New Provider Workshop June Hewlett Packard Enterprise - Fiscal Agent for the Arkansas Division of Medical Services

Transcription

1 New Provider Workshop June 2016 Hewlett Packard Enterprise - Fiscal Agent for the Arkansas Division of Medical Services

2 Agenda The Arkansas Medicaid Program Hewlett Packard Enterprise Provider Portal Report Your NPI Primary Care Physicians Provider Manuals Eligibility Plan Descriptions/Aid Categories/Benefit Limits Submitting Claims Claim Status WebRA Billing Tips Questions 2

3 The Arkansas Medicaid Program 3

4 Arkansas Medicaid Who Does What? County Offices (DCO) Arkansas Foundation for Medical Care (AFMC) ConnectCare Beacon Health Strategies Health Management Systems (HMS) Division of Medical Services (DMS) Hewlett Packard Enterprise 4

5 DHS County Offices County Caseworkers Work directly with beneficiaries Determine eligibility, plan description and eligibility timeframe Assist with Primary Care Physician (PCP) selection 5

6 Arkansas Foundation for Medical Care (AFMC) Serves as a liaison for Medicaid and providers: primary care providers, specified specialty providers and acute care hospitals Manages Medicaid Quality Improvement Projects including the Inpatient Quality Incentive Program Operates beneficiary complaint and transportation help lines Provides utilization and quality review for various Medicaid Programs Authorizes extensions of benefits 6

7 Arkansas Foundation for Medical Care (AFMC) Conducts therapy retrospective reviews Provides prior authorization for personal care 7

8 ConnectCare Helpline (Medical) Assign and change beneficiaries PCPs Assist beneficiaries in finding a dentist confirmation letters, PCP lists and outreach materials to beneficiaries

9 ConnectCare Helpline (Dental) Assist beneficiaries in finding a dentist Schedule dental appointments Make appointment reminders (phone call) Follow up with dental provider and beneficiary the business day after appointment

10 Beacon Health Strategies Mental Health Provides utilization management, continuing education and inspections of inpatient and outpatient mental health facilities for beneficiaries enrolled in the Medicaid Program Approves prior authorizations, certifications of need (CON) and continuing stay reviews Receives general questions at:

11 Health Management Systems Third-Party Recovery Health Management Systems (HMS) provides services that identify third-party payment sources (such as commercial insurance and health plans, Medicare and TRICARE) and recovers public health plan expenditures when third-party liability exists HMS

12 DHS Division of Medical Services Administers Arkansas Medicaid Division of Medical Services (DMS) establishes policy for all Medicaid Programs Provider Reimbursement establishes reimbursement rates TPL validates third-party liability information Program Development and Quality Assurance distributes Medicaid policy and monitors waiver programs Utilization Review assists with claims and makes coverage determinations Medical Assistance manages program communications plus dental and visual programs Pharmacy makes coverage determination and manages all drug-related issues 12

13 Office of Medicaid Inspector General Program Integrity Report Medicaid Fraud by calling the Arkansas Medicaid Inspector General's Hotline at AR-OMIG ( ) or report at the website: 13

14 Hewlett Packard Enterprise Fiscal Agent Provider enrollment Claims processing Remittance Advice Provider relations Medicaid Management Information System (MMIS) 14

15 Hewlett Packard Enterprise 15

16 Hewlett Packard Enterprise Monday through Friday (8 a.m. 5 p.m.) Toll-free in Arkansas (800) Local or out-of-state (501) Dedicated fax (501) Hewlett Packard Enterprise PO Box 8105 Little Rock, AR

17 Hewlett Packard Enterprise Provider Assistance Center Your first point of contact for billing, claim status, and other general questions is the Provider Assistance Center: Monday through Friday (8 a.m. - 5 p.m.) Toll-free in Arkansas (800) Local or out-of-state (501) Please Note: Provider Assistance no longer verifies eligibility. 17

18 Hewlett Packard Enterprise Electronic Data Interchange (EDI) The Hewlett Packard Enterprise EDI Support Center is open weekdays from 8 a.m. to 5 p.m. to assist providers with electronic claim submission issues, 997 batch responses, PES software delivery and setup support, software training and data transmission failures. Toll-free in Arkansas (800) Local or out-of-state (501) Address ARKEDI@hpe.com 18

19 Hewlett Packard Enterprise Research Analyst The Hewlett Packard Enterprise Research Analyst answers s sent to region mailboxes, researches claims issues from providers and submits eligible claims with appropriate override. Providers need to attach a cover letter explaining the reason for their inquiry and attach an original red and white claim form with their cover letter to the address below. Hewlett Packard Enterprise Attn: Research Analyst PO Box 8036 Little Rock, AR

20 Hewlett Packard Enterprise Provider Representatives Provider representatives handle billing and policy issues that have been escalated from the Provider Assistance Center. They are also available to visit your office by appointment. You can find your provider representative under Meet Your Hewlett Packard Enterprise Representative on the Medicaid website. You may contact your representative by calling (501) and entering their extension. 20

21 Provider Portal 21

22 Provider Portal The Arkansas Medicaid Provider Portal is the gateway to most online tools for providers. From the portal, providers can: Verify eligibility Submit claims View Remittance Advices Review caseload data (for PCPs) Report or change NPI information Reverse claims Provider Portal passwords do not expire. 22

23 Provider Portal Click Provider First-time visitors will enter the Provider s Medicaid number for the User ID and the associated tax ID or SSN for the Password. You will be prompted to change the password. Initial password is your Tax ID or your SSN. New password is a minimum of 8 alpha and numeric characters. 23

