HP Enterprise Services HomeTown Health Presentation

HP Enterprise Services

HomeTown Health Presentation

October 6, 2010Partnering for Success!

2 / Georgia MMIS Presentation October 2010 HP Enterprise Services

Web Portal PIN Letters• Web Portal User Account Management Guide

• Provider Change of Information Form available on readiness website.

• If you have not received the PN letter, contact EDI Services at:

770-325-9590 or toll free 1 [email protected]

• Provider IDs that were enrolled or became active in the Georgia Medicaid/Peach Care for Kids Program after July 31, 2010, must wait to receive their new MMIS Web Portal PIN in the mail after conversion has occurred or after (go-live) on November 1, 2010.


EDI PES CBT is loaded on the readiness website

PES software replaces WinASAP

EDI Reminder


Provider Readiness Web Portal

Web Portal Address

http://providerinfo.mmis.georgia.gov/providerprereadiness/home.aspx

CBTs for PES training

Remaining Workshop Dates/Locations

Workshop presentations

GMCF Training Documents

PodCasts


Post Office BoxesACS

Current POST OFFICE BOXES

HP Enterprise ServicesFuture

POST OFFICE BOXES

Member Correspondence PO Box 3000

Member & Provider CorrespondencePO Box 105200Tucker, GA 30085

Provider Enrollment PO Box 4000

Provider Enrollment & EDI ServicesPO Box 105201Tucker, GA 30085

Claims PO Box 5000

CMS 1500 Claims PO Box 105202Tucker, GA 30085

Crossover ClaimsPO Box 105203Tucker, GA 30085

ADA 2006 Dental Claims PO Box 105205Tucker, GA 30085

Adjustments & Voids PO Box 105206Tucker, GA 30085


Post Office Boxes continued

ACSCurrent

POST OFFICE BOXES

HP Enterprise ServicesFuture

POST OFFICE BOXES

Special Projects PO Box 6000 No Corresponding PO Box

Nurse Aid Registrations & PAs PO Box 7000

No Corresponding PO Box

Returned Mail PO Box 9000No Corresponding PO Box

Finance PO Box 888386

TPL/ Finance/ Buy-in PO Box 105207Tucker, GA 30085

Retro Claims/Certified Mail PO Box 888347

Special Handling Documents PO Box 105208Tucker, GA 30085

Non-Claim (miscellaneous) DocumentsPO Box 105209Tucker, GA 30085


GMCF PO Boxes (new)Review/Mail Type PO Box 105753

Atlanta, GA 30348

Nurse Aide Program PO Box 105329Atlanta, GA 30348

Prior Authorization PO Box 105330Atlanta, GA 30348

Medical Claims Review, SURS, CISWaiver: Katie Beckett; GAPP; ICWP

PO Box 105406Atlanta, GA 30348


Medicare Part B Inpatient Only Claims• Medicare EOB attached and should

not be handled like regular claims therefore PO Box to send these claims is Special Handling Documents

• PO Box 105208Tucker, GA 30085


Strategic National Implementation Process

• SNIP 4

• Will balance the claims

• Error report will be given if it does not balance correctly

• Affects 837 claims, it will not affect claims that are submitted via the Web Portal or PES


Outliers• The original claim processes and the provider receive an explanation of benefits (EOB) message

stating that this is a potential outlier claim.

– EOB 4399 - DRG CLM QUALIFIES AS OUTLIER.

• The outlier adjustments are processed in the system. The outlier adjustment is recalculated to determine if the claim is going to pay additional money.

– Outlier adjustments claims that meet the outlier threshold receives the EOB message EOB 9975 - IO - OUTLIER PRICING.

– If the Outlier claim no longer meets the outlier threshold, the Outlier claim will pay the same as the original claim and receive a letter - Outlier Initial Outlier Review Threshold DRG Denial Letter.

• The PO Box to send an outlier is:HP Enterprise Services

PO Box 105208Tucker, GA 30085-5208

• The items on the following slide must be submitted as outlined below for outlier review. Only required chart documents should be submitted for review. If the entire chart is submitted the record is not reviewed and the provider must resubmit the outlier record with only the required documents.


Cost Outlier Document Checklist* Cover Letter naming Contact Person * Copy of Original Claim(s) * Copy of Paid Remittance(s) Advice or Rendering Provider Activity Report * Detailed Itemized Charges with Revenue Codes * Charges documented on itemized bill correlate with UB-04 * Itemized bill is numbered by provider and quantities billed documented * Total charges and DOS match on itemized bill, RA and UB-04 * Charges documented in the itemized bill but not billed on the UB-04 are

identified and marked through on the itemized bill * Utilization Review Notes documenting severity of illness and intensity of

service criteria met, notes must be signed and dated * Physician Discharge Summary * Physician Orders * Operative Report (OR) Procedure Notes (if applicable). * Physical/Occupational/Speech/Respiratory Therapy Notes (if applicable) * Chart is organized and labeled for review and only documents required are

submitted * Request submitted within 90 day deadline of paid RA

Completed by: __________________ Date of completion: ____________


Transition Item Suspended Claims• Last ACS cycle suspended claims will be

denied.

