IHCP Updates

1. IHCP Updates HP Enterprise Services Provider Relations August 2010

2. Agenda Objectives Medical Education Payments Phase II National Correct Coding Initiative HIPAA 5010 Updating Third Party Liability Billing Tips NPI Rejections New IHCP Web site Helpful Tools Questions

3. Objectives Following this session, providers will be able to: Locate medical education payments on the Remittance Advice Understand upcoming changes with NCCI and 5010 Learn how to update TPL information Gain new understanding of general billing issues Use the new IHCP Web site

4. Medical Education Payments For Teaching HospitalsPhase II

5. Medical Education Payments For Teaching Hospitals BT200946 announced that medical education payments for risk-based managed care (RBMC) members are paid by HP Enterprise Services instead of the managed care organizations (MCOs) Reimbursement change became effective with claims with a "From" date of service on and after January 1, 2010 During Phase 1 of the implementation, claim-specific details about the medical education payments were not identifiable on the Remittance Advice (RA) • The combined Medical Education payment was shown as a "Non-claim Specific Payout" on the financial summary page of the RA • Reason code 8372 identified the medical education payment on the RA • Claim specific information may be obtained by contacting Customer Service at: 800-578-1278 Phase 1

6. Medical Education Payments For Teaching Hospitals Effective July 6, 2010, claim-specific detail for each medical education expenditure is incorporated in the RA • The RA now identifies the per-claim medical education payment amount • Medical education payments continue to be identified with reason code 8372 Providers no longer need to contact HP Customer Assistance to request the claim-specific detail appearing on RAs Phase 2

7. National Correct Coding Initiative

8. National Correct Coding Initiative What is it? In the 1990's, the Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment NCCI has been in place for many years and most providers are familiar with the editing methodologies with Medicare Based on input from a variety of sources: • American Medical Association (AMA) CPT Guidelines • Coding guidelines developed by national societies • Analysis of standard medical and surgical practices • Review of current coding practices

9. National Correct Coding Initiative The recent healthcare legislation passed into law (H.R. 3962), requires that Medicaid programs incorporate compatible methodologies of the National Correct Coding Initiative (NCCI) into their claims processing system • Section 1761 –Mandatory State Use of National Correct Coding Initiative, of this bill mandates that NCCI methodologies must be effective for claims received on or after October 1, 2010 • The IHCP has embarked on a project that will bring NCCI into the claims processing effective October 1, 2010. Initial editing will encompass three basic coding concepts: • NCCI Column I and Column II (also known as bundling) • Mutually Exclusive (ME) edits • Medical Unlikely Edits (MUE)

10. National Correct Coding Initiative Who will be affected? • NCCI will affect the following providers: • Institutional outpatient claims • Physician claims • Watch for more information in your bulletins, banner pages, and newsletters by logging on to www.indianamedicaid.com

11. HIPAA 5010

12. HIPAA 5010 The mandatory compliance date for ANSI version 5010 and the National Council for Prescription Drug Programs (NCPDP) version D.0 for all covered entities is January 1, 2012 If submitting claims to the IHCP, you need to prepare for these upgrades to prevent delay in payment The IHCP and HP will test transactions on a scheduled basis Specific transaction testing dates will be provided at a future date

13. HIPAA 5010 Transactions affected by this upgrade: • Institutional claims (837I) • Dental claims (837D) • Medical claims (837P) • Pharmacy claims (NCPDP) • Eligibility verifications (270/271) • Claim status inquiry (276/277) • Electronic remittance advices (835) • Prior authorizations (278) • Managed Care enrollment (834) • Capitation payments (820)

14. Testing Information All Trading Partners currently approved to submit 4010 and NCPDP 5.1 versions will be required to test and be approved for 5010 and D.0 transaction compliance • All software products used to submit 4010 and NCPDP 5.1 versions must be tested and approved for 5010 and D.0. Testing will begin January 2011 and include: • Clearinghouses, Billing services, software vendors, individual providers, provider groups Providers that exchange data with the IHCP using an IHCP- approved software vendor will not need to test • Each trading partner will be required to submit a new Trading Partner Agreement

