Massachusetts League of Community Health Centers September 28, 2016
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1 Massachusetts League of Community Health Centers September 28,
2 Agenda MassHealth Team New MassHealth Provider Portal Sneak Peak Overview of the Outreach Programs Health Safety Net Program Transition Questions & Concerns 2
3 Provider Relations Contacts Marianne Leahy Vice President, Network Management Phone: Keishia Christian Provider Relations Representative (North/East, MA) Phone: Daniel Archambault Provider Relations Representative (North/West, MA) Phone: Adeola Staveley Internal Provider Relations Representative Phone:
4 Additional MassHealth Contacts Tracy Gilman Executive Director Phone: Megan Mackin Statewide Outreach Coordinator Flor Piedrasanta Statewide Outreach Coordinator Andres Fernandez Member Intervention Specialist Rhonda Small Provider Outreach Coordinator 4
5 New MassHealth Provider Web Portal (PWP) October 2016
6 Register - Log-in Page
7 Home Page
8 Dental Information
9 Manage Users
10 Manage Users Add New User
11 Claims Prior Authorizations
12 Reports Sealants and Preventative 12
13 Provider Administration 13
14 Provider Administration Amount List
15 Provider Administration - List Associations
16 Patient Management 16
17 Patient Management - Member Eligibility 17
18 Patient Management - Member Eligibility
19 Broken Appointments
20 Submit Claims & Prior Authorizations 20
21 Submit Claims & Prior Authorizations
22 Search Claims & Prior Authorizations
23 Claim Details Void Claim 23
24 Claim Confirmation Report
25 Remittance
26 Document List
27 Document List - Search
28 Find a Dentist
29 Frequently Asked Questions - FAQ
30 Event Calendar
31 Contact Us
32 Account Information
33 Outreach Programs Fall 2016 October 2016
34 Statewide MassHealth Outreach Programs 34
35 Fluoride Varnish in a Medical Setting Why consider Fluoride Varnish in a Medical Setting? o New Outreach Coordinator! Flor Piedrasanta, RDH o Program Expansion: Lunch & Learn Quality Improvement- EHR, Workflow, In Operatory Guidance, Follow-up Support, Goal Setting o Goals: November 2016-June New Providers Ongoing- 80 New Providers 35
36 Smiling Stork Program Smiling Stork Program: o Increase health outcomes for women o Tools: Massachusetts DPH Perinatal Guidelines: o Outreach: Mailing of a letter, articles, and member collateral pieces to dentists. Drop-in materials for physicians and promotion of the perinatal guidelines through the fluoride varnish program. 36
37 Broken Appointment Broken appointments are a costly and unnecessary expense for providers. o New: Increased Reporting Report missed appointments Provider Web Portal (Community) o Reporting: Weekly report o Outreach: Call to members Postcard 37
38 Emergency Room Diversion Program Emergency room (ER) use for non urgent dental care is common problem among the Medicaid population. o ER usage is expensive, and hospitals are generally unable to treat the root cause of the dental issue effectively. o Billing is inconsistent. MassHealth ER Diversion Program o Education o Referrals o Tools o Member Follow-up / Reporting o Ultimate Goal 38
39 Health Safety Net Dental Program Transition to DentaQuest October 2016
40 HSN Dental Program Transition Overview: MassHealth has selected DentaQuest (DQ), the TPA for the MassHealth Dental Program, to be the new TPA for the Health Safety Net (HSN) Dental Program. Over the past several months, DQ has been working together with the Health Safety Net Dental program staff to streamline and reduce many administrative requirements. Administering the HSN dental program allows DQ to further expand the relationship with Massachusetts Community Health Centers (CHCs). Claims or adjustments to claims with dates of service January 1, 2017 or later must be submitted to DentaQuest
41 EDI Claims Submission: HSN Provider EDI Training o Technical training associated with EDI 837D and 835 transactions. o Held on Thursday, September 1, 2016 via webinar. o Mandatory training for the staff member(s) or clearinghouse vendor who manages the EDI transactions. o A second training is scheduled for Friday, September 30, 2016 from 2:00 p.m.- 4:00 p.m. o A copy of the presentation will be available on the provider web portal. 41
42 Miscellaneous Information: HSN Provider EDI Training o All HSN providers must complete the MassHealth Electronic Remittance Advices (ERA) Enrollment Request form. The form provides DentaQuest with all necessary information to initiate the ERAs. The form must be completed and returned to DentaQuest by 10/01/2016 to allow the provider to receive the 835D ERA as of November 1, 2016 whether directly or through a clearinghouse. Once returned and processed, a member of the EDI Team will reach out to the office in order to finalize the enrollment. o The Companion Guide is available on the MassHealth web portal at: 42
43 HSN General Provider Training Non-Technical HSN Program Provider Trainings: o 4 trainings scheduled the afternoon of the October MTF meetings, at various locations throughout the State. o Sessions will cover an overview of the program as well as any changes to the program or processes. o Office Reference Manual (ORM) will be available on the MassHealth web portal at o HSN refresher webinar to be scheduled for late November or early December. Session will review key issues covered in the October trainings and outline provider web portal features and functions unique to the HSN program and providers. 43
44 Questions & Answers 44
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