How to complete the Michigan Medicaid HMO logs in Excel

Transcription

1 How to complete the Michigan Medicaid HMO logs in Excel Julie Wiegand Health Services Associates, Inc 2 East Main Street Fremont, MI PH: wiegand@hsagroup.net Web:

2 In order to start the process you must download files from the CHAMPS DCH File Transfer website. This is the same place where your completed file must be unloaded along with the other files required for the cost report completion ( portal/dch portal). Below is a screen shot of the DCH File Transfer website.

3 Below is a screen shot of the DCH File Transfer website with the files that you will download, the HMO spreadsheet, the validator, steps on how to install the validator, steps on how to install a new validator, steps on how to use the validator.

4 Below is a screen shot of the correct Excel spreadsheet you must use when sending the file to Michigan Medicaid.

5 The tabs at the bottom are separated into the allowable Medicaid HMOs and MICHILD insurances that will count for the wrap around payment from Medicaid. You must have a contract with each HMO or MICHILD insurance in order for the payment to be allowed.

6 The first step is to run a report from your billing software that will export all the CPT codes billed for each Medicaid HMO or MICHILD insurance SEPARATELY each on it's own Excel spreadsheet in the following required columns (in this order). You will copy and paste the data into the Medicaid HMO log format from the previous pages. 1. Column A: Rendering NPI 2. Column B: Billing NPI (clinic) 3. Column C: Service Date 4. Column D: Beneficiary ID (must be Medicaid ID, note this is for MICHILD programs also) 5. Column E: Procedure/CPT Code 6. Column F: Paid Amount (or estimated amount, cannot be $0.01, must be fairly accurate estimate based on other procedures paid) 7. Column G: Payment Date (not required, but if you have it for one row of data must have it for all) 8. Column H: Place of Service (not required, but if you have it for one row of data must have it for all) 9. Column I: Other insurance (amount paid by primary insurance if Medicaid HMO/MICHILD is secondary, if you fill in one row must enter $0.00 for those rows that do not have payments from other insurance carriers). 10. Column J: Medicare status code (only used if Medicare is primary to Medicaid HMO/MICHILD insurance and will be 5 if it's a crossover, 1 if it's not. You must fill in all rows if you have data in any one row). 11. Column K: Beneficiary name **The other columns are not required, but if you have information in one row, all rows must have data in that column.

7 Once you have the data in the Medicaid HMO log format, run the "validator" to see if you have any problems with the data. This will search for date errors, check the field lengths for the NPI and beneficiary IDs to make sure they are the correct number of digits, checks for duplicate entries, checks for zero balance payments (cannot have zero payments, must enter the estimated payment).

8 Some common problems: 1. Duplicate records 2. Zero payment lines (if it's a Medicare crossover you should have a "5" in the Medicare status code column; otherwise it's a "1") 3. Zero payment lines (if it's a Commercial/Medicaid claim then you should have the primary insurance payment in "other insurance" column) 4. Rendering NPI and Billing NPI cannot be the same number, must have the individual provider NPI and the clinic NPI 5. Dates not entered correctly or out of range for the current cost report time frame 6. Not having data in all rows when you have data in a column for one or more rows A couple of tips when completing the logs: 1. Make sure to have the most current HMO log template downloaded from the DCH file transfer website 2 Make sure to have the most current validator downloaded from the DCH file transfer website 3. Note that this document is the support (the HMO logs) of your HMO visits and payments, not each line is a visit, but all CPT codes and payments must be reported 4. If a new validator comes out you must uninstall the old one to reinstall the new one