15. What You Need To Do If you bill IHCP directly • Begin the process to upgrade to the ANSI 5010 or NCPDP D.0 versions If you are using a billing service or clearinghouse • Find out if they are preparing for the HIPAA upgrades to ANSI v5010 and NCPDP vD.0 • IHCP Companion Guides will be available during the fourth quarter of 2010 Questions should be directed to INXIXTradingPartner@hp.com OR Call the EDI Solutions Service Desk • 1-877-877-5182 or (317) 488-5160 Watch for additional information on testing process, revised IHCP Companion Guides, and schedule for transaction testing on this mandated initiative in bulletins, banner pages, and newsletters at www.indianamedicaid.com

16. Updating TPL

17. Updating TPL • The IHCP Third Party Liability (TPL) program ensures compliance with federal and state TPL regulations. The program has two primary responsibilities: • Identify IHCP members who have third-party resources available • Ensure that those resources pay prior to the IHCP What is TPL?

18. Updating TPL TPL can be one of the following: • Commercial health insurance policies, group and individual • Medicare • TRICARE • Indiana Comprehensive Health Insurance Association (ICHIA) • Auto insurance • Homeowner’s insurance • Workers’ compensation • Other liability insurance The IHCP is the payer of last resort What is TPL?

19. How to update TPL information Contact the TPL Unit • Call: (317) 488-5046 or toll-free 1-800-457-4510 • Fax: (317) 488-5217 • Write to: HP TPL Unit P.O. Box 7262 Indianapolis, IN 46207-7262 Perform updates via Web interChange https://interchange.indianamedicaid.com/Administrative/logon.aspx

20. Updating TPL on Web interChange

21. Updating TPL on Web interChange

22. Billing Tips

23. Tips For Billers of Paper Claims Providers can avoid problems during claims processing by adhering to the following guidelines: • Paper billers should use the red drop-out ink claim forms • Ensure claim data is contained within their proper field locators • Do not add written notations on claim forms using red ink • Do not use stamps, including: "EOB Attached, Second Submission, Medicare Info" and so on • Do not add written notations within the body of the claim form • Avoid writing paper claim forms by hand • Do not include data in field locator 19 of the CMS-1500 claim form unless it is a certification code for a member assigned to Care Select • Do not indicate information in the area reserved for the National Drug Code (NDC)

24. Tips For Billers of Paper Claims Top reasons that paper claims are rejected and not entered into IndianaAIM: • LPI invalid or missing (applies to atypical providers only) • Claim form is illegible • Too many lines of detail • CMS-1500 allows six lines of detail • UB-04 allows 66 lines of detail (three pages) • Instructions for billing continuation claims can be found in Chapter 8, Section 2 of the IHCP Provider Manual • ADA 2006 allows 10 lines of detail Common reasons for claim rejections

25. Tips For Billers of Paper and Electronic Claims • Units exceed 9999.99 • Applies to CMS-1500 claims only • Claims with units that exceed 9999.99 should be referred to your field consultant for special handling • NPI invalid or missing • EnsureNPI of the rendering, billing, and/or group on all claims is reported on the provider enrollment file • NPI does not cross walk to a single Legacy Provider Identifier (LPI) • Use unique ZIP Code plus 4 and unique taxonomy code to obtain a one-to-one match Common reasons for claim rejections

26. UB-04 Billing Claim form completion

27. Electronic Claim Rejections

28. Electronic Claim Rejections January through March 2010: • Total number of electronic claim rejections – 93,800 • Total rejections caused by NPI errors – 15,778 • Percentage of rejections caused by NPI errors – 16.8% April through June 2010: • Total number of electronic claim rejections – 114,340 • Total rejections caused by NPI errors – 16,843 • Percentage of rejections caused by NPI errors – 14.7% NPI reject statistics

29. New Indiana Health Coverage Program Web site

30. Portal to Member and Provider Web Sites

31. Provider Web Site

32. Helpful Tools IHCP Web site at www.indianamedicaid.com IHCP Provider Manual (Web, CD-ROM, or paper) Customer Assistance • 1-800-577-1278, or • (317) 655-3240 in the Indianapolis local area Written Correspondence • P.O. Box 7263Indianapolis, IN 46207-7263 Provider field consultant • http://www.indianamedicaid.com/ihcp/ProviderServices/pr_list_frameset.htm

33. Q&A

34. HP Enterprise Services950 N. Meridian Street, Ste. 1150Indianapolis, IN 46204 Office of Medicaid Policy and Planning (OMPP)402 W. Washington Street, Room W374Indianapolis, IN 46204