NewMMIS Pilot Provider Orientation August 21 & 22, 2008

1. NewMMIS NewMMIS Pilot Provider Orientation August 21 & 22, 2008

2. Agenda

3. WELCOME!Pilot Phase II

4. NewMMIS Overview/Update • NewMMIS Timeline/Activities: • User Acceptance Testing (UAT) • Pilot • Trading Partner Testing (TPT) • Implementation

5. Purpose of Pilot • Primary objective : TEST, TEST, TEST • Pilot Responsibilities • Test transactions • Review responses • Identify defects • Based upon feedback CW may identify additional training needs • What you can expect • Claims may not pay accurately • Claims may deny • Responses may not be accurate • Reporting may not be 100%

6. Purpose of Pilot • Validate Infrastructure • Environment is stable • Interfaces are working • Security is working • Helpdesk ticketing system is functioning appropriately • Prepare for Implementation • Identify provider type specific defects • Identify additional training needs • Identify additional communication needs • Identify additional helpdesk & infrastructure needs

7. EDS Readiness report – 8/8/08 Commonwealth (CW) Testing/Validation 8/11 – 8/22 Pilot Start Date: 8/25/08 Pilot End Date: 9/12/08 Debriefing Assess Provider experience Assess User experience Assess system performance Pilot Timeline

8. Pilot Activities • Complete Trading Partner Testing • Complete test scenarios & provide feedback based on day-to-day business • Follow Pilot data parameters for transaction submission • Participate in debriefing

9. Pilot Functionality • HIPAA Batch Transactions • 270/271 • 276/277 • 837P • 837I • 997 • 835 • Direct Data Entry (DDE) • Eligibility Verification • Professional Health Care Claim • Institutional Health Care Claim • Claim Status Inquiry • Paper Claims • Cross-Over Claims / COB • View Metrics / Reports • Remittance Advice (RA) • Claims Metrics

10. Paper Claims Submission • For Pilot Providers submitting paper and TPL/COB claims, forward all paper claim forms to the following address: MassHealth Attn: Pilot PO Box 9118 Hingham, MA 02043 • Note "Pilot" on the claim form  • Submit TPL paper claims

11. Pilot Data Parameters • Conversion claims data through 4/23/08 • Member & Provider • PA/PAS/Referrals • Procedure/Revenue Codes • TPL • Use claim and member data through 4/23/08 to submit pilot transactions • Timely filing edits will apply • Converted claims cannot be modified • NewMMIS initiated claims can be modified and resubmitted

12. Pilot Data Parameters • Batch cycles that will be run during Pilot: • Claims • Financial—Thursday • Eligibility Verification System (EVS) • System Wide • HIPAA Batch Cycles • Tracking number will display immediately • 997 will display estimated 15 – 30 minutes • HIPAA related response estimated 45 minutes to 1 hour • Batch Cycles are supported between 8:00AM – 5:00 PM

13. Pilot Data Parameters • Use NewMMIS Provider ID/Service Location (PID/SL) on all claims (obtain number after Pilot training) • Use NewMMIS Member ID on DDE to obtain member number through REVS or NewMMIS EVS functionality • HIPAA 837 batch claims will accept current MassHealth Member ID, however, NewMMIS ID is preferred • Input2 leading Zeros when using existing referral numbers on claim submission

14. Constraints • Dupe “S” procedures –Some legacy service codes are flagged/bypassed (small number of denials for services performed on the same day/same member) • Impact: Primarily DME • Approach: Work around constraint • Professional claims with PA pricing– PA end dates may effect pricing • Impact: DME • Approach: Do not submit claims with PA Pricing procedure codes

15. Constraints • Max unit override – In some instances current MMIS allows more units than on current procedure file. Some NewMMIS claims may be “cut back” • Impact: Physician, CHC, MH Centers, State agencies, OPD • Approach: Submit claims but be aware of constraint (less than 10 codes) • Home Health Claims – X-walk issue with Type of Bill • Impact: Home Health • Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports

16. Constraints • Holiday/weekend rates – Claims may not reflect special rates • Impact: Home Health • Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports • Restrictive Messages – Under CW review; less than 20 may result in incorrect messages being issued to providers • Impact: All • Approach: Work around constraint • Do not submit codes with modifiers

17. Constraints • Payment based on provider specialty - claims may not pay accurately (25 estimated procedure codes impacted) • Impact: State Agencies • Approach: Work around constraints • Procedures codes paid on both a class rate and provider specific rates - Claims may pay incorrectly - (primarily when Community Health Centers (CHC) bill certain clinic visits codes e.g. codes 9993xx) • Impact: CHCs • Approach: Do not submit certain procedure codes • Remittance Advice – currently prints portrait, which may be difficult to read • Impact: All • Approach: View remit on screen and use discretion when printing

18. Test Scenarios • Review list of test scenarios and select those that are pertinent to your day to day activities/ identified in your survey response • Perform up to 10 test case scenarios - examples: • Check Member Eligibility • Submit a Claim • Download RA or 835 • Complete the test scenario, including feedback section and email to your Pilot Coordinator • Follow-up outreach activities may occur

19. List of Pilot Test Scenarios

20. Eligibility Test Scenario

21. Pilot Participants Readiness • Continue preparing for the transition • Complete Trading Partner Testing (as applicable) • Review EDI submission instructions • Provide member numbers • Use your NPI – it is required • Obtain your User ID/Password (to access CST web page) • Complete System Readiness activities: • Billing intermediary • Practice management • Software vendors • Review Pilot Materials: • Companion guides • Billing instructions • Review E-Learning • Participate in Pilot overview

