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

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Presentation on theme: "HP Enterprise Services Hometown Health Presentation December 1, 2010 Partnering for Success!"— Presentation transcript:

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

2 2/ Georgia MMIS Presentation December 2010 HP Enterprise Services Web Portal  Web Portal Address  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 3/ Georgia MMIS Presentation December 2010 HP Enterprise Services EDI Helpdesk EDI Services Phone Number or toll free EDI Address: HP staff may begin sending web portal PIN letters via . The address to send the PIN request is above. When requesting a PIN via , 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 should be encrypted (secure ).

4 4/ Georgia MMIS Presentation December 2010 HP Enterprise Services 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 accounts? –Users who do not have an account can not be registered. 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.

5 5/ Georgia MMIS Presentation December 2010 HP Enterprise Services 835 Crosswalk 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

6 6/ Georgia MMIS Presentation December 2010 HP Enterprise Services Remittance Advices 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. 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.

7 7/ Georgia MMIS Presentation December 2010 HP Enterprise Services Web Portal_Password Resets Challenge Question EDI Helpdesk

8 8/ Georgia MMIS Presentation December 2010 HP Enterprise Services Provider Enrollment Applications pending at close of ACS Questions about enrollment –Contact Us_Secure portal –Phone Call; select enrollment option

9 9/ Georgia MMIS Presentation December 2010 HP Enterprise Services Potential Claim Issues 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 strenuous and repetitive movements of loads. That does not mean it is work-related, strange Medicare accepted codes and did not question the diagnosis.

10 10/ Georgia MMIS Presentation December 2010 HP Enterprise Services Potential Claim Issues ESC 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"

11 11/ Georgia MMIS Presentation December 2010 HP Enterprise Services Claim POA Edit 4754 Present on Admission (POA) –Edits inactivated Friday 11/12 –Claims Scheduled for Reprocessing 11/19

12 12/ Georgia MMIS Presentation December 2010 HP Enterprise Services Inpatient Claim Revenue Codes Add revenue codes 110, 120, 130, 140, 150, 170 –Corrected –Claims Scheduled for Reprocessing 11/19

13 13/ Georgia MMIS Presentation December 2010 HP Enterprise Services DRG Information 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

14 14/ Georgia MMIS Presentation December 2010 HP Enterprise Services Reminder Condition Codes listed in Part II Policy Manual, Appendix O page 17, covered codes.

15 15/ Georgia MMIS Presentation December 2010 HP Enterprise Services Billing Change_Swingbed 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.

16 16/ Georgia MMIS Presentation December 2010 HP Enterprise Services Web Portal_Provider Enrollment Forms

17 17/ Georgia MMIS Presentation December 2010 HP Enterprise Services ACS Denied Claims_Last Cycle Legacy edit 9856 –HP converted these claims and began reprocessing on the cycle dated 11/29

18 18/ Georgia MMIS Presentation December 2010 HP Enterprise Services Provider Assistance 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 – –

19 19/ Georgia MMIS Presentation December 2010 HP Enterprise Services Member Related Data 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.

20 20/ Georgia MMIS Presentation December 2010 HP Enterprise Services Medicare Part B Inpatient Only Claims Medicare EOB attached and should not be handled like regular claims therefore PO Box to send these claims is Special Handling Documents PO Box Tucker, GA 30085

21 21/ Georgia MMIS Presentation December 2010 HP Enterprise Services Any questions?


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