New Provider Workshop

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Lambert Harper
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1 New Provider Workshop AFMC MMIS Subcontractor for the Arkansas Division of Medical Services June 2018

2 Agenda Introduc-on: The New MMIS system Let s get started: Nine-digit provider ID, NPI Who and what is Medicaid? Different en<<es: DMS, DCO, AFMC, HMS, OMIG, DXC, etc. Billing ma<ers: Provider manual, billing <ps, <mely filing, eligibility verifica<on (crosswalks) The new portal: Features, brief demo (eligibility overview, how to access RA, check status, request PA,) Things to know: Hot topics and issues Contacts: Frontline, job aids, PAC, EDI, representa<ves map

3 Let s get started Nine-digit provider ID and what it means NPI Atypical not needing an NPI Addi;onal things to know at the beginning

4 Who and what is Medicaid? Department of County Offices (DCO) Division of Medical Services (DMS) AFMC o MMIS outreach specialists: o ConnectCare: o Provider relanons outreach specialists: providerrelanons@afmc.org o AFMC ReviewPoint prior authorizanons help desk: Beacon Health Strategies: Health Management Systems (HMS): HMS-0184 Office of Medicaid Inspector General (OMIG): DXC Technology:

5 DHS County Offices Work directly with beneficiaries Determine eligibility, plan description and eligibility timeframe Assist with primary care physician (PCP) selection

6 DHS Division of Medical Services (DMS) Administers Arkansas Medicaid DMS establishes policy for all Medicaid programs Utilization review assists with claims and makes coverage determinations Medical assistance manages program communications plus dental and visual programs Pharmacy makes coverage determinations and manages all drug-related issues

7 AFMC Serves as a liaison for Medicaid and providers: primary care providers, specified specialty providers, PCMH-PT and acute care hospitals Manages Medicaid quality improvement projects, including the Inpatient Quality Incentive (IQI) program Operates beneficiary complaint and transportation help lines Provides utilization and quality review for various Medicaid programs Authorizes extensions of benefits

8 AFMC - MMIS Provider Outreach Specialist Provider outreach specialists handle billing that has been escalated from the Provider Assistance Center. They are also available to visit your office by appointment. This can be done virtually or face-to-face. You can find your provider outreach specialist at or on the Medicaid website under AFMC Outreach Specialist You may contact your representadve by calling and entering their extension (please refer to the map)

9 AFMC ConnectCare Helpline Assigns and changes beneficiaries PCP Educates beneficiaries about Medicaid s confirma9on no9ces, PCP lists, and outreach materials to beneficiaries Processes PCP dismissals Coordinates with caseworkers to assign PCPs for foster children

10 AFMC Provider Rela1ons Outreach Specialist Provider relations outreach specialists are policy experts and educators who work with health care providers. They help practices navigate the Medicaid system and stay up-to-date on policy and procedures. During visits the specialists will educate on state initiatives, provide educational tools to implement best practices and gather feedback for the state. Some of the current initiatives include: Patient Centered Medical Home (PCMH) PASSE You can find your provider relations outreach specialist map and provider packets with updated information at You can also visit the Medicaid website and the specialists are listed under Medicaid Managed Care Services (MMCS) Outreach Specialist

11 AFMC ReviewPoint AFMC s current scope of clinical review provides prior authorization (prospective) and/or extension of benefits for the following: Surgical/medical procedures, assistant surgeons for inpatient hospital, inpatient concurrent for Medicaid Utilization Management Program (MUMP), organ and bone marrow transplants, DME (wheelchair/prosthetics), hyperalimentation, targeted case management Therapy EOB/PA therapy services more than 90 minutes per week, extension of benefits (EOB), molecular pathology, personal care for under 21, conduct reviews and prior authorizations for Child Health Management Services Prior Authorizations Help Desk:

12 Beacon Health Strategies Mental Health Provides u+liza+on management, con+nuing educa+on and inspec+ons of inpa+ent and outpa+ent mental health facili+es for beneficiaries enrolled in the Medicaid program Approves prior authoriza+ons, cer+fica+ons of need (CON) and con+nuing stay reviews hcp:// Receives general ques+ons at:

13 HMS Third-party Recovery Health Management Systems (HMS) provides services that iden8fy third-party payment sources (such as commercial insurance and health plans, Medicare and TRICARE) and recovers public health plan expenditures when third-party liability exists HMS-0184

14 Office of Medicaid Inspector General Program Integrity OMIG detects schemes of fraud, curbs unacceptable practices, and improves quality of care as it relates to Medicaid fraud, waste and abuse. Medicaid fraud can be reported by calling: Arkansas Medicaid Inspector General's Hotline: AR-OMIG ( ), or Report on the website: hfp://omig.arkansas.gov/

15 DXC Technology Fiscal Agent Provider enrollment Claims processing Remi4ance advice Provider Assistance Center (PAC) Electronic Data Interchange (EDI) Medicaid Management Informa>on System (MMIS)

16 DXC Technology Provider Enrollment Monday through Friday (8 a.m. 5 p.m.) Toll-free in Arkansas: Local or out-of-state: Dedicated fax: DXC Technology PO Box 8105 LiHle Rock, AR

17 DXC Technology Provider Assistance Center (PAC) Your first point of contact for billing, claim status, and other general ques8ons is PAC: Monday through Friday (New hours: 6 a.m. 6 p.m.) Toll-free in Arkansas Local or out-of-state

