PROVIDER FOCUS. Georgia Medicaid WHAT S INSIDE? First Quarter 2012 v. Georgia Medicaid Fair Compliant. Owners & Operators

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1 WHAT S INSIDE? First Quarter 2012 v PROVIDER FOCUS Fair 5010 Compliant Owners & Operators Mailing Claims & Non-Claims Online Hard Copy Attachments Provider Enrollment Updates Nursing Facility Updates Territory Listing & Representatives

2 MEDICAID FAIR November 2011 The Department of Community Health (DCH) and HP Enterprise Services would like to thank everyone that attended the November Fair. The event was a success, with hundreds of registered providers in attendance. The fair took place on November 16, 2011, at the Centreplex in Macon, Georgia. Attendees included DCH, HP Enterprise Services leadership, Georgia Medical Care Foundation (GMCF) and the Care Management Organizations (CMS). Guest speakers presented on a number of topics, including: 5010 Amerigroup Community Care Children's Intervention School Services and the Administrative Claiming for Education Program Children's Intervention Services Crossover Claims Dental Services Durable Medical Equipment Eligibility/Third Party Liability Georgia Medical Care Foundation/Prior Authorizations Health Check Services Health Information Technology/Medical Assistance Provider Incentive Repository Home Health Services Hospital Services ICD-10 Nursing Facilities Physician Services Provider Enrollment Peach State Health Plan Waiver Programs, including Money Follows the Person Web Portal Training WellCare of Georgia 1

3 MEDICAID FAIR November 2011 Additionally, DCH business partners, including the Georgia Families CMOs (Amerigroup Community Care, Peach State Health Plan and WellCare of Georgia), Georgia Medical Care Foundation (GMCF), Health Management Systems (HMS), Scion, MAXIMUS, Magellan, Dentaquest and Policy Studies Inc. (PSI) were also present. For those unable to attend, presentations can be viewed on the Web Portal (https://mmis.georgia.gov) under Provider Information, Provider Notices. Details about the May 2012 Fair coming soon! 2

4 5010 COMPLIANT GET READY Effective January 1, 2012, all Electronic Data Interchange (EDI) transactions submitted to must be HIPAA 5010 compliant. All providers, billing agents and clearinghouses must work together along with the Department of Community Health s (DCH) Provider Enrollment Unit to ensure that all credentials are current and valid. Providers should also make sure the following information is accurate with the Provider Enrollment Unit: National Provider Identifier is on file with Zip code plus 4 digit extension is accurate and updated for service location and mail to address Tax ID is correct Taxonomy codes related to each Medicaid provider number are on file Providers are allowed to update the following areas via the Demographic Maintenance: Taxonomies page allows providers to add, view, update and delete the taxonomies related to the provider account that has logged onto the secure Web Portal. Providers may only update their mail to address, , phone, after hours and fax numbers, handicap accessible, phone, after-hours phone numbers and website address information through the secure Web Portal. Providers, billing agents and clearinghouses must be sure that addresses submitted in loop 2010AA (Billing Provider loop) do not include a post office box or lockbox address. To verify the provider address information in the Georgia Medicaid Management Information System (GAMMIS), login (https://mmis.georgia.gov) enter the rendering provider ID only, click the results row to display additional information. All requests to update provider information must be made in writing. A Change of Information form must be submitted along with a written request of clarification for the necessary address change. The Change of Information form is located on the Web Portal (https://mmis.georgia.gov) under Provider Enrollment. Please complete the form and mail to: HP Enterprise Services Provider Enrollment PO BOX Tucker GA,

5 OWNERS & OPERATORS Effective October 1, 2011, applicants are required to fill out the Ownership and Managing Officials Control information on the enrollment (Web Portal or paper) application. The Centers for Medicare & Medicaid Services requires that ownership and managing employee information be collected for all healthcare providers that provide services that are publicly funded so that states may qualify for federal funds. For detailed information refer to: Code of Federal Regulations located in Title 42, Public Health, Chapter 4, Sub Chapter C, Part 455, Sub Part D, section through There is no distinction between for-profit and not-for-profit. Applicants must disclose the Owner(s) and Managing Employees of their practice, facility, or business. An individual enrolling in a group practice or business must disclose the ownership information of direct and indirect owners of the group practice or business. An owner is defined as a person or corporation with an ownership or controlling interest that: 1. Has an ownership interest totaling five percent or more in a disclosing entity; 2. Has an indirect ownership interest equal to five percent or more in a disclosing entity; 3. Has a combination of direct and indirect ownership interests equal to five percent or more in a disclosing entity; 4. Owns an interest of five percent or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least five percent of the value of the property or assets of the disclosing entity; 5. Is an officer or director of a disclosing entity that is organized as a corporation; or 6. Is a partner in a disclosing entity that is organized as a partnership. A Managing Employee is defined as a general manager, business manager, administrator, director, or other individual that exercises operational or managerial control over, or who directly or indirectly, conducts the day-to-day operation of the institution, organization, or agency, either under contract or through some other arrangement, whether or not the individual is a W-2 employee. Failure to provide all the required information may result in a denial for participation. 4

