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The Department of Medical Assistance Services asks you to please see the information below which is sent in advance of the potential for Hurricane Irene to affect the Commonwealth of Virginia over the next few days. If you would be so kind as to share as appropriate, it would be greatly appreciated.
This message deals specifically with the following programs:
Nursing Facility Admissions
Pre-Admission Screenings for NF Admissions Transportation Pharmacy
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Message Sent To Provider Associations Representing Hospitals and Nursing Facilities for distribution to their respective members and the Virginia Department of Social Services and Virginia Department of Health (for pre-admission screeners):
Due to the upcoming potential for inclement weather, the Department of Medical Assistance Services (DMAS) has instituted the following emergency procedures.
- All pre-admission screening requirements are currently being waived for emergency admissions to the nursing facilities due to the potential for inclement weather. The time frame covered for this waiver Saturday, August 27, 2011 to Tuesday, August 30, 2011. Any admission to nursing facilities during this time frame will be approved by DMAS provided documentation is given to support the emergency admission. All documentation related to the emergency admission should be directed to Melissa Fritzman via fax at (804) 612-0040. The documentation should include the completed PIRS form and information regarding the nature of the emergency admission.
- All emergency transportation needed to facilitate movement of individuals from their homes to a nursing facility and/or hospital will be reimbursed by DMAS. Our transportation coordinator, LogistiCare, has been notified of DMAS' intent to honor all emergency transportation issues related to the facilitation of movement of these individuals to nursing facilities and/or hospital during the period of Saturday, August 27, 2011 to Tuesday, August 30, 2011. All transportation claims related to the movement of individuals to nursing facilities/hospitals in an emergency basis because of the inclement weather should be sent directly to Melissa Fritzman at the following address and should include clear documentation that of the nature of the transportation related to an emergency placement.
- Please contact LogistiCare at 1-866-679-6330 during the period of Saturday, August 27, 2011 to Tuesday, August 30, 2011 for emergency placements ONLY. This number will only be active during the time frame outlined above specifically for emergency placements ONLY. The approvals will cover round trip transportation.
Send claims to:
Melissa Fritzman, Supervisor
Long-Term Care Division
Department of Medical Assistance Services
600 East Broad Street, Suite 1300
Richmond, Virginia 23219
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Message Sent To Va. Pharmacists' Association to forward to Va.
Pharmacists:
In the event that you lose access to your POS system due to the effects of Hurricane IRENE and are unable to submit Medicaid pharmacy claims on-line, we ask that you take every step possible to supply Medicaid and FAMIS enrollees with needed medications.
If you have access to a phone or the Internet, you should verify eligibility in either of the following two methods.
- Use the automated voice-response MediCall system 800-884-9730 or 800-772-9996.
- Use the Internet web-based verification system, ARS, if you are already enrolled to use the system.
- Medicaid will not be responsible for any of the Dual Medicare Part D covered medication.
If none of the above is available, we ask that you fill prescriptions based on the enrollee being able to present a plastic ID card. If it is not possible to verify eligibility in any way, please supply the patient with a 72 hour supply of their medication if needed until claims can be submitted.
Claims should be entered into your POS system when it becomes available.
DMAS will honor claims for all prescriptions that were filled under the above circumstances. If claims are rejected for eligibility errors or any other reason that cannot be overridden, please send documentation for the rejected claims to DMAS and will ensure appropriate payment is made.
Any claims for recipients whose eligibility cannot be verified, and their eligibility was canceled, DMAS will have to pay theses claims separately off-line. Providers will need to submit these claims on paper to DMAS at the address listed below.
Pharmacy Program
Department of Medical Assistance Services
600 East Broad Street, Suite 1300
Richmond, Virginia 23219
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