1. MPAA Updates 10/31/14

2. Agenda New look of CHAMPS MSA 14-34 Proposed Policy 1442 New look of TPL webpage L-Letter 14-28 Top Rejections Additional Updates

3. New look of CHAMPS CHAMPS new look and feel as of 9/29/14, same functionality

5. Defects in the new look of CHAMPS Print member summary hyperlink does not print all that is displayed on the screen Print function in blue ribbon Screen capture tool on your computer Change print setting to landscape Internet Explorer version 9 users have encountered problems accessing Archived Documents, Adobe setting instructionsAdobe setting instructions When accessing DDE from the favorites function, the billing NPI does not pre-populate Until corrected, access DDE without using the favorites feature

6. MSA 14-34 Inpatient Hospital Claim Requirements for Newborns

7. MSA 14-34 Inpatient hospital newborn claims dates of discharge on or after October 1,2014 Admission type Newborn Admission type of 4 Origin code of 5 or 6 Value code 54 reported with birth weight in grams as a whole number Further clarification being issued to clarify that cesarean and induction information should be reported on the mother’s claim not on the newborn’s claim Condition Code "81": C-sections or inductions performed at less than 39 weeks gestation for medical necessity Condition Code "82": C-sections or inductions performed at less than 39 weeks gestation electively Condition Code "83": C-sections or inductions performed at 39 weeks gestation or greater

8. Proposed Policy Project 1442 Diagnosis Related Group (DRG) Grouper Update, DRG Rate Update, Rehabilitation Per Diem Rate Update, Birth Weight Reporting, Prospective Capital, All Patient Refined DRG (APR-DRG) Notification

9. Proposed Policy 1442 Comments on this policy due by November 14, 2014 Effective January 1, 2015, claims for inpatient hospital discharges using the DRG methodology will be processed using Medicare DRG Grouper Version 32.0 Claims for discharges on or after January 1, 2015 that fail to report the newborn priority (type of) admission or visit and newborn birth weight will be denied Reporting of cesarean sections or inductions related to gestational age will continue to result in informational editing only

10. New look of TPL web page DCH-0078 electronic webpage

12. New look of TPL webpage Save this link to your favorites www.michigan.gov/reportTPL www.michigan.gov/reportTPL MDCH is now receiving monthly files from BCBS and BCN Currently files are handled manually, loaded by the 15 th of each month TPL is no longer making many changes to the TPL coverage file related to BCBS or BCN If a change, start or term date, has happened within the last 30-60 days to the BCBS or BCN coverage, MDCH will receive the update in the next monthly file, no need to submit the DCH-0078 form

13. L-Letter 14-28 Fee-for-Service Healthy Michigan Plan Beneficiaries with Retroactive Health Plan Enrollment Dates

14. L-Letter 14-28 L-Letter was only mailed to affected providers Inpatient Hospital claim recoveries total $1,753,817.70 Outpatient Hospital claim recoveries total $1,287,146.45 Credited claims appeared on Remittance Advice October 16,2014 Providers should bill claims to health plans within 60 days of the MDCH take-back The health plan must process these claims for all in- network and out-of-network providers without prior authorization, even if prior authorization is normally required for the service

15. Top Denials Top CARC’s and RARC’s for Inpatient and Outpatient Hospitals

16. Top Denials IPH CARC 24: Beneficiary enrolled in a managed care plan Payer at the time of admission is responsible for the claim CARC 251/RARC N205: Predictive modeling has reviewed the documentation submitted IPH claims admission/discharge reports are missing CARC 133/RARC N47: Fifteen day re-admission Always check against your own facility prior to contacting provider support CARC 16/RARC N253: Attending NPI not active on date of service Attending NPI must be active and enrolled on the claim header from date of service Provider verification tool can be used to verify enrollment CARC 109/RARC N193: Substance abuse Check diagnosis information on claim

17. Top Denials OPH CARC A8: Ungroupable DRG/APC One or more lines on the claim has denied which causes the claim not to be able to be priced by the APC software CARC 251/RARC N205: Predictive modeling has reviewed the documentation submitted OPH claims missing orders/results CARC 16/RARC M51: Missing procedure code CARC 22/RARC N598-: Other insurance is primary Review eligibility for other payer information prior to submitting claim

18. Additional Updates

19. Effective September 26,2014 MDCH is now processing OPH claims using the July APC software Effective September 26,2014 the attending NPI reported has to be effective on the Header date of service Effective December 12,2014 EZ link will no longer be an available option to submit claim documentation such as: Consent forms Medical Documentation Predictive Modeling After December 12,2014 providers will need to use Document Management Portal (DMP) tips and tutorial to submit claim documentationtips and tutorial

20. Resources

21. Provider Resources Medicaid Provider Training One on One trainings requests Association requests Current trainings available Provider Support www.michigan.gov/medicaidproviders 1-800-292-2550 ProviderSupport@michigan.gov Evaluation Form