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HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

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Page 1: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

HP Enterprise Services

Hometown Health Presentation

November 16, 2010

Partnering for Success!

Page 2: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

2 / Georgia MMIS Presentation November 2010 HP Enterprise Services

AgendaAgenda

Web Portal

Claims Processing

Provider Assistance

PO Boxes

Page 3: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

3 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Web Portal Web Portal Address

www.mmis.georgia.gov

Unable to access: Make sure you have entered the above address ACS is no longer rerouting to the new web portal Close all browsers and then try again

Web Portal Navigational CBT Provider Information>>Web Portal Training

Provider Web Portal Navigational Guide Provider Information>>Provider Manuals

Web Portal User Account Management Guide Provider Information>>Provider Manuals

Page 4: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

4 / Georgia MMIS Presentation November 2010 HP Enterprise Services

EDI Helpdesk EDI Services Phone Number

770-325-9590 or toll free 1 877-261-8785

EDI Email Address: [email protected]

HP staff may begin sending web portal PIN letters via email.   The email address to send the PIN request is above.  When requesting a PIN via email, the following information must be included:

• Individual providers:  Provider name and ID, location address, date of birth and SSN

• Facility providers:  Provider name and ID, and tax ID

Indicate on subject line PIN REQUEST Because of the sensitive information being sent, the email should be

encrypted (secure email). 

Page 5: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

5 / Georgia MMIS Presentation November 2010 HP Enterprise Services

835 and 277U Transactions

HP Enterprise Services is sending 835 and 277U transactions to the Provider Payee ID. 

For any Provider that is receiving their 835 and/or 277U transactions through a Trading Partner (i.e.  Clearing House, Billing Agent etc), those Providers must:

 1. Activate the PIN based on the letter received for the Payee

Provider ID. 

2. Log into the account and delegate the Trading Partner expected to receive the 835 and/or 277U for that Payee Provider ID.

After the weekly cycle is complete, EDI will automatically route the 835 and/or 277U to the TP that was delegated.

Page 6: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

6 / Georgia MMIS Presentation November 2010 HP Enterprise Services

835 Crosswalk

• The EOB / Adjustment Reason / Remark Codes crosswalk has been loaded for HIPAA transactions. The information is located on the web portal

Provider Information>>Provider Notices

Page 7: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

7 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Remittance Advices• At this point HP Enterprise Services has loaded all of the Remittance

Advices (RA) that were provided by the previous Fiscal Agent. HP Enterprise Services does not anticipate getting any additional RAs.

Providers can obtain claim status information through the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov.

NOTE: Please be aware that if the RA image is not present on GAMMIS then it was not received from the previous Fiscal Agent.

• Recommend for ACS last cycle using a range of dates on panel to pull the RA from web portal. Recommend span of Friday to Monday.

Page 8: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

8 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Paper RAsIn cooperation with the Department of Community Health

(DCH), HP Enterprise Services will no longer provide a paper Provider Remittance Advices (RA).

In order to obtain your RA, Providers can log into the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov with your payee identification number and follow the steps below:

1. Click on Reports2. Then click on Financial Reports3. Click on the drop-down tab and select Remittance Advice 4. Enter the From Date and To Date5. Click Search

Page 9: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

9 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Payments Amounts

Where do providers find payments not the RA just payment amounts?

This is the payment summary page that used to be on the GHP site but was never a requirement or request to add on the new site until it was mentioned during the BETA session. Post go live recommendation from BETA.

IVRS• The previous Interactive Voice Response System (IVRS) with

Affiliated Computer Services (ACS), required Healthcare providers to enter their Rendering Identification Number to check the status of their weekly payment check. The new HP Enterprise Services IVRS requires Healthcare providers to enter their Payee Identification Number to gain access to their weekly payment check status.

Page 10: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

10 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Web Portal Procedure SearchIn the GHP portal it indicated if a CPT/HCPCS was covered or non-

covered. Where is this located on the HP portal?

The Procedure Code Search panel allows providers and billing agents to perform searches for procedure code information in relation to Georgia Medicaid.

The Categories of Service panel allows providers and billing agents to view detailed restrictions for the procedure code based on the search criteria entered on the procedure code search panel. An exact match must be identified before displaying results on the panel. The detailed information includes restrictions based on a provider's category of service.

Page 11: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

11 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Claim Search

• Should claims that have been billed show up in the web portal? We are unable to see the claims.

Navigational Path: Claims - Search (Void, Adjust)

Page 12: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

12 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Web Portal_Password Resets

• Challenge Question• EDI Helpdesk

Page 13: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

13 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Provider Enrollment

• Applications pending at close of ACS• Questions about enrollment

– Contact Us_Secure portal– Phone Call; select enrollment option

Page 14: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

14 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Web Portal_Claims

Case Sensitivity for Web claim Submissions

• Due to case sensitive issues, HP Enterprise Services recently became aware of some Provider web portal claim denials.  When entering an online claim, Providers must be aware of how a Members name is entered into the Georgia Medicaid Management Information System (GAMMIS).

In order to avoid denial of the claim, capitalization of Members names must appear in the same format as the name on file with HP Enterprise Services.

If Providers have any questions about the correct capitalization of a Members name, please visit the eligibility section on GAMMIS https://www.mmis.georgia.gov. HP Enterprise Services is currently working to resolve the issue.

Page 15: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

15 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Claim POA

• Edit 4754 Present on Admission (POA)– Edits inactivated Friday 11/12– Claims Scheduled for Reprocessing

11/19

Page 16: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

16 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Inpatient Claim Revenue Codes

• Add revenue codes 110, 120, 130, 140, 150, 170– Corrected– Claims Scheduled for Reprocessing

11/19

Page 17: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

17 / Georgia MMIS Presentation November 2010 HP Enterprise Services

DRG Information

• Providers need to know the calculated DRG to know if a claim has been denied erroneously.

• Currently the remits are only showing the DRG assigned if the claim is in a paid status. – TBD

Page 18: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

18 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Billing Change_Swingbed

• A Level 1 PASSAR screening must be completed prior to a patient being admitted to Swing Bed. The information will be entered as a prior authorization. DCH will begin editing this information on January 01, 2011.

Page 19: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

19 / Georgia MMIS Presentation November 2010 HP Enterprise Services

ACS Denied Claims_Last Cycle• Legacy edit 9856

– HP will convert these claims and begin reprocessing cycle dated 11/20

Page 20: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

20 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Provider Assistance

• Contact Center– Busy Phones

• Getting assistance on basic calls from other accounts

• Adding additional staff on temporary basis• Option to call other phone number for

eligibility information– 877-843-9024 – 800-766-4456

Page 21: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

21 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Member Related Data

• Member ID Cards– If members have not received their new ID

card they can contact either of the numbers to request a reissue.

• PMP Assignment– If hospital authority is showing as some

patients PMP on the web portal, you can request the member to contact HP to select a new PMP.

Page 22: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

22 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Post Office Boxes

ACSCurrent

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

 

UB04 Claims PO Box 105204 Tucker, GA 30085

 

Adjustments & Voids PO Box 105206Tucker, GA 30085

Page 23: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

23 / Georgia MMIS Presentation November 2010 HP Enterprise Services

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 9000 No 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 Part B Claims & OutliersPO Box 105208Tucker, GA 30085

 

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

Page 24: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

24 / Georgia MMIS Presentation November 2010 HP Enterprise Services

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

Page 25: HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

25 / Georgia MMIS Presentation November 2010 HP Enterprise Services

Any questions?