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HP Enterprise Services Hometown Health Presentation November 12, 2009 Partnering for Success!

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Presentation on theme: "HP Enterprise Services Hometown Health Presentation November 12, 2009 Partnering for Success!"— Presentation transcript:

1 HP Enterprise Services Hometown Health Presentation November 12, 2009 Partnering for Success!

2 2/ Georgia MMIS Presentation November 2009 Agenda Introduction/Background Project Phases Testing Approach Claim Submission Provider Assistance Questions

3 3/ Georgia MMIS Presentation November 2009 We’re Excited to be Back… History in Georgia Georgia MMIS Fiscal Agent July 1, 1987 – March 31, 2003 Georgia Immunization Registry System May 2003 – Present Data Broker March 2008 – Present

4 4/ Georgia MMIS Presentation November 2009 Project Phases EDS System Development Life Cycle √ Startup √ Design √ Development √ System Testing User Acceptance Testing Implementation

5 5/ Georgia MMIS Presentation November 2009 User Acceptance Testing December 2009 – June 2010 –DCH subject matter experts will create and execute test cases designed to thoroughly test the new MMIS. Provider Beta Testing March 2010 – April 2010 –Selected provider’s will have an opportunity to participate in testing the new MMIS solution. Electronic Data Interchange Testing February 2010 – May 2010 –All providers who submit claims electronically will be required to submit test claims to EDS to ensure they can successfully submit claims prior to July 1, –All clearinghouses, billing services and vendors will be required to submit test claims to EDS to ensure they can successfully submit claims prior to July 1, Testing Timeframes

6 6/ Georgia MMIS Presentation November 2009 Operational Readiness Testing March 2010 – May 2010 –DCH subject matter experts will create and execute test cases designed to thoroughly all operational areas of the EDS Account. –EDS Account staff participate in Operational Readiness Testing, including: Provider Enrollment Member Enrollment Call Center Data Entry Resolution Electronic Data Interchange Mailroom Buy In Teaming Partners Testing Timeframes

7 7/ Georgia MMIS Presentation November 2009 Claim Submission Web Portal HIPAA X Format Electronic Data InterChange  Clearinghouses  Vendors  Billing Services  EDS Software interChange accepts multiple media, including :  Magnetic Tape  CD  FTP  Bulletin Board via PC modem dial up  POSnet  Internet Paper UB04

8 8/ Georgia MMIS Presentation November 2009 Provider Assistance Web Portal Computer Based Training Contact Us Claim Status Claim Submission Eligibility verification Provider Enrollment Remittance Advices FAQ Manuals Workshop Locations/Data

9 9/ Georgia MMIS Presentation November 2009 Provider Assistance Provider Enrollment Team Enrolling Providers  Web Portal applications  Paper applications Workflow  Instant identification of enrollment application in process  Automatic routing to next step in enrollment process Provider Enrollment Assistance Member Enrollment Team Enrolling Members  Presumptively eligible pregnant women  Presumptively eligible newborns, including multiple births Provider Member Enrollment Assistance

10 10/ Georgia MMIS Presentation November 2009 EDI Helpdesk Web Portal Password Resets Enrolling Providers in Electronic Claim Submission Testing Provider and Vendors prior to Electronic Claim Submission Assistance  EDI related questions  Transmission questions  WinASAP will no longer be accepted; providers must transition to PES or other electronic software. EDI related questions Provider Assistance

11 11/ Georgia MMIS Presentation November 2009 Provider Assistance Contact Center Automated Voice Response  Claim Status  Check Amounts  Prior Authorization Status  Member Eligibility Member Contact Center Provider Contact Center Written Correspondence Team Field Representatives  11 Field Representatives – 1 Hospital Field Representative  Attend provider association meetings  Presenting training seminars to providers requesting such training  Offering on-site visits and training to providers and office billing staff  Offering on-site visits for claims resolution assistance  Billing Manuals

12 12/ Georgia MMIS Presentation November 2009 Field Representative Territories

13 13/ Georgia MMIS Presentation November 2009 Provider Training Statewide April 2010 – June 2010  166 Workshops Total  28 Institutional Workshops Ongoing training throughout life of contract Association Meetings Medicaid Fairs

14 14/ Georgia MMIS Presentation November 2009 Tentative April Workshop Schedule CityDay of WkDate DuluthThursday4/1/2010 MariettaMonday4/5/2010 CartersvilleTuesday4/6/2010 ConyersWednesday4/7/2010 AtlantaThursday4/8/2010 MaconMonday4/12/2010 FitzgeraldWednesday4/14/2010 AugustaFriday4/16/2010 ColumbusMonday4/19/2010 SavannahThursday4/22/2010

15 15/ Georgia MMIS Presentation November 2009 Tentative May Workshop Schedule CityDay of WkDate DuluthMonday5/3/2010 AtlantaFriday5/7/2010 AlbanyTuesday5/11/2010 FitzgeraldWednesday5/12/2010 SavannahMonday5/17/2010 ThomasvilleFriday5/21/2010 AugustaWednesday5/26/2010

16 16/ Georgia MMIS Presentation November 2009 Tentative June Workshop Schedule CityDay of WkDate DuluthTuesday6/1/2010 MariettaWednesday6/2/2010 CartersvilleThursday6/3/2010 ConyersFriday6/4/2010 AtlantaMonday6/7/2010 SavannahWednesday6/9/2010 AugustaMonday6/14/2010 ColumbusTuesday6/15/2010 AtlantaThursday6/17/2010 MaconThursday6/17/2010 ThomasvilleFriday6/18/2010

17 17/ Georgia MMIS Presentation November 2009 The EDI cut off is noon each Friday. EDS will process fee for service claims each week and continue to issue payments on a weekly basis Each individual working for a provider must have their own password to access the web portal Other Information

18 18/ Georgia MMIS Presentation November 2009 Transition Items i HP Enterprise Services will mail new Member ID Cards in June 2010 i HP Enterprise Services will mail Web Portal PIN letters to providers May/June 2010

19 19/ Georgia MMIS Presentation November 2009 ACS  Last Claims Cycle - June 25, 2010 g Last day to submit electronic claims for processing - June 25, 2010 g Last day paper claims are received for processing - June 18, 2010  Last day to receive calls - June 30, 2010 HP Enterprise Services  First Claims Cycle - July 2, 2010 i First day to submit electronic claims for processing – June 28, 2010  First day paper claims are received for processing - June 21, 2010  First day to receive calls - July 1, 2010 Tentative Timeframes

20 20/ Georgia MMIS Presentation November 2009 Any questions? Mary-ann.barndt-


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