HP Enterprise Services Home. Town Health Presentation October 6, 2010 Partnering for Success!
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 1 877 -261 -8785 ediservices. gammis@hp. com • 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 (golive) on November 1, 2010. 2 / Georgia MMIS Presentation October 2010 HP Enterprise Services
EDI Reminder EDI PES CBT is loaded on the readiness website PES software replaces Win. ASAP 3 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Provider Readiness Web Portal Ø Web Portal Address http: //providerinfo. mmis. georgia. gov/providerprere adiness/home. aspx Ø CBTs for PES training Ø Remaining Workshop Dates/Locations Ø Workshop presentations Ø GMCF Training Documents Ø Pod. Casts 4 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Post Office Boxes ACS Current POST OFFICE BOXES HP Enterprise Services Future POST OFFICE BOXES Member Correspondence PO Box 3000 Member & Provider Correspondence PO Box 105200 Tucker, GA 30085 Provider Enrollment PO Box 4000 Provider Enrollment & EDI Services PO Box 105201 Tucker, GA 30085 Claims PO Box 5000 CMS 1500 Claims PO Box 105202 Tucker, GA 30085 Crossover Claims PO Box 105203 Tucker, GA 30085 ADA 2006 Dental Claims PO Box 105205 Tucker, GA 30085 Adjustments & Voids PO Box 105206 Tucker, GA 30085 5 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Post Office Boxes ACS Current POST OFFICE BOXES Special Projects PO Box 6000 continued HP Enterprise Services Future POST OFFICE BOXES No Corresponding PO Box Nurse Aid Registrations & PAs PO Box 7000 No Corresponding PO Box Returned Mail PO Box 9000 TPL/ Finance/ Buy-in PO Box 105207 Tucker, GA 30085 Finance PO Box 888386 Retro Claims/Certified Mail PO Box 888347 Special Handling Documents PO Box 105208 Tucker, GA 30085 Non-Claim (miscellaneous) Documents PO Box 105209 Tucker, GA 30085 6 / Georgia MMIS Presentation October 2010 HP Enterprise Services
GMCF PO Boxes (new) Review/Mail Type PO Box 105753 Atlanta, GA 30348 Nurse Aide Program PO Box 105329 Atlanta, GA 30348 Prior Authorization PO Box 105330 Atlanta, GA 30348 Medical Claims Review, SURS, CIS Waiver: Katie Beckett; GAPP; ICWP PO Box 105406 Atlanta, GA 30348 7 / Georgia MMIS Presentation October 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 105208 Tucker, GA 30085 8 / Georgia MMIS Presentation October 2010 HP Enterprise Services
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 9 / Georgia MMIS Presentation October 2010 HP Enterprise Services
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: • 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. 10 HP Enterprise Services PO Box 105208 Tucker, GA 30085 -5208 / Georgia MMIS Presentation October 2010 HP Enterprise Services
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: ______ 11 / Georgia MMIS Presentation October 2010 HP Enterprise Services
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 12 / Georgia MMIS Presentation October 2010 HP Enterprise Services
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 13 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 30 days October 1 TRAINING -Business Office Director and Medicaid Billers Completed HP Provider Training - sessions still available in October https: //www. seeuthere. com/rsvp/invitation. asp? id=/m 1 c 9 c 3 a 711 A 8 GNN 81 V 2 UB BILLING -Download new billing manual for 1500 and UB-04 http: //providerinfo. mmis. georgia. gov/providerprereadiness/Forms. Manuals. aspx -Review Part II Policy & Procedure Manual -Pay attention to new Remittance Advice Codes 14 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 30 days EDI 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 X 12 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. 15 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 30 days EDI 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/Peach. Care 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 WINASAP 2003 16 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 30 days EDI CHECKLIST Continued EDI FAQ's: http: //providerinfo. mmis. georgia. gov/Provider. Pre. Readiness/Link. Click. aspx ? fileticket=e-Jd 7 l. V 71 Z 4%3 D&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 24 th -Document status of all Provider Enrollment applications with Jackie Koffi at DCH - Medicaid. -Review Mail-to address information for practice/providers, update as needed. 17 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 20 working days October 4 th -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 18 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 15 working days October 11 th -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 website http: //providerinfo. mmis. georgia. gov/providerprereadiness/Home. aspx 19 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 10 working days October 18 th -Address any existing open items. -Continue daily monitoring of website http: //providerinfo. mmis. georgia. gov/providerprereadiness/Home. aspx - Continue daily monitoring of emails from Home. Town Health or DCH 20 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 7 working days October 21 st -Final day to submit claims to ACS via WINASAP Software 21 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist - 6 working days October 22 nd -Final day to submit claims to ACS via Web Portal or through clearinghouse 22 / Georgia MMIS Presentation October 2010 HP Enterprise Services
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 23 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Cutover Checklist – 15 working days after 15 DAYS AFTER CUTOVER Attend the HTH Annual Fall Conference to meet HP Medicaid Hospital Rep Cheryl Kelly and bring your questions for Mary Ann Barndt-Williams 24 / Georgia MMIS Presentation October 2010 HP Enterprise Services
Any questions? 25 / Georgia MMIS Presentation October 2010 HP Enterprise Services
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