Deficit Reduction Act

DRA is Here.

Failure to comply may put your Medicaid reimbursements at risk. In addition to NDC reporting requirements, your DRA submissions may also fall under review of auditors under the Comprehensive Medicaid Integrity Plan (CMIP/MIP). Your State Bulletin

What is the CMIP?

The Center for Medicare and Medicaid Services Comprehensive Medicaid Integrity Program (CMIP or MIP) was established by Section 6034 of the DRA and provides more resources to fight Medicaid fraud, waste and abuse. Medicaid Integrity Contractors (MICs) are entities the CMS has contracted to audit… read more

Resources

Centers for Medicare and Medicaid Services (CMS): DRA
Provides CMS overview and official links regarding the Deficit Reduction Act.
Centers for Medicare and Medicaid Services (CMS): CMIP
Provides CMS overview and official links to Comprehensive Medicaid Integrity Plan.
CA: Key Differentiators for DRA Compliance
Presents several key nuances that are important for California Medi-Cal providers to recognize for DRA compliance and NDC reporting.
Automated DRA Compliance
For more information on DRA compliance and Sentry’s unrivaled solutions, Contact Us.

How the Deficit Reduction Act Affects Hospitals

New Challenges in Medicaid Billing Require Additional Diligence

Whitepaper presents inherent obstacles associated with DRA compliance and the tools that can safely and accurately guide your organization to overcome these hurdles.
How the Deficit Reduction Act Affects Hospitals Whitepaper

Deficit Reduction Act: In Effect

Pharmacy Management Infrastructure

Sentinel RCM™ is a comprehensive mixed-use pharmacy revenue cycle management and compliance platform.
  • Advanced ordering, compliance & inventory management features.
  • Financial and reporting functions securely delivered via the web, providing full visibility into a hospital’s pharmacy operations.
  • Seamless integration with DRA Tool™, delivering an unrivaled DRA compliance application.
Read More

Automated Compliance Application

Sentinel RCM™ provides the DRA Tool™ as a module to assist your organization in maintaining compliance to this detailed new requirement. DRA Tool™ allows users to:
  • Execute on adopted, documented, electronically enforced Policies and Procedures.
  • Automatically place the correct 11 Digit NDC or true acquisition cost on the 837 claim.
  • Access built-in support for key coding schemes used for pharmacy procurement (NDCs), pharmacy billing (CDMs), and financial adjudication of claims (J-Codes/HCPC Codes).
  • Automatically update mapping tables and crosswalk tools to reflect changes in the regulatory environment, procurement practices, or administration.
  • Access a comprehensive “three click” audit trail – integrating all steps of the process flow.
  • Simultaneously comply with the different requirements of each state.
Read More
“Medicaid is telling me to include a NDC on my outpatient claims. How do I do that accurately?”

State Bulletins Address DRA Mandates

A comprehensive list of official bulletins from state Medicaid organizations that address DRA and required NDC reporting. For more information, select the link to your state bulletin below.
State Bulletin Link Status State Medicaid Link Telephone Number
ALABAMA Yes Effective Now Alabama Medicaid 907.465.3030
ALASKA Yes Effective Now Alaska Medicaid 800.770.5650
ARIZONA Arizona Medicaid 602.417.4000
ARKANSAS Yes Effective Now Arkansas Medicaid 501.682.8368
CALIFORNIA Yes Effective Now California Medicaid 800.541.5555
COLORADO Colorado Medicaid 303.866.2993
CONNECTICUT Connecticut Medicaid 800.842.8440
DELAWARE Yes Effective Now Delaware Medicaid 302.454.7154
FLORIDA Yes Effective Now Florida Medicaid
GEORGIA Yes Effective Now Georgia Medicaid 800.766.4456
HAWAII Yes Effective Now Hawaii Medicaid
IDAHO Idaho Medicaid 208. 334.5747
ILLINOIS Yes Effective Now Illinois Medicaid 877.782.5565
INDIANA Yes Effective Now Indiana Medicaid 317.655.3240
IOWA Yes Effective Now Iowa Medicaid 800.338.7909
KANSAS Yes Effective Now Kansas Medicaid 800.933.6593
KENTUCKY Yes Effective Now Kentucky Medicaid 800.807.1232
LOUISIANA Yes Effective Now Louisiana Medicaid 888.342.6207
MAINE Yes Effective Now Maine Medicaid 207.287.2674
MARYLAND Yes Effective Now Maryland Medicaid 410.767.5800
MASSACHUSETTS Massachusetts Medicaid 617.573.1770
MICHIGAN Michigan Medicaid 517.373.3740
MINNESOTA Yes Effective Now Minnesota Medicaid 800.657.3739
MISSISSIPPI Mississippi Medicaid 601.359.6050
MISSOURI Yes Effective Now Missouri Medicaid 800.375.1406
MONTANA Yes Effective Now Montana Medicaid 877.463.3464
NEBRASKA Yes Effective Now Nebraska Medicaid 402.471.3121
NEVADA Yes Effective Now Nevada Medicaid 702.668.4200
NEW HAMPSHIRE Yes Effective Now New Hampshire Medicaid 800.423.8303
NEW JERSEY Yes Effective Now New Jersey Medicaid
NEW MEXICO Yes Effective Now New Mexico Medicaid 505. 827.3181
NEW YORK Yes Effective Now New York Medicaid 800.343.9000
NORTH CAROLINA North Carolina Medicaid 919.855.4400
NORTH DAKOTA Yes Effective Now North Dakota Medicaid 701.328.2310
OHIO Yes Effective Now Ohio Medicaid 800.686.1516
OKLAHOMA Oklahoma Medicaid 405.521.3646
OREGON Yes Effective Now Oregon Medicaid 503.945.5772
PENNSYLVANIA Effective Now Pennsylvania Medicaid 800.692.7462
RHODE ISLAND Yes Effective Now Rhode Island Medicaid 401.462.5300
SOUTH CAROLINA Yes Effective Now South Carolina Medicaid 888.549.0820
SOUTH DAKOTA Yes Effective Now South Dakota Medicaid 605.773.3165
TENNESSEE Tennessee – TennCare 888.816.1680
TEXAS Texas Medicaid 877.541.7905
UTAH Yes Effective Now Utah Medicaid 800.662.9651
VERMONT Yes Effective Now Vermont Medicaid 802 879.5900
VIRGINIA Yes Effective Now Virginia Medicaid 804.786.6273
WASHINGTON Yes Effective Now Washington Medicaid 800.562.3022
WEST VIRGINIA Yes Effective Now West Virginia Medicaid 304.558.5963
WISCONSIN Wisconsin Medicaid 608.266.3901
WYOMING Yes Effective Now Wyoming Medicaid 800.251.1268