Integrated Payment & Reporting System (IPRS) and Target Populations

2. Integrated Payment & Reporting System (IPRS) and Target Populations

3. IPRS* • In 2oo2 North Carolina began implementing the IPRS system to replace the 3 existing, non-integrated, claims systems that had been in use. • This system was built on the MMIS used for processing Medicaid claims • The system was designed to track, pay, & report on all claims for services rendered * NCDHHS Site http://www.ncdhhs.gov/mhddsas/iprsmenu/index.htm

4. IPRS (Benefits) The desired benefits for this system were: • Create 1 integrated system for processing and reporting all MH/DD/SAS and Medicaid claims • Have the ability to receive claims electronically • Ability to track consumers and their eligibility • Ability to monitor and report on LMEs’ service delivery and program performance • Improve claims processing and reduce payment cycle time • Determine Service needs and leverage fund allocations to all LMEs

5. PBH and IPRS • Due to our waiver PBH was exempt from this system. • PBH has the ability to manage both the Medicaid and State funds for Cabarrus, Davidson, Rowan, Stanly, and Union Counties. • Due to this the State has not been able to accurately report on how PBH is performing in relation to other LMEs.

6. *MH/DD/SAS Community Systems Progress Indicators, Report for Second Quarter SFY 2007-2008

7. Beginning July 1st PBH will be participating 100% in the IPRS system

8. What this means for providers • Providers will be required to assign consumers receiving a State Funded Service to the appropriate Target Populations at time of admission • Providers are expected to update Target Populations any time there is a change (Diagnosis, GAF, etc.)

9. What this means for providers • Providers will need to make sure the Target Population selected is compatible with the service being requested (i.e. IOP with ASHMT) • If these processes are not done it could result in returned TARs, delays, and possibly interfere with payment for services

10. Where to complete Target Populations • Last month there was a training for all providers offered on the new enrollment process in Provider Direct. • User manual can be accessed at: http://www.pbhcare.org/providerdirect.asp (See Section 2) • Part of this system is the entering of Target Populations • This system is currently set up with “logic” that prevents Concurrency problems and Target Populations being entered that do not match the Diagnosis

12. Important Site to Knowhttp://www.ncdhhs.gov/mhddsas/iprsmenu/index.htm

13. Target Population Eligibility Matrix

14. Crosswalk for all Diagnosis and Target Populations

15. Detailed information and criteria for each Target Population

16. Concurrency Table

17. Array of Services

18. Summary • July 1st PBH will be participating in the NC IPRS System • Providers will be responsible for assigning appropriate Target Population(s) to consumers receiving State Supported services. • PBH and Providers must work together to make sure accurate information is provided to the State.