| How is the physician to bill so that the claim is not denied for Medicare and/or no prior authorization? Acute care cases in which the patient has Medicare Part A or Part B only requires certification from eQ Health Solutions (eQHS). Only those patients with Medicare Part A and Part B are exempt from certification. Failure to obtain certification when the patient has Medicare Part A only prohibits any other provider who rendered services during the admission to be reimbursed by Medicaid. In situations where the hospital failed to obtain certification as required, the physician can request the hospital obtain certification or request certification from eQ Health Solutions so that he/she can submit claims for processing for inpatient physician visits. The physician must provide any necessary information for review. In addition, the hospital must be a Mississippi Medicaid provider in order for the physician to request this certification. If a baby is not placed in the well baby nursery or is moved to another nursery level prior to the mother's discharge, how are these days covered by Medicaid? Providers should seek Medicaid certification by eQ Health Solutions (eQHS) when a newborn Is admitted to any setting other than a 'well baby nursery' (i.e., NICU/PICU, Intermediate, etc.) regardless of the mother's length of stay. (Changing the infant's status or level of care without physically transferring the infant to a more acute setting does not require eQHS certification.) Transfers from a well baby setting to a more acute care setting. (The infant's transfer date should be used as the certification admit date.) Remains in a well baby setting when the mother is discharged from the facility. (The mother's discharge date should be used as the infant's certification admit date.) In these situations, charges for the baby should not be included on the claim for the mother but on the claim for the baby.
Note: HSM name change to eQHS effective Dec. 1, 2013.