Cancer Control Program

Information for Health Care Providers

If you wish to provide screening services for the Program, please call John Veazey at 401-222-6843. Reimbursement to providers is based on 80% of the participating provider fee schedule for Rhode Island Medicare.

For information not found on this website concerning program services, management, or statistics, please call Brenda DiPaolo, Program Director, at 401-222-1161.

For additional copies of Provider Guidelines, Forms and Instructions, please call Brenda DiPaolo at 401-222-1161

Frequently Asked Questions (FAQ) for Health Care Providers:

1. How often should a new Enrollment Form be completed?
2. Where should the stamps be placed?
3. Are Site Numbers still used?
4. How do we know if a CPT Code is reimbursable?
5. Who is eligible for Medical Assistance (Title XV)?
6. When should a woman be enrolled in Medical Assistance?
7. If eligible for Medical Assistance, how long does a woman have
coverage?
8. What is the scope of coverage under the Title XV Medical
Assistance option?
9. What is the notification process of enrollment into Medicaid?
10. Does the WCSP provide on-site training about how to fill out the clinical forms?
11. What happens with all the screening results and data submitted to the WCSP?

1. How often should a new Enrollment form be completed?
New Enrollment forms should be completed annually. If a client is new to your facility, have her complete an Enrollment form (this assists WCSP with Tracking clients through screening and follow-up process).
Bottom Line: When in doubt, Enroll!

2. Where should the stamps be placed?

• Your office stamp may be placed on all WCSP Enrollment and Screening Forms or the 3-digit stamp may be used.
• The Women’s Cancer Screening Program Stamp MUST BE PLACED ON ALL PAP SMEAR REQUISITIONS AND ALL MAMMOGRAM REFERRALS, ETC. This is the FLAG for the lab or radiology facility to invoice the WCSP and not the client for services provided.

3. Are Site Numbers still used?
In previous years, the WCSP provided a 3-digit code to all Providers. We will continue to honor the 3-digit code sites. All new Providers, enrolled within the last few years, have not been assigned with a 3-digit code. Important: Each invoice must have either a 3-digit site code or the name of the referring physician.

4. How do we know if a CPT Code is reimbursable?
To find out if a CPT is reimbursable, you need to refer to the WCSP current Provider Reimbursement Schedule.

5. Who is eligible for Medical Assistance (Title XV)?

• Woman has met the WCSP eligibility criteria (income and age);
• Woman must reside in RI;
• Woman must be a U.S. Citizen or a qualified immigrant (please submit copy of permanent resident alien card along with the Medical Assistance application). Note: Working VISAs or copies of SSN cards are not considered proof of permanent resident alien status;
• Woman must have no other individual or group insurance;
• Woman needs treatment for breast or cervical cancer or a pre-cancerous condition of the breast or cervix.

6. When should a woman be enrolled in Medical Assistance?

• A woman should complete a Medicaid application as of the date in which treatment was recommended by her provider indicating the need for the following diagnostic/treatment procedures:
• For Cervical Cancer Procedures > L.E.E.P’s, “CONES” or beyond
• For Breast Cancer Procedures > All Biopsies (Surgical, Stereotactic, Ultrasound Guided) or beyond.
• The CLINICAL CONTACT at the health care site must submit an enrollment form as well as the screening results indicating the NEED FOR TREATMENT.
• The ORIGINAL completed and signed Medical Assistance Application form and the ORIGINAL Verification of Need indicating the need for treatment form should be mailed to the Case Management Coordinator at the RI Dept. of Health.

7. If eligible for Medical Assistance, how long does a woman have this coverage?

• A woman with a pre-cancerous condition is eligible for services for 4 months; at the end of 4 months a re-determination is made by DHS. A woman will not be removed from Medicaid without prior correspondence from the DHS office.
• A woman with a cancerous condition is eligible for services for 1 year; at the end of this period a re-determination is made by DHS.
• DHS will correspond directly with the woman regarding re-determinations.

8. What is the scope of coverage under the Title XV Medical Assistance option?
During the period of eligibility, a woman is entitled to full Medicaid coverage. Coverage is not limited to treatment of a pre-cancerous condition or diagnosis of cancer. DHS staff contact each client enrolled into Medicaid to explain the scope of services available through Medicaid Assistance once a client is accepted into the Medicaid program.

9. What is the notification process of enrollment into Medicaid?

• As soon as all required forms are received by HEALTH, the WCSP Case Management Coordinator will meet with a representative from DHS to determine eligibility (usually within 7 days of receipt of completed application by HEALTH).
• On the following workday, the Case Management Coordinator calls the Provider Site that initiated enrollment into Medicaid to inform them of the decision (if they are enrolled in Medical Assistance and effective date of enrollment).
• In most cases, DHS will call the woman within 24 hours to notify her of eligibility.
• In about a week, the WCSP Case Management Coordinator will also contact the woman to ensure the woman understands the program and the benefits and to answer any other questions the woman may ask.
• The WCSP fiscal staff will contact each provider site for invoices submitted to the Program to inform them of the client’s Medicaid coverage.

10. Does the WCSP provide on-site training about how to fill out the clinical forms?
Yes. All Participating screening providers are trained prior to providing services for the program. The WCSP will visit the provider site at a time agreed upon by the office staff to review the necessary forms to be completed by the site for each woman enrolled in the WCSP. Additionally, on an as needed basis, WCSP staff will visit a provider site to retrain staff as a result of staff turnover and present any information needed regarding program services, eligibility requirements, enrollment procedures (including MA enrollment for certain clients), and procedures for filling out clinical data forms.

11. What happens with all the screening results and data submitted to the WCSP?

• All screening results are entered into CaST (Cancer Screening and Tracking System);
• CaST allows the Program to track women through the length of the study;
• CaST has the ability to generate reports and queries;
• CaST data is submitted to CDC April 15th and October 15th;
• For each client out of compliance (60 days from screening to diagnosis, 60 days from diagnosis to treatment), WCSP is required to document reasons for non-compliance. WCSP will contact the Provider site for information needed for each and every woman who is out of compliance.