1 / 26

Medicaid Managed Care Organization Training by Department for Public Health

Comprehensive training conducted by The Department for Public Health & Custom Data Processing on October 18th, 2011. Registration process for MCO card or letter back of the card with detailed steps provided for CoventryCares, Kentucky Spirit Health, and WellCare. Verification of patient eligibility, registration process, managed care services, and billing procedures outlined.

jenifer
Download Presentation

Medicaid Managed Care Organization Training by Department for Public Health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MEDICAIDMANAGED CARE ORGANIZATION(MCO) TRAININGCONDUCTED BY :THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSINGOctober 18th, 2011

  2. REGISTRATION MCO CARD OR LETTER

  3. BACK OF CARD

  4. Identified with #6 Log on to www.directprovider.com Call CoventryCares IVR line @ 1-855-300-5528 http://chcmedicaid-kentucky.coventryhealthcare.com/

  5. Identified with #7 Log on to www.KentuckySpiritHealth.com Search by date of service and Medicaid ID # or KY Spirit ID # Call automated system(IVR) at 1-866-643-3153 from a touch tone phone Call Ky Spirit Health Plan Provider Services @ 1-866-643-3153

  6. Identified with #8 Log on to www.kentucky.wellcare.com Call WellCare’s IVR @ 1-877-389-9457 Call WellCare’s Customer Service @ 1-877-389-9457

  7. VERIFY PATIENT ELIGIBILITY • Verify Medicaid # and MCO member #. • Print both initially and place in patient chart. • This will provide proof for billing/inquiries in case there are any problems. • If no card or letter use KY Health Net & call the MCO listed there. • Key into Registration.

  8. Registration Process

  9. Medicaid Eligibility & Number

  10. Managed Care fields • Medicaid MCO – drop down of available MCO’s. Previously shown as: “Managed Care Region” • MCO Member # - up to 20 characters available Previously shown as: “Managed Care Member #”

  11. Managed Care Fields

  12. Medicaid MCO Drop Down

  13. MCO Member #

  14. Label changes • PEF label will show MCO/REGN# • Registration label will show MCO Member #

  15. PEF Label – REGN# will be MCO

  16. PEF Label – REGN# will be MCO MCO COV

  17. 2nd Registration Label – PART# will be MCOMember # 1234567890 MCO

  18. SERVICES • CODING IS THE SAME AT THIS TIME • Anything currently covered by Preventive.

  19. CHECK OUT PROCEDURES ENTER PEF

  20. CHECK OUT VERIFY Appropriate Medicaid status is in MDCD Field on Encounter Entry Screen Put Y in bill screen field On Bill Screen a). If not payor code 2, re-verify system information b). If not working properly call LHO Help Desk at 502-564-6663, option 5. Localhealth.helpdesk@ky.gov

  21. Encounter Entry ScreenCheck MCD field for Medicaid

  22. Fill out the encounter. It is recommended to request the bill screen when you start entering encounters.

  23. Bill Screen – Check the payor codes

  24. BILLING CDP is working with each MCO to program their specific requirements. IE: VFC modifiers. New E-reports must be created. Testing of billing files-live during first week.

  25. QUESTIONS?

More Related