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1 NewMMIS Pilot NewMMIS Pilot Provider Orientation August 21 & 22, 2008 NewMMIS
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2 Agenda 9:00 – 9:05 AMSign/Registration 9:05 – 9:55 AMPresentation Welcome NewMMIS Overview & Update Purpose of Pilot Pilot Timeline Pilot Activities Pilot Functionality Paper Claims Submission Pilot Data Parameters & Constraints Test Scenarios Pilot Participant Readiness Provider Communications Help Desk Support Pilot Coordinators Pilot Provider Access Contact/Available Resources E-Learning Debriefing Next Steps 9:55 - 10:00 AMQuestions & Answers
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WELCOME! Pilot Phase II
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4 NewMMIS Overview/Update NewMMIS Timeline/Activities: User Acceptance Testing (UAT) Pilot Trading Partner Testing (TPT) Implementation
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5 Purpose of Pilot Primary objective : TEST, TEST, TEST Pilot Responsibilities Test transactions Review responses Identify defects Based upon feedback CW may identify additional training needs What you can expect Claims may not pay accurately Claims may deny Responses may not be accurate Reporting may not be 100%
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6 Purpose of Pilot Validate Infrastructure Environment is stable Interfaces are working Security is working Helpdesk ticketing system is functioning appropriately Prepare for Implementation Identify provider type specific defects Identify additional training needs Identify additional communication needs Identify additional helpdesk & infrastructure needs
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7 EDS Readiness report – 8/8/08 Commonwealth (CW) Testing/Validation 8/11 – 8/22 Pilot Start Date: 8/25/08 Pilot End Date: 9/12/08 Debriefing Assess Provider experience Assess User experience Assess system performance Pilot Timeline
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8 Pilot Activities Complete Trading Partner Testing Complete test scenarios & provide feedback based on day-to-day business Follow Pilot data parameters for transaction submission Participate in debriefing
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9 Pilot Functionality HIPAA Batch Transactions 270/271 276/277 837P 837I 997 835 Direct Data Entry (DDE) Eligibility Verification Professional Health Care Claim Institutional Health Care Claim Claim Status Inquiry Paper Claims Cross-Over Claims / COB View Metrics / Reports Remittance Advice (RA) Claims Metrics
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10 Paper Claims Submission For Pilot Providers submitting paper and TPL/COB claims, forward all paper claim forms to the following address: MassHealth Attn: Pilot PO Box 9118 Hingham, MA 02043 Note "Pilot" on the claim form Submit TPL paper claims
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11 Pilot Data Parameters Conversion claims data through 4/23/08 Member & Provider PA/PAS/Referrals Procedure/Revenue Codes TPL Use claim and member data through 4/23/08 to submit pilot transactions Timely filing edits will apply Converted claims cannot be modified NewMMIS initiated claims can be modified and resubmitted
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12 Pilot Data Parameters Batch cycles that will be run during Pilot: Claims Financial—Thursday Eligibility Verification System (EVS) System Wide HIPAA Batch Cycles Tracking number will display immediately 997 will display estimated 15 – 30 minutes HIPAA related response estimated 45 minutes to 1 hour Batch Cycles are supported between 8:00AM – 5:00 PM
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13 Pilot Data Parameters Use NewMMIS Provider ID/Service Location (PID/SL) on all claims (obtain number after Pilot training) Use NewMMIS Member ID on DDE to obtain member number through REVS or NewMMIS EVS functionality HIPAA 837 batch claims will accept current MassHealth Member ID, however, NewMMIS ID is preferred Input 2 leading Zeros when using existing referral numbers on claim submission
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14 Constraints Dupe “S” procedures – Some legacy service codes are flagged/bypassed (small number of denials for services performed on the same day/same member) Impact: Primarily DME Approach: Work around constraint Professional claims with PA pricing – PA end dates may effect pricing Impact: DME Approach: Do not submit claims with PA Pricing procedure codes
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15 Constraints Max unit override – In some instances current MMIS allows more units than on current procedure file. Some NewMMIS claims may be “cut back” Impact: Physician, CHC, MH Centers, State agencies, OPD Approach: Submit claims but be aware of constraint (less than 10 codes) Home Health Claims – X-walk issue with Type of Bill Impact: Home Health Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports
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16 Constraints Holiday/weekend rates – Claims may not reflect special rates Impact: Home Health Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports Restrictive Messages – Under CW review; less than 20 may result in incorrect messages being issued to providers Impact: All Approach: Work around constraint Do not submit codes with modifiers
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17 Constraints Payment based on provider specialty - claims may not pay accurately (25 estimated procedure codes impacted) Impact: State Agencies Approach: Work around constraints Procedures codes paid on both a class rate and provider specific rates - Claims may pay incorrectly - (primarily when Community Health Centers (CHC) bill certain clinic visits codes e.g. codes 9993xx) Impact: CHCs Approach: Do not submit certain procedure codes Remittance Advice – currently prints portrait, which may be difficult to read Impact: All Approach: View remit on screen and use discretion when printing
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18 Test Scenarios Review list of test scenarios and select those that are pertinent to your day to day activities/ identified in your survey response Perform up to 10 test case scenarios - examples: Check Member Eligibility Submit a Claim Download RA or 835 Complete the test scenario, including feedback section and email to your Pilot Coordinator Follow-up outreach activities may occur
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19 List of Pilot Test Scenarios POSC-LOGProvider logs in to Provider Online Service Center EVS-DDEProvider submits DDE member eligibility PHYS-DDEProvider submits Physician DDE claim INST-DDEProvider submits Institutional DDE claim STATUS-DDEProvider submits DDE claim status CLAIM-837PProvider submits 837P CLAIM-837IProvider submits 837I EVS-270Provider submits 270 STATUS-276Provider submits 276 CLAIM-997Provider views 997 EVS-271Provider views 271 STATUS-277Provider views 277 CLAIM-RAProvider views RAs CLAIM-835Provider views 835 CLAIM-REPProvider views metric reports
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20 Eligibility Test Scenario
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21 Pilot Participants Readiness Continue preparing for the transition Complete Trading Partner Testing (as applicable ) Review EDI submission instructions Provide member numbers Use your NPI – it is required Obtain your User ID/Password (to access CST web page) Complete System Readiness activities: Billing intermediary Practice management Software vendors Review Pilot Materials: Companion guides Billing instructions Review E-Learning Participate in Pilot overview
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22 Pilot Participants Readiness Identify for Pilot: Provider numbers Member identification numbers Billing Intermediaries/Vendors Identify claims you will use during testing Identify PA/PAS & referral numbers you will use during testing using the data parameters date (4/23/08) Coordinate resources within your organization Determine daily testing timeframes
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23 Pilot Participant Readiness NewMMIS PID/SL will be provided to all Pilot participants Billing Intermediaries/Large Organizations: Identify the name and Legacy provider numbers of the providers you will submit claims on behalf of during Pilot CW will validate the existing relationship Once the NewMMIS PID/SL is validated, it will be provided to you. This number is not to be shared with anyone and must only be used for testing purposes
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24 Provider Communications Help Desk Pilot Coordinators Pilot Provider Primary Contact Weekly Status Meetings Email Debriefing
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25 Help Desk Trading Partner Testing (TPT) Testing must be completed for HIPAA Transactions before providers can submit “production” transactions in the Pilot environment Help Desk at @ 1-888-824-3484
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26 Help Desk Support Mirror implementation Enhancements to existing customer service center environment Monitoring tools in place to track caller, types of calls, response time results Anticipated response time for critical impact is immediate < or = to 3 hours Email option: pilotsupport@mahealth.net
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27 The help desk is the first line of support for providers with questions on their use of the NewMMIS Support hours of operation: Phone: 1-888-824-3484 Monday - Friday 8AM - 5PM No after hours or weekend support will be available A Three tier support system to address provider technical & non technical issues Tier 1 = CST Tier 2 = NewMMIS Technical Team Tier 3 = NewMMIS SMEs and BAs Help Desk Support