6 MAILING CLAIMS & NON CLAIM-DOCUMENTS To ensure receipt and timely processing of claims and documents, please mail all paper claims and non-claim documents directly to the following HP Enterprise Services post office boxes: HP Enterprise Services Forms City, State PO Box Number Zip Code + 4 Member / Provider Correspondence Tucker, Georgia PO BOX Provider Enrollment / EDI Services Tucker, Georgia PO BOX CMS 1500 Claims Tucker, Georgia PO BOX Crossover Claims Tucker, Georgia PO BOX UB04 Claims Tucker, Georgia PO BOX ADA 2006 Dental Claims Tucker, Georgia PO BOX Adjustments and Voids Tucker, Georgia PO BOX TPL / Finance / Buy-in Tucker, Georgia PO BOX Part B Claims, Retro Enrollment Claims and Outliers Tucker, Georgia PO BOX Non-Claim Documents (Miscellaneous) Tucker, Georgia PO BOX NOTE: Please do not mail paper claims and non-claim documents to McRae, Georgia. 5

7 SENDING ONLINE HARD COPY ATTACHEMENTS Attachments can be included as part of the secure Web Portal claim submission process. The ability to upload an attachment is provided on the Hard- Copy Attachment panel (shown below) when filing Dental, Institutional, and/or Professional claims. NOTE: Attachments may also be sent via fax or mail. STEP 1 - Complete the Hard-Copy Attachments panel (prior to submitting a claim) with a transmission of EL Electronic Upload or FT File Transfer. HARD COPY ATTACHMENT PANEL - FIELD DESCRIPTIONS (REQUIRED FIELDS ARE IDENTIFIED WITH AN ASTERISK) CONTROL NUMBER This is a unique identification number created by the provider. It is used to identify the document being attached or submitted electronically to HP Enterprise Services. The control number is not used or stored in the system. It should also not contain any protected health information (PHI). An example of a unique control number/identifier you can create is: JDOE*PROF*ELE*ATT*** TRANSMISSION (REQUIRED FIELD) This displays a drop-down list. Use it to select the transmission method by which the attachments are to be sent. The upload capability will be made available when the transmission type is Electronic or File Transfer. REPORT TYPE (REQUIRED FIELD) Use it to select the type of document, report, or file that is being attached. Click the add button to activate the panel 6

8 SENDING ONLINE HARD COPY ATTACHEMENTS STEP 2 - The claim will suspend (EOB Waiting for Attachment from Provider). Next, click the upload button on the Hard-Copy Attachments panel. STEP 4 - Select the upload attachment button. STEP 5 - Upload is successful. Click the upload button to activate the panel STEP 3 - Using the Attachment Upload panel, you will be able to browse for the file to attach. When the choose File Selection window opens, select the file to upload by browsing to the location where you saved the documents on your computer. File must be in a PDF, TIFF, JPEG or JPG format. We hope that this information has been helpful For more information related to filing online claims using the secure Web Portal, please refer to the Provider Billing Manuals. Manuals can be viewed on the Web Portal (https://mmis.georgia.gov) under Provider Information, Provider Manuals. 7

