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WebEx Recap Network Provider Training on Contract Documents and Other System Changes October 17, 2013.

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Presentation on theme: "WebEx Recap Network Provider Training on Contract Documents and Other System Changes October 17, 2013."— Presentation transcript:

1 WebEx Recap Network Provider Training on Contract Documents and Other System Changes October 17, 2013

2 AGENDA 1. Introduction 2. New Exhibits and Other Cost Accumulator (OCA) Crosswalk Overview Exhibit H, Funding Detail Exhibit G, Cost Center Funding by OCA Budget Flexibility Invoice 3. Other Related Issues Payer of last resort Invoice Validation Process 4. Adjournment

3 1. Introduction Reinstatement of Sequestration & GAA Reductions All Treatment and Prevention Funding Details will be revised and sent out to Providers. Reporting changes

4 2. Exhibits & Crosswalk Overview OCA Crosswalk: Review of the “OCA Crosswalk.” The table provides a description from the old OCAs cross walked to the new OCAs, the related categories and the cost centers by program. OCA-Cross-Walk-October-2013.pdf

5 2. Exhibits & Crosswalk Overview Exhibit H, Funding Detail The revised Exhibit H incorporates the new Other Cost Accumulators (OCAs) in accordance with the Department of Children and Families (DCF) Approved Operating Budget (AOB) for fiscal year As an easy reference and for historical purposes, a two (2) year history of changes made to the Funding Detail will be noted at the bottom of the document.

6 2. Exhibits & Crosswalk Overview Exhibit G, Cost Center Funding by OCA The format for the Exhibit G has changed. Funding is now tracked by OCA and Cost Center. The OCA allocations are indicated towards the top of the document underneath the Program headings. Rates are on the left side of the document. Open cost centers will be BOLD and have a rate. Highlighted cost centers indicate a TANF eligible cost center. Providers will allocate the funds for each OCA across the open cost centers.

7 2. Exhibits & Crosswalk Overview Budget Flexibility Providers will be granted the flexibility to shift funds up to $25,000 or thirty (30) percent, whichever is higher, between Alcohol and Drug Other Cost Accumulators (OCA) and between Residential and Non-Residential Cost Centers/OCAs. Within each OCA there is unlimited flexibility to realign funds among cost centers. Any shift of funds in excess of the aforementioned amounts will require a formal contract amendment.

8 2. Exhibits & Crosswalk Overview Invoice The format for Exhibit E, Monthly Payment/Advance Request, has changed. Local Match, Medicaid, First, Second, Third and SSI/SSDI units shall be reported on the worksheet section of the invoice and backed out. The invoice submission date has changed from the 10 th to the 7 th calendar day of the month beginning with November services. The implementation date for the revised invoice begins with the November invoice (due December 7 th ) The invoice validation will be based on the first data run, therefore it is advisable to report and correct data errors more frequently. To obtain a copy of the revised invoice, please visit: documents-and-other-system-changes/

9 3. Other Related Issues Payer of Last Resort Excerpt from the Revised Exhibit B, Method of Payment to be amended into all contracts “Third Party Billing a. The Department is always the payer of last resort. The ME and the Network Provider specifically agree that the Department, through the ME, is never a liable third party. The Network Provider shall not bill the ME for services provided to: i. Individuals who have third party insurance coverage when the services provided are covered under the insurance plan; or ii. Medicaid enrollees or recipients of another publically funded health benefits assistance program, when the services provided are covered by said program, regardless of limitation. b. The Network Provider may bill the ME if services are provided to: i. Individuals who have lost coverage through Medicaid, or any other publically funded health benefits assistance program coverage for any reason during the period of non-coverage; or ii. Individuals who have a net family income at or above 150 percent of the Federal Poverty Income Guidelines, subject to the sliding fee scale requirements in Rule 65E F.A.C. c. In no event shall Medicaid, any health insurance, another publically funded health benefits assistance program, or the ME be billed for the same service provided to the same individual on the same day.”

10 3. Other Related Issues Invoice Validation Process Data submission date remains the same: 4 th calendar day of the month following the month of services The invoice validation will be based on the first data run The move is toward having “real time data” in order for this to occur providers will need to submit data more frequently. Suggested frequency is a weekly basis if not more. Orphan service reports will be provided weekly to providers Providers are directed to the “Special Allocation OCAs and Matching Modifiers” table provided. Providers with special allocations are required to utilize the special modifiers effective November 1, Failure to properly code the services will affect the provider’s ability to draw down the funding for the special allocation. Similarly, failure to report the proper modifier will skew the data for other OCAs. The OCA modifier (MODIFIER4) will continue to be populated by the SFBHN IT team until further notice. and-Matching-Modifiers.pdf

11 SUMMARY  Exhibit’s E, G, and H have been revised to align with the AOB and to meet new DCF reporting requirements  Providers will receive their revised Funding Detail within a week to start the Amendment process  Data submission date remains the same: 4th calendar day of the month following the month of services  Invoice Due Date Effective Immediately: 7th Calendar day of the month beginning with October 2013 services.  Utilization of Revised Invoice Template: Beginning with November 2013 services  Invoice validation will be based off of the fist data run  Implementation of the new data reporting to include Modifiers: Beginning with November 2013 services  Providers will need to report and correct data errors weekly  All of the documents presented at the meeting are posted on the following website: system-changes


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