HP Enterprise Services Hometown Health Presentation

1. HP Enterprise Services Hometown Health Presentation December 1, 2010 Partnering for Success!

2. Web Portal • Web Portal Address www.mmis.georgia.gov • Web Portal Navigational CBT • Provider Information>>Web Portal Training • Provider Web Portal Navigational Guide • Provider Information>>Provider Manuals • Web Portal User Account Management Guide • Provider Information>>Provider Manuals

3. EDI Services Phone Number 770-325-9590 or toll free 1 877-261-8785 EDI Email Address: ediservices.gammis@hp.com HP staff may begin sending web portal PIN letters via email.   The email address to send the PIN request is above.  When requesting a PIN via email, the following information must be included: Individual providers:  Provider name and ID, location address, date of birth and SSN Facility providers:  Provider name and ID, and tax ID Indicate on subject line PIN REQUEST Because of the sensitive information being sent, the email should be encrypted (secure email).  EDI Helpdesk

4. Web Portal Questions • We have noticed that the new web portal does not seem to show if Medicaid coverage is retro and what dates the retro covers. Will this be addressed? • Retro eligibility spans are on the eligibility response. • How do you register users that do not have individual email accounts? • Users who do not have an email account can not be registered. Email is a requirement to register an account with our security system. • If the hospital owns a physician practice, do we register pin under providers name or practice name? • You register pins for every provider number for which you wish to access information using the web portal. • We have been told that we have to have Adobe 10.1 to be able to upload attachments, this requires us to purchase a license from Adobe, does HP have any other solution to this? • In order to read .PDF documents, you must have a .pdf reader. The freely available adobe acrobat reader is such a product.http://get.adobe.com/reader/

5. The EOB / Adjustment Reason / Remark Codes crosswalk has been loaded for HIPAA transactions. The information is located on the web portal. The crosswalk has been updated as of November 30, 2010 and will be loaded to the web portal no later than Thursday, December 2. Provider Information>>Provider Notices 835 Crosswalk

6. At this point HP Enterprise Services has loaded all of the Remittance Advices (RA) that were provided by the previous Fiscal Agent. HP Enterprise Services does not anticipate getting any additional RAs. Providers can obtain claim status information through the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov. NOTE: Please be aware that if the RA image is not present on GAMMIS then it was not received from the previous Fiscal Agent. Recommend for ACS last cycle using a range of dates on panel to pull the RA from web portal. Recommend span of Friday to Monday. Remittance Advices

7. Challenge Question EDI Helpdesk Web Portal_Password Resets

8. Applications pending at close of ACS Questions about enrollment Contact Us_Secure portal Phone Call; select enrollment option Provider Enrollment

9. Crossover Related Issue ESC 1011/EOB 1009_UNABLE TO DETERMINE CATEGORY OF SERVICE. REFER TO YOUR BILLING MANUAL ESC 1005/EOB 1005_UNABLE TO DETERMINE PROVIDER SPECIALTY FOR THE DOS BILLED Part B Crossover Related Issue ESC 3357/EOB 0280_CLAIM INDICATES THIS SERVICE IS DUE TO A WORK-RELATED ACCIDENT/INJURY. The claims have the E-code of E92.70 Overexertion and strenuousand repetitive movements of loads.   That does not mean it is work-related, strange Medicare accepted codes and did not question the diagnosis.  Potential Claim Issues

10. ESC 6705 - INPATIENT VS. NURSING HOME CLAIM CONFLICT Hospital claims failing ESC 6705 when NF claim has billed with revenue code 185. Criteria for this edit states: Audit 6705 and 6706 work together. Post the audit if all of the following are true: Current claim type is Inpatient (I). Current Contract/COS is 010. History claim type is Long Term Care (L). History claim does not have revenue code 185 anywhere on the claim. Same or overlapping header FDOS/TDOS. Same member. ESC 4801/EOB 4801_THESE SERVICES CANNOT BE BILLED ON THIS CLAIM FORM OR THE PROVIDER TYPE LISTED FOR THIS PROVIDER NUMBER CANNOT FILE THIS TYPE OF CLAIM  Rev Code: 921 PERI VASCUL LAB Procedure code: 93880_DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY No reimbursement rule for 070 submitted for claims team to research Injectables Rev 636 are being denied with 4393 "Invalid Revenue Code/Procedure code Combination" Potential Claim Issues

11. Edit 4754 Present on Admission (POA) Edits inactivated Friday 11/12 Claims Scheduled for Reprocessing 11/19 Claim POA

12. Add revenue codes 110, 120, 130, 140, 150, 170 Corrected Claims Scheduled for Reprocessing 11/19 Inpatient Claim Revenue Codes

13. Providers need to know the calculated DRG to know if a claim has been denied erroneously. Currently the remits are only showing the DRG assigned if the claim is in a paid status. TBD DRG Information

14. Condition Codes listed in Part II Policy Manual, Appendix O page 17, covered codes. Reminder

15. A Level 1 PASSAR screening must be completed prior to a patient being admitted to Swing Bed. The information will be entered as a prior authorization. DCH will begin editing this information on January 01, 2011. Billing Change_Swingbed

16. Web Portal_Provider Enrollment Forms

17. Legacy edit 9856 HP converted these claims and began reprocessing on the cycle dated 11/29 ACS Denied Claims_Last Cycle

18. Contact Center Busy Phones Getting assistance on basic calls from other accounts Adding additional staff on temporary basis Option to call other phone number for eligibility information 877-843-9024 800-766-4456 Provider Assistance

19. Member ID Cards If members have not received their new ID card they can contact either of the numbers to request a reissue. PMP Assignment If hospital authority is showing as some patients PMP on the web portal, you can request the member to contact HP to select a new PMP. Member Related Data

20. Medicare EOB attached and should not be handled like regular claims therefore PO Box to send these claims is Special Handling Documents PO Box 105208 Tucker, GA 30085 Medicare Part B Inpatient Only Claims

21. Any questions?