: Effective July 1, 2006 All Providers
26-May-06 Update to the Hospital Provider Manuals and New Prior Authorization Contractor: Effective June 12, 2006 Hospital and Non-emergency, Outpatient MRI/CAT/PET Scan and MCOs
26-May-06 Changes to the Preauthorization of Inpatient Psychiatric Services and and changes to the Psychiatric Services Manual: Effective June 12, 2006 Inpatient Psychiatric Services Providers and MCO
22-May-06 Prior Authorization transition information  change in Hospital Service Transition Date to KePRO - June 12th; one-time change in PA number for certain types of requests; Clarification of Outpatient Psychiatric Service Limits All Pharmacies and MCOS
11-May-06 Update to the Rehabilitation Provider Manual and New Prior Authorization Contractor Effective June 5, 2006 Rehabilitative Services providers
5-May-06 Update to the Home Health Provider Manual and New Prior Authorization Contractor Effective June 5, 2006 Home Health providers and MCOs
5-May-06 Update to the Durable Medical Equipment and Supplies Provider Manual and New Prior Authorization Contractor Effective June 5, 2006 DME providers and MCOs
3-May-06 Correction to March 31, 2006 Medicaid Memo regarding Rate Increase for Personal Care and Related Services and Adult Day Health Care ? May 1, 2006 Mental Health and Mental Retardation Agencies, Providers of Case Management Waiver Services, Enrolled Service Facilitators under Medicaid Waivers, and Medicaid Recipients Receiving Consumer-Directed (CD) Services
26-Apr-06 Changes to the Preauthorization of Outpatient Psychiatric Services and changes to the Psychiatric Services Manual Outpatient Psychiatric Services and MCOs
26-Apr-06 Changes to the Preauthorization of Outpatient Psychiatric Services and Changes to the Mental Health Clinic Provider Manual Mental Health Clinics and MCOs
3-Apr-06 Contracting of Services to a Qualified Fiscal Agent for Consumer-Directed Fiscal Agent Services - Summer 2006 Mental Health and Mental Retardation Agencies, Providers of Case Management Waiver Services, Enrolled Service Facilitators under Medicaid Waivers, and Medicaid Recipients Receiving Consumer-Directed (CD) Services
1-Apr-06 Increased Dispensing Fee for Brand Name Drug Products - May 1, 2006 All Providers
31-Mar-06 Rate Increase for Personal Care and Related Services and Adult Day Health Care May 1, 2006 Personal Care, Mental Health/Mental Retardation, Consumer-Directed, Respite Care, Private Duty Nursing, Adult Day Health, who provide Personal Care and Related Services and Adult Day Health Care Services
24-Mar-06 EPSDT Blood Lead Testing Requirements, Lead-Safe Virginia, and the Discontinued Usage of the Division of Consolidated Laboratories All EPSDT Providers and all MCOs
20-Mar-06 Notification of Contract Award and New Prior Authorization and Utilization Review Process - Spring 2006 All Providers and all MCOs
1-Mar-06 Discontinuation of Virginia Medicaid Interim Reimbursement for Medicare Part D Drugs for Dual Eligibles - March 8, 2006 All Pharmacies and MCOs
27-Feb-06 Implementation of the National Provider Identification Number (NPI): Typical Anticipated Initial Implementation Date: January 1, 2007 Health Care Providers and MCOs
27-Feb-06 Implementation of the National Provider Identification Number: Atypical Anticipated Initial Implementation Date: January 1, 2007 Treatment Foster Care, Case Management, Respite Care, Personal Care, Adult Day Health Care, Family Caregiver Training, Education Services (Schools), Assisted Living, Non-Emergency Transportation, and Mental Retardation Waiver and/or Developmental Disabilities Waiver Service Providers who are not eligible to obtain a National Provider Identifier (NPI)
1-Feb-06 Changes to Virginia Medicaid Billing Instructions for HIPAA Compliance Utilization of Interim Bill Types Hospitals, Intermediate Care Facilities, Residential Treatment Facilities, Nursing Facilities, Hospice, and Temporary Detention Order providers
30-Jan-06 New Virginia Medicaid Interim Reimbursement for Medicare Part D Drugs for Dual Eligibles - Effective January 31, 2006 All Pharmacies and MCOs
12-Jan-06 Changes to Processing of Medicare -Crossover Claims-Addendum All Pharmacies and MCOs