MHNet Provider Resources and Claims Assistance

1. Welcome Impact Plus

2. Agenda • Introductions • High Level Claim Workflow • Claim Department • Remittance Advices (RA) • Refunds • Web Information • Phone Numbers • FAQ

3. 837 = claims 999/997 = file acknowledgement 277/Cstat = claim level acknowledgments 835 = remits

4. Claim Department • Claim turn around time is 30 days • The Claims Department would answer all questions associated with the processing and finalization of a claim

5. Remittance Advice

7. Remittance Advices • Providers will receive a RA for all claims that are received, but are currently in process • Providers will receive a RA for all claims that are paid, denied or adjusted. • Providers will only receive one RA, even though they may receive 2 checks from the commonwealth (one for DCBS and one for DMH)

8. Provider Needs to Submit a Refund to MHNet Please contact Provider Relations or Claims for any overpayments: If you have any questions, please contact the Claims Department at 866-99CLAIM or the Provider Relations Department (Jay Mingus) at 800-835-2094. We appreciate your cooperation and continued partnership with MHNet.

9. Website Information • Our website, www.mhnet.com, offers several resources at your fingertips! • Under the provider tab, you can access the below subsets and find the following: • Provider Billing: CMS 1500 form, CMS 1450 form, W-9 • Provider Resources: Provider manual, Medical Necessity Criteria • Note: This is just a sample of information that can be found on the website.

10. FAQ • Will the providers be able to run tests regarding claims submission? No, we can validate production files, but do not have a method for obtaining test claims.If providers are submitting electronically, claims can enlist the help of their front end team to validate receipt. • If the provider is using the clearinghouse Availity to push their claims to Emdeon, and they do not have to pay an initial set-up fee with Availity, then they shouldn’t have to pay a set up fee for the use of Emdeon, correct? This relationship is between the provider and Availity (or any other clearinghouse a provider may use). Emdeon would not bill providers additionally for these MHNET claims once a practice has implemented an EDI claim solution through their existing clearinghouse. • What is the initial set up fee to use Emdeon as their clearinghouse, and is that payment made directly to Emdeon? It depends on the provider’s level of service and what product they buy. Contract and relationship would be made directly with Emdeon. MHNet subsidizes the transactional claim costs once a practice has implemented an EDI claim solution. Monthly subscription costs are usually based on volumes, number of providers, etc. and included with that could be additional services such as real-time transactions, reports, ERA, etc. • Will there be a claims transaction fee with Emdeon? Emdeon costs are based on product used and are handled through a monthly subscription fee rather than a per/transaction cost. MHNet subsidizes Emdeon for MHNet members so additional transaction charges would not be passed to the submitter specific for MHNet. However, a practice must implement an EDI claim solution and product, whichwould have costs associated with it.

11. Important Numbers • General information: www.mhnet.com • Provider Representative: Jay Mingus, Senior Provider Relations Representative: jtmingus@mhnet.com, (office) 502-264-3484, (fax) 502-239-8737 • Benefits/Eligibility/Authorizations: National Service Center 888-604-6106 • National Service Center contacts: Chris Slocum, Regional Executive Director; Kim Richardson, Kentucky Regional Executive Director; Cat Jones, Outpatient Clinical Supervisor; Jeff Sutherland, Inpatient Clinical Supervisor. • Claims: 866-992-5246, also 866-99CLAIM • Emdeon: www.emdeon.com and our payor ID is 74289 • Mail paper claims to: MHNet, P.O. Box 7802, London, KY 40742 EDI Claim Submission questions: EDIClaims@cvty.com