HP Enterprise Services HomeTown Health Presentation September 9, 2010 Partnering for Success!

HP Enterprise Services

HomeTown Health Presentation

September 9, 2010

Partnering for Success!

2 / Georgia MMIS Presentation September 2010 HP Enterprise Services

Provider Beta Testing

August 16 – August 20 TuckerAugust 30 – September 3 Cordele

Feedback from Participants?

BETA Testing and Workshops


Web Portal PIN Letters

• Each current Georgia Medicaid provider will receive a Georgia Health Partnership Web Portal registration information letter, mailed last week, indicating their login and temporary password.

• The Georgia Health Partnership Web Portal registration information letter will be sent to the “mail to” address on file.

• Each provider must create a username and password prior to accessing the Georgia Health Partnership Web Portal for any claims related functionality available via the secure area of the Georgia Health Partnership Web Portal.

• Web Portal User Account Management Guide

• Provider Change of Information Form available on readiness website.


EDI Helpdesk

EDI Services Phone Number Available after September 1, 2010770-325-9590 or toll free 1 877-261-8785

EDI Email Address: [email protected]

EDI PES CBT will be on readiness website by end of week

PES software will be available on readiness website on October 1, 2010

Provider Assistance


Claims with Two Precerts

• The new MMIS will not allow for two prior authorizations to be submitted on the same claim. However there are changes associated with the submission of these claims.

• DCH and GMCF have added an additional prior authorization code ZT for Physical Therapy, Speech Therapy and Occupational Therapy. ZD is the prior authorization code for Drug Therapy.

• Providers must use the condition code GO ‘distinct medical visit on same day’ (FL 18-28) on both claims. The new MMIS has been designed to recognize the GO condition code and will not deny the second claim as a duplicate of the first claim. The appropriate PA is placed in FL 63 Treatment Authorization Codes.


Billing Manuals will be available via the web portal. The current billing information contained in the DCH Part I Policy and Procedures Manual will be removed.

The UB-04 Billing Manual is on the readiness website for review.

Transition Information


5010 and Web Portal-InstitutionalInstitutional Header (NEW)• Release of Information values removed, leaving I (Informed

Consent) and Y (Yes) as the only values per 5010.

• Admission Type will be required for all Institutional claim types.

• Admit Source will be required on all IP and OP claims.

• Patient Status will be required for all Institutional claims types.

• Remove Covered and Non Covered Days fields from the header. This will be sent through the value panel only. Value 80 (Covered Days) Value 81 (Non Covered Days)

• Other Physician 2 will be removed.


5010 and Web Portal-Institutional


Institutional Diagnosis Changes

• Increasing the allowance of E-Codes to be sent to 12.

• Increasing the allowance of Patients Reason for Visit to be sent to 3.

• Patient Reason for Visit will be required on an OP claim. New error message "Patient's Reason for Visit is Required for Outpatient" (STILL IN DISCUSSION WITH EDI)



Institutional Detail (NEW)• Accommodation Rate removed.• Drug Unit Count and Drug Unit of Measure fields being

added.



Professional Header (NEW)

• Related Cause Code 3 Removed.

• Release of Information values removed, leaving I (Informed Consent) and Y (Yes) as the only values.

• Accident Date will be required if Related Cause Code = AA (Auto Accident) or OA (Other Accident).

• Accident State will be required if Related Cause Code = AA (Auto Accident).

• Related Cause Code will be required if Accident State or Accident Date are entered.

5010 and Web Portal-Professional




Professional Detail (NEW)

• Medicare Allowed Amount field removed. This value is being pre-calculated by the system.

• Drug Unit Count and Drug Unit of Measure fields are being added.

• Diagnosis Pointer values changed from 1-8 to 1-12. 5010 will now allow up to 12 diagnosis codes on professional.





Member Professional Detail (NEW)

• Medicare Allowed Amount field removed. This value is being pre-calculated by the MMIS. Value cannot be displayed that isn’t permitted by HIPAA.



Other Payer Header - all claim types (NEW)

• Date of Birth, Gender and Allowed Amount removed. Allowed Amount is pre-calculated by the MMIS.

• Insurance Type Code removed from Institutional. Values are changing.

• Payer Responsibility with 5010 will allow more values. For 4010, we display Primary, Secondary, Tertiary. 5010 expands that to fourth, fifth, sixth, etc.

• Group or Policy Number is becoming an optional field.

• Insurance Company Name is becoming an optional field.

• Relationship and Claim Filing values changing.

5010 and Web Portal-All Claim Types


5010 and Web Portal-All Claim Types Institutional

Professional


Member Other Payer Header - all claim types (OLD)

Member Other Payer Header - all claim types (NEW)

Medicare Allowed Amount field removed. This value is being pre-calculated by the MMIS. A Value cannot be displayed that isn’t permitted by HIPAA.

5010 and Web Portal-All Claim Types


Any questions?

Documents

HP Enterprise Services HomeTown Health Presentation September 9, 2010 Partnering for Success!