18 Billing ma)ers New benefits plans (crosswalk helps determine coverage) Benefit limits (Sec;on II) Timely filing guidelines How to submit pseudo claims Ways to submit claims via Portal, PES, Vendor and Paper Healthcare portal registra;on: you must register to use the portal *Note: PES will be going away soon

19 Training tools and resources Medicaid website: Frontline Provider manuals FAQs Vendor specs Fee schedule PES software *Note: PES will be going away soon

20 Provider manuals Sec$on I General policy General informa$on, sources, beneficiary eligibility and responsibili$es, provider par$cipa$on, administra$ve (and non-compliance) remedies and sanc$ons, PCP case management program, and required services and ac$vi$es Sec$on II Provider manual (varies by provider type) Program or provider specific informa$on, program coverage, prior authoriza$on, reimbursement and billing procedures Hint: When searching the manual use Control+F for a faster search

21 Provider manuals Section III Section IV Section V Billing information: General information, remittance advice and status report, adjustment request, additional or other payment sources, pseudo claims and reference books Glossary: Arkansas Medicaid acronyms and terms Claim forms, Arkansas Medicaid forms, contacts and links Hint: When searching the manual use Control+F a for faster search

22 Provider manuals Appendix A Update log: Update number and effective date (formerly Appendix A) Number and release dates for updates Program publications/notifications: transmittal letters, official notices, remittance advice messages and notices of rule-making

23 Timely filing Medicaid requires providers to submit all claims no later than 12 months from the date of service. The 12-month filing deadline applies to all claims, including: Claims for services provided to recipients with joint Medicare/Medicaid eligibility Adjustment requests and resubmissions of claims previously considered Claims for services provided to individuals who acquire Medicaid eligibility retroacevely

24 Timely filing Medicare/Medicaid crossover claims Federal regula2ons dictate that providers must file the Medicaid por2on of claims for dually eligible beneficiaries within 12 months of the beginning date of service The Medicare claim will establish 2mely filing for Medicaid If the provider files with Medicare during the 12-month Medicaid filing deadline Medicaid may then consider payment of a Medicare deduc2ble and/or coinsurance, even if more than a year has passed since the date of service Federal regula2ons permit Medicaid to pay its por2on of the claim within six months aaer no2ce of the disposi2on of the Medicare claim Providers may not electronically transmit any claims for dates of service over 12 months

25 Timely Filing Claims With Retroac5ve Eligibility (Pseudo Claims) Providers have 12 months from the approval date of the beneficiary s Medicaid eligibility to resubmit a clean claim after filing a pseudo claim. After the 12-month filing deadline (12 months from the Medicaid approval date), claims will be denied for timely filing and will not be paid. It is the responsibility of the provider to verify the eligibility approval date. Once a beneficiary receives retro eligibility, the provider must submit a paper claim, proof of the pseudo claim, and a cover letter to research for special processing. DXC Technology Attn: Research Analyst PO BOX 8036 Little Rock, AR 72203

26 Benefits Arkansas Medicaid administers more than 50 programs. Here are just a few of the many benefits available to eligible beneficiaries (see Section II of the Physician Manual): Physician services InpaBent hospital OutpaBent hospital Lab/X-ray PrescripBon Therapy (OT/PT/Speech) Mental health Emergency room Long-term care Hospice Dentistry (under age 21 and for qualifying aid categories for ages 21+) Medical equipment

27 Ways to submit claims New health care portal Vendor so1ware Provider Electronic Solu8ons (PES) Paper-UB-04, CMS-1500, dental Note: PES will be going away soon

28 Mail paper claims to: DXC Technology A"n: Claims PO Box 8034 Li"le Rock, AR Special Claims A"n: Research Analysts P.O. Box 8036 Li"le Rock, AR 72203

29 New provider portal

30 Provider health care portal features Online provider enrollment applica0on Eligibility verifica0on Submit all claim types (professional, ins0tu0onal, dental, crossover and third-party) Ability to edit (adjust), void and copy claims View status of claims Prior authoriza0on request and status check Real-0me claims processing RemiCance advise held up to seven years Secure correspondence Refer to the Naviga0ng the Portal Webinar for a step-by-step demonstra0on of the portal ACachments for claims and prior authoriza0ons

31 Arkansas Medicaid website

33 What s Trending Provider Assistance Center (PAC) has new hours: 6 a.m. 6 p.m. New crossover and adjustment forms Claims submi@ed electronically must be entered by 6 p.m. on Friday New Medicaid website: Not sure why claim denied on RA? Check Claim Search on the portal for details on denial under AdjudicaIon errors Any topics that are relevant during the training session will be added on this page. The topics will be from Frontline or official no<ces/policy changes

34 Contact information DXC Technology Medicaid Website Provider Assistance Center (new hours 6 a.m. 6 p.m.) Electronic Data Interchange (EDI) AFMC MMIS provider outreach representapves MMIS provider representapve map at afmc.org/mmis

35 Evalua&ons Your feedback is important to us! Please take 6me to complete the evalua6on that will be ed to you. Thank you for a=ending today!

36 Questions?

Living Choices Assisted Living September 2016 HP Fiscal Agent for the Arkansas Division of Medical Services

Living Choices Assisted Living September 2016 HP Fiscal Agent for the Arkansas Division of Medical Services 1 Topics for Today Provider Training Provider Manuals Submitting Claims Claim Adjustments and