• Claims will be denied for the following EOBs:– legacy edit 9855 and– legacy edit 9856

• HP will convert these claims and begin reprocessing cycle dated 11/8


Cutover Checklist - 30 days Oct. 1 - The following items should already be completed

PROVIDER PIN LETTERS-All Providers should have received Provider Personal Identification Number (PIN) Letter Mailing.

WEB PORTAL-Providers should have received a Web Portal registration information and PIN letter in September-Regardless of whether you bill on the portal ALL providers must register/activate their pin number as outlined in letter.-Providers must add billing agents when creating the new account.-The billing agent’s email address is required to add the agent as an authorized user.-Web portal training is included in HP Implementation training


October 1TRAINING

-Business Office Director and Medicaid Billers Completed HP Provider Training - sessions still available in Octoberhttps://www.seeuthere.com/rsvp/invitation/invitation.asp?id=/m1c9c3a7-11A8GNN81V2UB

BILLING-Download new billing manual for 1500 and UB-04 http://providerinfo.mmis.georgia.gov/providerprereadiness/FormsManuals.aspx -Review Part II Policy & Procedure Manual-Pay attention to new Remittance Advice Codes

Cutover Checklist - 30 days


Cutover Checklist - 30 daysEDI CHECKLIST

-Confirm that Clearinghouses, Software Vendors, and Billing Agents have tested with HP and refer them to this link: http://providerinfo.mmis.georgia.gov/providerprereadiness/home.aspx

-All EDI Trading Partners who are currently enrolled with ACS to submit or retrieve electronic transactions must contact EDI Services to have their new trading partner Web Portal account setup with HP Enterprise Services and be assigned to their trading partner ID

-These trading partner Web Portal accounts will not be automatically created or converted from ACS’ system (only the enrollment of the trading partner submitting electronically will be converted, not the Web Portal account). If these trading partner EDI Web Portal accounts are not setup by the EDI Services team, the provider will not be able to delegate the EDI trading partner to download EDI X12 files (835-ERA’s) on the providers’ behalf and the trading partner will also be unable to Upload EDI batch files using the Web Portal.


Cutover Checklist - 30 daysEDI CHECKLIST Continued

ACTION REQUIRED TO RECEIVE 835 FROM CLEARINGHOUSE -Once the trading partner Web Portal account has been setup and assigned by EDI Services, please inform your Georgia Medicaid/PeachCare for Kids™ providers that in order for you to receive their 835 (ERA’s) on their behalf, the providers must logon to their secure web portal account, select Account Management, and click “Add Agent” to delegate your assigned trading partner Web Portal account. Please be sure to give them your assigned Web Portal trading partner user name and your registered e-mail address, so that they may delegate the correct EDI trading partner account.

-PES Software: If you do not submit Medicaid claims through a clearinghouse or directly on the portal then download new software to replace WINASAP2003


Cutover Checklist - 30 daysEDI CHECKLIST Continued

EDI FAQ's:http://providerinfo.mmis.georgia.gov/ProviderPreReadiness/LinkClick.aspx?fileticket=e-Jd7lV71Z4%3D&tabid=61

TESTING: Ensure that your hospital or your Clearinghouse has tested with HP - see notes

PROVIDER ENROLLMENT/Physician related-Do not submit provider enrollment applications to DCH/ACS past September 24th

-Document status of all Provider Enrollment applications with Jackie Koffi at DCH - Medicaid.

-Review Mail-to address information for practice/providers, update as needed.


Cutover Checklist - 20 working days October 4th

-Continue to monitor current ACS claim submissions and follow-up any open claims.

-Submit test electronic claims if using new PES Software.

-Address and resolve any electronic claim issues within 10 business days.

-Begin daily monitoring of GA MMIS web site for updates - http://providerinfo.mmis.georgia.gov/providerprereadiness/Home.aspx



-Continue to monitor current ACS claim submissions.

-Verify EDI and ERA connections are operational.

-Collect and record all HP telephone and fax numbers for: -Customer Service, -Provider Enrollment -Provider Relations-EDI-ERA

-Place test calls and become familiar with the GA MMIS IVR query system.

-Continue daily monitoring of websitehttp://providerinfo.mmis.georgia.gov/providerprereadiness/Home.aspx



-Address any existing open items.

-Continue daily monitoring of websitehttp://providerinfo.mmis.georgia.gov/providerprereadiness/Home.aspx

- Continue daily monitoring of emails from HomeTown Health or DCH


Cutover Checklist - 7 working daysOctober 21st

-Final day to submit claims to ACS via WINASAP Software


Cutover Checklist - 6 working daysOctober 22nd

-Final day to submit claims to ACS via Web Portal or through clearinghouse


Cutover Checklist - 3 working days after

AFTER CUTOVER

-Attend the HTH Medicaid Webinar to report status of your claims following conversion to HP and receive guidance from HP


Cutover Checklist – 15 working days after

15 DAYS AFTER CUTOVERAttend the HTH Annual Fall Conference to meet HP Medicaid Hospital Rep Cheryl Kelly and bring your questions for Mary Ann Barndt-Williams


Any questions?