9 PROVIDER ENROLLMENT UPDATES NPI Number and Managed Care Plan Enrollment The Department of Community Health s (DCH) Provider Enrollment department is currently updating enrollment files to reflect the most accurate National Provider Identifier (NPI) and taxonomy numbers on enrollment files. The NPI and taxonomy number on the enrollment file must match the Managed Care Plans credentialing number. If the NPI and taxonomy number does not match the Managed Care Plans credentialing number listed on the provider ID file, an NPI Update Form must be submitted to HP Enterprise Services Provider Enrollment to update the enrollment file. The NPI Update Form is located on the Web Portal (https://mmis.georgia.gov) under Provider Information, Forms, select Enrollment in the drop down box. Complete the form and mail to: HP Enterprise Services Provider Enrollment PO BOX Tucker GA, Payee Numbers DCH s Provider Enrollment department is currently creating payee numbers for all provider contracts that are currently paying to the rendering provider ID number. The current provider payee and Electronic Funds Transfer (EFT) information will be listed on the newly created payee number. If the payee and/or EFT account information is incorrect, submit an updated W-9 Form and/or EFT Agreement reflecting the accurate information. The forms are located on the Web Portal (www.mmis.georgia.gov) under Provider Enrollment. Complete the form(s) and mail to: HP Enterprise Services Provider Enrollment PO BOX Tucker GA,

10 NURSING FACILITY UPDATES Prior authorization requirements for nursing facility claims will go into effect in the spring of Currently, HP Enterprise Services and the Department of Community Health (DCH) are in the final stages of building the infrastructure that will support this requirement. Prior Authorization (PA) for Nursing Facility services is tied to the Federal Pre-Admission Screening and Resident Review (PASRR) process. When a Level I (DMA-613) is submitted on the Medicaid Management Information System (MMIS) Web Portal, a Pre-Certification number is assigned. When the Level I Pre-Certification number is approved, it becomes the PA number that will be used in MMIS. A similar process will apply for Level II approvals. Prior Authorization is required for all Medicaid nursing facility claims (categories of service 110 & 160). Prior authorization is required for those members who have had or are expected to have a stay 30 consecutive days or more. In late winter 2012, a series of statewide workshops will be offered for providers to learn more about the specific requirements and expected date of implementation. Please check banner messages for workshop dates and locations nearest you. 9

11 FIELD SERVICE REPRESENTATIVES Territory / Representative 1 North GA Open 2 Atlanta Shay Daniels 3 Northeast GA Stanfinie Clayton 4 Northwest GA Shareé Daniels 5 Southeast Metro Shemekia Brown 6 Middle GA Tsani Merriweather 7 Augusta Anthony Banks 8 Southwest GA Jill McCrary 9 Southeast GA Veronica Meng 10 South GA Donna Hendley 11 Statewide Janey Griffin Counties Bartow, Catoosa, Chattooga, Cherokee, Dade, Dawson, Fannin, Floyd, Forsyth, Gilmer, Gordon, Habersham, Hall, Lumpkin, Murray, Pickens, Rabun, Stephens, Towns, Union, Walker, White, Whitfield Fulton Banks, Barrow, Clarke, Elbert, Franklin, Gwinnett, Hart, Jackson, Madison, Oconee, Walton Carroll, Cobb, Douglas, Haralson, Paulding, Polk Clayton, DeKalb, Rockdale Butts, Chattahoochee, Coweta, Fayette, Harris, Heard, Henry, Jasper, Jones, Lamar, Marion, Meriwether, Monroe, Muscogee, Newton, Pike, Spalding, Talbot, Taylor, Troup, Upson Baldwin, Burke, Columbia, Glascock, Greene, Hancock, Jefferson, Jenkins, Johnson, Lincoln, McDuffie, Morgan, Oglethorpe, Putnam, Richmond, Screven, Taliaferro, Warren, Washington, Wilkes Bibb, Bleckley, Calhoun, Clay, Crawford, Crisp, Dodge, Dooly, Dougherty, Houston, Laurens, Lee, Macon, Peach, Pulaski, Quitman, Randolph, Stewart, Schley, Sumter, Telfair, Terrell, Twiggs, Webster, Wheeler, Wilcox, Wilkinson Appling, Bacon, Bryan, Bulloch, Camden, Candler, Charlton, Chatham, Effingham, Emanuel, Evans, Glynn, Jeff Davis, Long, Liberty, McIntosh, Montgomery, Tattnall, Toombs, Treutlen, Ware, Wayne Atkinson, Baker, Ben Hill, Berrien, Brantley, Brooks, Clinch, Coffee, Colquitt, Cook, Decatur, Early, Echols, Grady, Irwin, Lanier, Lowndes, Miller, Mitchell, Pierce, Seminole, Thomas, Tift, Turner, Worth Hospital Field Representative 10

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