HP Enterprise Services Hometown Health Presentation

1. HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!

2. Web Portal Claims Processing Provider Assistance PO Boxes Agenda

3. Web Portal • Web Portal Address www.mmis.georgia.gov • Unable to access: • Make sure you have entered the above address • ACS is no longer rerouting to the new web portal • Close all browsers and then try again • 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

4. 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

5. HP Enterprise Services is sending 835 and 277U transactions to the Provider Payee ID.  For any Provider that is receiving their 835 and/or 277U transactions through a Trading Partner (i.e.  Clearing House, Billing Agent etc), those Providers must: 1. Activate the PIN based on the letter received for the Payee Provider ID.  2. Log into the account and delegate the Trading Partner expected to receive the 835 and/or 277U for that Payee Provider ID. After the weekly cycle is complete, EDI will automatically route the 835 and/or 277U to the TP that was delegated. 835 and 277U Transactions

6. The EOB / Adjustment Reason / Remark Codes crosswalk has been loaded for HIPAA transactions. The information is located on the web portal Provider Information>>Provider Notices 835 Crosswalk

7. 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

8. In cooperation with the Department of Community Health (DCH), HP Enterprise Services will no longer provide a paper Provider Remittance Advices (RA).In order to obtain your RA, Providers can log into the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov with your payee identification number and follow the steps below: 1. Click on Reports Then click on Financial Reports Click on the drop-down tab and select Remittance Advice 4. Enter the From Date and To Date 5. Click Search Paper RAs

9. Where do providers find payments not the RA just payment amounts? This is the payment summary page that used to be on the GHP site but was never a requirement or request to add on the new site until it was mentioned during the BETA session. Post go live recommendation from BETA. IVRS The previous Interactive Voice Response System (IVRS) with Affiliated Computer Services (ACS), required Healthcare providers to enter their Rendering Identification Number to check the status of their weekly payment check. The new HP Enterprise Services IVRS requires Healthcare providers to enter their Payee Identification Number to gain access to their weekly payment check status. Payments Amounts

10. In the GHP portal it indicated if a CPT/HCPCS was covered or non-covered. Where is this located on the HP portal? The Procedure Code Search panel allows providers and billing agents to perform searches for procedure code information in relation to Georgia Medicaid. The Categories of Service panel allows providers and billing agents to view detailed restrictions for the procedure code based on the search criteria entered on the procedure code search panel. An exact match must be identified before displaying results on the panel. The detailed information includes restrictions based on a provider's category of service. Web Portal Procedure Search

11. Should claims that have been billed show up in the web portal? We are unable to see the claims. Navigational Path: Claims - Search (Void, Adjust) Claim Search

12. Challenge Question EDI Helpdesk Web Portal_Password Resets

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

14. Case Sensitivity for Web claim Submissions Due to case sensitive issues, HP Enterprise Services recently became aware of some Provider web portal claim denials.  When entering an online claim, Providers must be aware of how a Members name is entered into the Georgia Medicaid Management Information System (GAMMIS). In order to avoid denial of the claim, capitalization of Members names must appear in the same format as the name on file with HP Enterprise Services. If Providers have any questions about the correct capitalization of a Members name, please visit the eligibility section on GAMMIS https://www.mmis.georgia.gov. HP Enterprise Services is currently working to resolve the issue. Web Portal_Claims

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

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

17. 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

18. 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

19. Legacy edit 9856 HP will convert these claims and begin reprocessing cycle dated 11/20 ACS Denied Claims_Last Cycle

20. 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

21. 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

22. Post Office Boxes

23. Post Office Boxes continued

24. 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

25. Any questions?