1 NewMMIS Pilot NewMMIS Pilot Provider Orientation August 21 & 22, 2008 NewMMIS

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: :00 AMQuestions & Answers

WELCOME! Pilot Phase II

4 NewMMIS Overview/Update  NewMMIS Timeline/Activities:  User Acceptance Testing (UAT)  Pilot  Trading Partner Testing (TPT)  Implementation

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%

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

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

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

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

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  Note "Pilot" on the claim form  Submit TPL paper claims

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

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

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

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

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

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

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

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 to your Pilot Coordinator  Follow-up outreach activities may occur

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

20 Eligibility Test Scenario

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

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

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

24 Provider Communications  Help Desk  Pilot Coordinators  Pilot Provider Primary Contact  Weekly Status Meetings   Debriefing

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

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  option:

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:  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

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

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

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  Etc.

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

32 Access  User ID & Passwords:  User ID and password to access the Pilot environment will be sent to you via shortly after you attend the Pilot training  The will be auto-generated to the 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:

33 Contact Information  CST Phone Number:  for MassHealth Customer Service:   Paper Claims Mailing Address: MassHealth Attn: Pilot PO Box 9118 Hingham, MA 02043

34 Available Resources  Check our web site often for the most up-to-date information:  Masshealth provider bulletins & transmittal letters  MassHealth trainings  E-Learning: masshealthnewmmisprovidertraining.ehs.state.ma.us/

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

36 E-Learning/Help Overview  E-Learning overview  Navigation  Panel help & field level help

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

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!!!

39 Q & A Questions & Answers