West Virginia Medicaid & MHNet

1. West Virginia Medicaid & MHNet WV Medicaid - October 2010

2. Presentation Points: • A high level overview of MHNet’s end-to-end processes for WV Medicaid • A more detailed workflow of MHNet’s Access to Care process and, • specifically, MHNet’s outpatient Access to Care process as it will interface with the incoming APS data • Turn around times for specified components • MHNet contacts WV Medicaid - October 2010

3. WV Medicaid - October 2010

4. Eligibility Load Metrics • Turn around time on eligibility load from receipt = 3 business days. • Load rate standard = 97% • Errors from the load are worked within 5 business days. WV Medicaid - October 2010

5. Access to Care – Facility-Based Services • MHNet’s understanding is access to facility-based services will not go through the APS authorization process • MHNet’s facility-based process flow is illustrated to show how it integrates with the outpatient access to care process • For facility-based care, providers calling are given authorization during the call. An authorization letter is sent the next business day either via USPS or fax WV Medicaid - October 2010

6. WV Medicaid - October 2010

7. WV Medicaid - October 2010

8. Outpatient Access To Care • MHNet will process information from the previous evening’s APS file during the following business day • MHNet’s typical process to notify providers of authorization is via USPS, but we fax authorizations to providers the same day if the client wishes • If needed, additional information is obtained via an outgoing call to the provider and entered into MHNet’s system during that call so the authorization can be completed WV Medicaid - October 2010

9. Claims Submission • Currently, MHNet offers submission of claims (both provider and facility-based) via either paper or electronically through a clearinghouse • There is no transaction fee for electronic claims submission WV Medicaid - October 2010

10. Claims Processing Standards • Claims processed within 15 business days = 92.5% • Claims processed within 30 business days = 99% • Number of days on hand = 2.5 WV Medicaid - October 2010

11. Claim Payment • MHNet cuts provider checks twice a week • Checks are mailed via USPS by the end of business same day • MHNet will have electronic remittance advice & EFT payment capabilities available May 2011 when our system conversion is complete WV Medicaid - October 2010

12. MHNet contacts • Carelink Contact: Todd White - 304-348-2041 - twhite@cvty.com • MHNet Account Manager for Carelink: • Dierdre Chang - 954-826-9507 – dchang@mhnet.com • MHNet Clinical Contact: • Malaika Vasiliadis - 407-831-6211 – mvasiliadis@mhnet.com • MHNet Network Contact: • Jon Turner - 304-348-2920 – jlturner@mhnet.com • MHNet Claims Operations: • Deb Hager - 701-250-5416 – djhager@cvty.com • MHNet Operations Contact: • Talitha Appenzeller – 563-323-5181 – tjappenzeller@mhnet.com WV Medicaid - October 2010