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28 Help Desk Support - Priority Priority/ Severity ImpactDescriptionResponse Time Resolution Time Level 1Critical No work around High: Large number of Providers affected Affects online processing Major component not available for use Loss of functionality Problem cannot be bypassed 3 hours 6 hours Level 2Serious Work around available Moderate: Large number of Providers affected Potentially affects online commitment Serious slow response times & functionality 6 hours 12 hours Level 3Moderate to Low Non- critical problem Low: No direct impact on Provider Few functions impaired Problem can be by passed & acceptable to the Provider 12 hours 5 days
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29 Pilot Coordinator Activities Pilot Coordinators: This team is comprised of NewMMIS Functional Coordinators (FCs). They will function as liaison to Pilot Providers. Pilot Coordinators Role: Serve as a liaison to Pilot Providers Conduct welcome call – initial contact Check in with providers Collect test scenarios feedback from Providers Review monitoring reports & confer with Providers regarding status of activities & support needs Research issues, identify defects and solutions Conduct debriefing with Providers Report debriefing results to Project Leadership
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30 Pilot Provider Role of Pilot Provider Primary contact: Coordinate activities within your organization Work directly with the NewMMIS Pilot Coordinator to communicate issues and resolve Pilot process concerns from your organization Validate the number of pilot participants/users from your organization Confirm your organization is prepared for Pilot by validating that participants/users have conducted the following activities: Completed TPT Reviewed the E-learning Identified the member and claims data that will be used for Pilot Participants/users have helpdesk number and email Etc.
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31 Access Provide Access To Pilot Environment The Commonwealth will issue User ID & Passwords to all participants Provide security data collection information required to initiate a request for a User ID & password Contact Pilot Support to provide security data Environment available on 8/25/08
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32 Access User ID & Passwords: User ID and password to access the Pilot environment will be sent to you via email shortly after you attend the Pilot training The email will be auto-generated to the email address you supplied to us (security data collection information) The password is temporary and will be revoked once Pilot is completed Once you receive the User ID and Password, you must log-in to Virtual Gateway, change your password, and set up a series of security questions. This User ID and password can then be used to access the NewMMIS Pilot Environment on 8/25/08. URL: www.mass.gov/masshealth/newmmispilot
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33 Contact Information CST Phone Number: 1-888-824-3484 Email for MassHealth Customer Service: Email Address @ pilotsupport@mahealth.net Paper Claims Mailing Address: MassHealth Attn: Pilot PO Box 9118 Hingham, MA 02043
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34 Available Resources Check our web site often for the most up-to-date information: www.mass.gov/masshealth/newmmis Masshealth provider bulletins & transmittal letters MassHealth trainings E-Learning: http:// masshealthnewmmisprovidertraining.ehs.state.ma.us/
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35 Available Resources Accessing E-learning Tips If you have not yet registered, go to Don’t have a user name click here Allow pop ups…. Go to tools on your menu bar, Select Pop Up Blocker, then select Turn off Pop up blocker Complete all fields, regardless of * (don’t forget county) User name must be different from password Password must be a minimum of 6 characters Select one provider type if you have many. If you have multiple provider types, have different staff select different provider numbers and types. Select Register Select Continue Select Course Catalog Select appropriate courses, beginning with A Provider Information and Navigation course Select course from center of screen Select Enroll Select Launch Select Launch again
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36 E-Learning/Help Overview E-Learning overview Navigation Panel help & field level help
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37 Debriefing At the end of Pilot, a debriefing session will be held to obtain feedback on the NewMMIS and the overall Pilot experience: Assess Provider experience Assess User experience Assess System performance
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38 Next Steps Issue User IDs & Passwords Identify provider numbers to test Review E-learning Define testing data & testing timeframes Submit HIPAA Batch Tests (TPT) Open Pilot Environment Test, Test, Test!!!
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39 Q & A Questions & Answers
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