22. Pilot Participants Readiness • Identify for Pilot: • Provider numbers • Member identification numbers • Billing Intermediaries/Vendors • Identify claims you will use during testing • Identify PA/PAS & referral numbers you will use during testing using the data parameters date (4/23/08) • Coordinate resources within your organization • Determine daily testing timeframes

23. Pilot Participant Readiness • NewMMIS PID/SL will be provided to all Pilot participants • Billing Intermediaries/Large Organizations: • Identify the name and Legacy provider numbers of the providers you will submit claims on behalf of during Pilot • CW will validate the existing relationship • Once the NewMMIS PID/SL is validated, it will be provided to you. This number is not to be shared with anyone and must only be used for testing purposes

24. Provider Communications • Help Desk • Pilot Coordinators • Pilot Provider Primary Contact • Weekly Status Meetings • Email • Debriefing

25. Help Desk • Trading Partner Testing (TPT) • Testing must be completed for HIPAA Transactions before providers can submit “production” transactions in the Pilot environment • Help Desk at @ 1-888-824-3484

26. Help Desk Support • Mirror implementation • Enhancements to existing customer service center environment • Monitoring tools in place to track caller, types of calls, response time results • Anticipated response time for critical impact is immediate < or = to 3 hours • Email option: pilotsupport@mahealth.net

27. The help desk is the first line of support for providers with questions on their use of the NewMMIS Support hours of operation: Phone: 1-888-824-3484 Monday - Friday 8AM - 5PM No after hours or weekend support will be available A Three tier support system to address provider technical & non technical issues Tier 1 = CST Tier 2 = NewMMIS Technical Team Tier 3 = NewMMIS SMEs and BAs Help Desk Support

28. Help Desk Support - Priority

29. Pilot Coordinator Activities • Pilot Coordinators: This team is comprised of NewMMIS Functional Coordinators (FCs). They will function as liaison to Pilot Providers. • Pilot Coordinators Role: • Serve as a liaison to Pilot Providers • Conduct welcome call – initial contact • Check in with providers • Collect test scenarios feedback from Providers • Review monitoring reports & confer with Providers regarding status of activities & support needs • Research issues, identify defects and solutions • Conduct debriefing with Providers • Report debriefing results to Project Leadership

30. Pilot Provider • Role of Pilot Provider Primary contact: • Coordinate activities within your organization • Work directly with the NewMMIS Pilot Coordinator to communicate issues and resolve Pilot process concerns from your organization • Validate the number of pilot participants/users from your organization • Confirm your organization is prepared for Pilot by validating that participants/users have conducted the following activities: • Completed TPT • Reviewed the E-learning • Identified the member and claims data that will be used for Pilot • Participants/users have helpdesk number and email • Etc.

31. Access • Provide Access To Pilot Environment • The Commonwealth will issue User ID & Passwords to all participants • Provide security data collection information required to initiate a request for a User ID & password • Contact Pilot Support to provide security data • Environment available on 8/25/08

32. Access • User ID & Passwords: • User ID and password to access the Pilot environment will be sent to you via email shortly after you attend the Pilot training • The email will be auto-generated to the email address you supplied to us (security data collection information) • The password is temporary and will be revoked once Pilot is completed • Once you receive the User ID and Password, you must log-in to Virtual Gateway, change your password, and set up a series of security questions. • This User ID and password can then be used to access the NewMMIS Pilot Environment on 8/25/08. • URL: www.mass.gov/masshealth/newmmispilot

33. Contact Information • CST Phone Number: 1-888-824-3484 • Email for MassHealth Customer Service: • Email Address @ pilotsupport@mahealth.net • Paper Claims Mailing Address: MassHealth Attn: Pilot PO Box 9118 Hingham, MA 02043

34. Available Resources • Check our web site often for the most up-to-date information: www.mass.gov/masshealth/newmmis • Masshealth provider bulletins & transmittal letters • MassHealth trainings • E-Learning:http://masshealthnewmmisprovidertraining.ehs.state.ma.us/

35. Available Resources • Accessing E-learning Tips • If you have not yet registered, go to Don’t have a user name click here • Allow pop ups…. Go to tools on your menu bar, Select Pop Up Blocker, then select Turn off Pop up blocker • Complete all fields, regardless of * (don’t forget county) • User name must be different from password • Password must be a minimum of 6 characters • Select one provider type if you have many. If you have multiple provider types, have different staff select different provider numbers and types. • Select Register • Select Continue • Select Course Catalog • Select appropriate courses, beginning with A Provider Information and Navigation course • Select course from center of screen • Select Enroll • Select Launch • Select Launch again

36. E-Learning/Help Overview • E-Learning overview • Navigation • Panel help & field level help

37. Debriefing • At the end of Pilot, a debriefing session will be held to obtain feedback on the NewMMIS and the overall Pilot experience: • Assess Provider experience • Assess User experience • Assess System performance

38. Next Steps • Issue User IDs & Passwords • Identify provider numbers to test • Review E-learning • Define testing data & testing timeframes • Submit HIPAA Batch Tests (TPT) • Open Pilot Environment • Test, Test, Test!!!

39. Q & A Questions & Answers