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HP Enterprise Services
Hometown Health Presentation
November 12, 2009
Partnering for Success!
2 / Georgia MMIS Presentation November 2009
AgendaAgenda
• Introduction/Background
• Project Phases
• Testing Approach
• Claim Submission
• Provider Assistance
• Questions
3 / Georgia MMIS Presentation November 2009
We’re Excited to be Back…
History in Georgia
Georgia MMIS Fiscal AgentJuly 1, 1987 – March 31, 2003
Georgia Immunization Registry SystemMay 2003 – Present
Data BrokerMarch 2008 – Present
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Project PhasesProject Phases
EDS System Development Life Cycle
√ Startup√ Design
√ Development√ System Testing
User Acceptance TestingImplementation
5 / Georgia MMIS Presentation November 2009
User Acceptance TestingDecember 2009 – June 2010
– DCH subject matter experts will create and execute test cases designed to thoroughly test the new MMIS.
Provider Beta TestingMarch 2010 – April 2010
– Selected provider’s will have an opportunity to participate in testing the new MMIS solution.
Electronic Data Interchange TestingFebruary 2010 – May 2010
– All providers who submit claims electronically will be required to submit test claims to EDS to ensure they can successfully submit claims prior to July 1, 2010.
– All clearinghouses, billing services and vendors will be required to submit test claims to EDS to ensure they can successfully submit claims prior to July 1, 2010.
Testing Timeframes
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Operational Readiness TestingMarch 2010 – May 2010
– DCH subject matter experts will create and execute test cases designed to thoroughly all operational areas of the EDS Account.
– EDS Account staff participate in Operational Readiness Testing, including:
• Provider Enrollment• Member Enrollment• Call Center• Data Entry• Resolution• Electronic Data Interchange• Mailroom• Buy In• Teaming Partners
Testing Timeframes
7 / Georgia MMIS Presentation November 2009
Claim Submission
Web Portal
HIPAA X12 837 Format
Electronic Data InterChange Clearinghouses Vendors Billing Services EDS Software
interChange accepts multiple media, including: Magnetic Tape CD FTP Bulletin Board via PC modem dial up POSnet Internet
Paper UB04
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Provider Assistance
Web PortalComputer Based TrainingContact UsClaim StatusClaim SubmissionEligibility verificationProvider EnrollmentRemittance AdvicesFAQManualsWorkshop Locations/Data
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Provider Assistance
Provider Enrollment TeamEnrolling Providers
Web Portal applications Paper applications
Workflow Instant identification of enrollment application in process Automatic routing to next step in enrollment process
Provider Enrollment Assistance
Member Enrollment Team
Enrolling Members Presumptively eligible pregnant women Presumptively eligible newborns, including multiple births
Provider Member Enrollment Assistance
10 / Georgia MMIS Presentation November 2009
EDI HelpdeskWeb Portal Password ResetsEnrolling Providers in Electronic Claim SubmissionTesting Provider and Vendors prior to Electronic Claim
SubmissionAssistance
EDI related questions Transmission questions
WinASAP will no longer be accepted; providers must transition to PES or other electronic software. EDI
related questions
Provider Assistance
11 / Georgia MMIS Presentation November 2009
Provider Assistance
Contact CenterAutomated Voice Response
Claim Status Check Amounts Prior Authorization Status Member Eligibility
Member Contact Center 1-866-211-0950
Provider Contact Center 1-800-766-4456
Written Correspondence Team
Field Representatives 11 Field Representatives – 1 Hospital Field Representative Attend provider association meetings Presenting training seminars to providers requesting such training Offering on-site visits and training to providers and office billing staff Offering on-site visits for claims resolution assistance Billing Manuals
12 / Georgia MMIS Presentation November 2009
Field Representative Territories
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Provider Training
Provider Training
Statewide April 2010 – June 2010 166 Workshops Total 28 Institutional WorkshopsOngoing training throughout life of contractAssociation MeetingsMedicaid Fairs
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Tentative April Workshop Schedule
City Day of Wk Date
Duluth Thursday 4/1/2010
Marietta Monday 4/5/2010
Cartersville Tuesday 4/6/2010
Conyers Wednesday 4/7/2010
Atlanta Thursday 4/8/2010
Macon Monday 4/12/2010
Fitzgerald Wednesday 4/14/2010
Augusta Friday 4/16/2010
Columbus Monday 4/19/2010
Savannah Thursday 4/22/2010
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Tentative May Workshop Schedule
City Day of Wk Date
Duluth Monday 5/3/2010
Atlanta Friday 5/7/2010
Albany Tuesday 5/11/2010
Fitzgerald Wednesday 5/12/2010
Savannah Monday 5/17/2010
Thomasville Friday 5/21/2010
Augusta Wednesday 5/26/2010
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Tentative June Workshop Schedule
City Day of Wk Date
Duluth Tuesday 6/1/2010
Marietta Wednesday 6/2/2010
Cartersville Thursday 6/3/2010
Conyers Friday 6/4/2010
Atlanta Monday 6/7/2010
Savannah Wednesday 6/9/2010
Augusta Monday 6/14/2010
Columbus Tuesday 6/15/2010
Atlanta Thursday 6/17/2010
Macon Thursday 6/17/2010
Thomasville Friday 6/18/2010
17 / Georgia MMIS Presentation November 2009
• The EDI cut off is noon each Friday.
• EDS will process fee for service claims each week and continue to issue payments on a weekly basis
• Each individual working for a provider must have their own password to access the web portal
Other Information
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Transition Items
HP Enterprise Services will mail new Member ID Cards in June 2010
HP Enterprise Services will mail Web Portal PIN letters to providers
May/June 2010
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ACS Last Claims Cycle - June 25, 2010 Last day to submit electronic claims for processing -
June 25, 2010 Last day paper claims are received for processing -
June 18, 2010 Last day to receive calls - June 30, 2010
HP Enterprise Services First Claims Cycle - July 2, 2010 First day to submit electronic claims for processing –
June 28, 2010 First day paper claims are received for processing - June 21, 2010 First day to receive calls - July 1, 2010
Tentative Timeframes
