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Special Education Listserv

Subject: Medicaid Claim Conversion Deadline

Source: Special Education Finance

Intended Audience: Special Education Directors, Superintendents, Financial Administrators

Date: March 19, 2012

The Centers for Medicare and Medicaid Services changed the required format of claims when billing MO HealthNet.  The claim version changed from version 4010 to the version 5010 on January 1, 2012.  To learn more about 5010, visit: http://www.dss.mo.gov/mhd/providers/pdf/5010provider-info.pdf.  The discretionary period to allow use of version 4010 ends March 31, 2012.  Beginning April 1, 2012, MO HealthNet will only accept version 5010 claims.  Version 4010 claims submitted on or after April 1, 2012, will be rejected and a disruption of payment will occur. 

To see if your district still needs to convert, please go the following link: http://www.dese.mo.gov/divspeced/Finance/HIPAA5010Conversion.html.  The districts listed at this link have been identified as currently submitting version 4010 claims by MO HealthNet.  To assure claims are not rejected on April 1, 2012, contact your software vendor, clearing house, or whoever does your billing to find out when you will be upgraded to version 5010.  If you have any questions, the Wipro Infocrossing Help Desk may be reached at 573-635-3559 or via email at the HIPAA Support address 5010support@momed.com.

For school districts enrolled with MO HealthNet, but not currently submitting claims, you must assure your software vendor, clearing house, or whoever does your billing has upgraded to version 5010 prior to claims submission.  Claims submitted on eMOMED are automatically created in version 5010.  If you have any questions, the Wipro Infocrossing Help Desk may be reached at 573-635-3559 or via email at the HIPAA Support address 5010support@momed.com.

For more detailed information, please refer to the December 12, 2011, MO HealthNet provider bulletin "X12 v5010 and NCPDP vD.0 Implementation" volume 34, number 17 at http://www.dss.mo.gov/mhd/providers/pages/bulletins.htm