HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!
Agenda Web Portal Claims Processing Provider Assistance PO Boxes 2 / Georgia MMIS Presentation November 2010 HP Enterprise Services
Web Portal Ø Web Portal Address www. mmis. georgia. gov Ø Unable to access: Ø Web Portal Navigational CBT Ø Make sure you have entered the above address Ø ACS is no longer rerouting to the new web portal Ø Close all browsers and then try again Ø Ø Provider Web Portal Navigational Guide Ø Ø Provider Information>>Web Portal Training Provider Information>>Provider Manuals Web Portal User Account Management Guide Ø Provider Information>>Provider Manuals 3 / 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: ediservices. gammis@hp. com 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). 4 / Georgia MMIS Presentation November 2010 HP Enterprise Services
835 and 277 U Transactions HP Enterprise Services is sending 835 and 277 U transactions to the Provider Payee ID. For any Provider that is receiving their 835 and/or 277 U 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 277 U for that Payee Provider ID. After the weekly cycle is complete, EDI will automatically route the 835 and/or 277 U to the TP that was delegated. 5 / 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 6 / 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. 7 / Georgia MMIS Presentation November 2010 HP Enterprise Services
Paper RAs In 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 Reports 2. Then click on Financial Reports 3. Click on the drop-down tab and select Remittance Advice 4. Enter the From Date and To Date 5. Click Search 8 / 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. 9 / Georgia MMIS Presentation November 2010 HP Enterprise Services
Web Portal Procedure Search In the GHP portal it indicated if a CPT/HCPCS was covered or noncovered. 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. 10 / 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) 11 / Georgia MMIS Presentation November 2010 HP Enterprise Services
Web Portal_Password Resets • Challenge Question • EDI Helpdesk 12 / 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 13 / 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. 14 / 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 15 / 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 16 / 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 17 / 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. 18 / 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 19 / 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 20 / 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. 21 / Georgia MMIS Presentation November 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 UB 04 Claims PO Box 105204 Tucker, GA 30085 Adjustments & Voids PO Box 105206 Tucker, GA 30085 22 / Georgia MMIS Presentation November 2010 HP Enterprise Services
Post Office Boxes ACS Current POST OFFICE BOXES continued HP Enterprise Services Future 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 105207 Tucker, GA 30085 Retro Claims/Certified Mail PO Box 888347 Special Handling Documents Part B Claims & Outliers PO Box 105208 Tucker, GA 30085 Non-Claim (miscellaneous) Documents PO Box 105209 Tucker, GA 30085 23 / 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 105208 Tucker, GA 30085 24 / Georgia MMIS Presentation November 2010 HP Enterprise Services
Any questions? 25 / Georgia MMIS Presentation November 2010 HP Enterprise Services
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