24 Report Your NPI 24

25 Report Your NPI Arkansas Medicaid Website 25

26 Report Your NPI 26

27 John Doe (000)

28 John Doe (000)

29 John Doe (000) xxxxxxxx

30 NPI Registry Disclose via the Freedom of Information Act (FOIA) Search for providers' NPI numbers Visit the NNPES website: Query-only database (NPI Registry) Downloadable file 30

31 Primary Care Physicians 31

32 Primary Care Physician (PCP) Arkansas Medicaid operates as a Primary Care Case Management Program. Most beneficiaries are required to have a PCP, and most services require PCP referral. Beneficiaries that are not required to enroll with a PCP include: Beneficiaries with Medicare coverage Residents of an Intermediate Care Facility for the Mentally Retarded Residents of Long Term Care facilities Beneficiaries on spend-down aid categories Retroactive eligible beneficiaries 32

33 Primary Care Physician (PCP) Main responsibilities: Provide health education Assess medical conditions, initiating and recommending treatment or therapy Refer to specialty physicians, hospital care, and other medically necessary services Locate needed medical services Coordinate prescribed medical and rehabilitation services with other professionals Monitor the enrollees prescribed medical and rehabilitation services 33

34 Beneficiaries Main Responsibilities Select a PCP (most beneficiaries) Report changes in income or circumstances Report TPL 34

35 Arkansas Medicaid Information Interchange (AMII) Quarterly Provider Reports for PCPs The AMII section of the Provider Portal offers PCPs special reports on their participation and clients under their care. The reports include: Caseload information Cancer screenings Diabetes screenings Recipient screenings 35

36 Arkansas Medicaid Information Interchange (AMII) Password Requirements Click Provider, log into the Portal, and select AMII in the Available tools menu. Please read the disclaimer in the text box. Check the box I accept terms and conditions. Minimum of 8 characters up to 32 Contain at least 1 uppercase alpha character Contain at least 1 lowercase alpha character 36

37 Provider Manuals 37

38 Provider Manual Sections Section I General Policy General information, sources, beneficiary eligibility and responsibilities, provider participation, administrative (and non-compliance) remedies and sanctions, and PCP case management program and required services and activities Section II Provider Manual (varies by provider type) Program or provider specific information, program coverage, prior authorization, reimbursement and billing procedures Continued 38

39 Provider Manual Sections Section III Billing Information General information, Remittance Advice and status report, adjustment request, additional or other payment sources, pseudo claims and reference books. Section IV Glossary AR Medicaid acronyms and terms Section V Claim Forms Claim forms, AR Medicaid forms, contacts and links Continued 39

40 Provider Manual Sections Appendix A Update Log update number and effective date (formerly Appendix A) Number and release dates for updates Program Publications / Notifications - transmittal letters, official notices, remittance advice messages and notices of rulemaking 40

41 Eligibility 41

42 Verify Eligibility Using the Portal (DDE) 42

43 Eligibility Verification Inquiry Enter NPI Provider NPI: Taxonomy: Medicaid Provider ID: Address: City: State: Zip Code: Arkansas 43

44 Eligibility Verification Inquiry Recipient Complete one of the following search options: Beneficiary ID and Date of Birth Beneficiary ID, First Name and Date of Birth Beneficiary ID, First Name and Last Name Beneficiary ID, First Name, Last Name and Date of Birth Last Name, First Name, and Date of Birth Search Fields Beneficiary ID: Birth Date: Last Name: First Name: MI: 44

45 Eligibility Verification Inquiry Dates of Service Complete a range of dates on when you expect the service to be rendered. This will determine if the subscriber is covered by Medicaid during this date period. From (required): To (required): 10/01/ /01/2012 Submit Note: Eligibility is date specific and can only be honored if it was checked on the day of service. 45

46 Eligibility Verification Response Subscriber Eligibility/Service Information Eligibility or Benefit Information 1 (Active Coverage) Coverage Level Code IND (Individual) Service Type Code 30 (Health Benefit Plan Coverage) Insurance Type Code MC (Medicaid) Plan Coverage Description 61 (PW-PL ) Date Time Period Service Type Code 01 (Medical Care) Service Coverage Indicator Y Service Copay $0.00 Service Coinsurance 000 Service Type Code 30 (Health Benefit Health Care Coverage) Service Coverage Indicator Y Service Copay $0.00 Service Coinsurance

47 Eligibility Verification Response Eligibility Verification will give a generic response that will include 13 service types. 1 Medical Care 86 Emergency Services 30 Health Benefit Plan Coverage 88 Pharmacy 33 Chiropractic 98 Professional (Physician) Visit-Office 35 Dental AL Vision (Optometry) 47 Hospital MH Mental Health 48 Hospital-Inpatient UC Urgent Care 50 Hospital-Outpatient 47

48 Eligibility Verification Response Extended Eligibility or Benefit Information Includes: Primary Care Physician (PCP) Information Third Party Liability (TPL) Benefit Information Waiver Service Eligibility Information 48

49 Verifying Eligibility Provider's Responsibility Although you may search eligibility for past dates, AR Medicaid will only accept proof of verifying eligibility if it was checked on the date of service. Cost to verify eligibility is 10 ; you are charged only if a response is received. 49

50 Voice Response Providers can verify a beneficiary s eligibility by calling the automated Voice Response System (VRS). By dialing the Provider Assistance Center line and selecting option 3, the VRS will retrieve recipient Medicaid eligibility, PCP and other information. Toll-free in Arkansas: (800) Local or out of state: (501)

51 Plan Descriptions Aid Categories Benefit Limits 51

52 Plan Descriptions Overview All Medicaid beneficiaries are assigned to a plan description with corresponding levels of coverage. These are listed in Section I of the Arkansas Medicaid provider manuals. 52

53 Plan Descriptions General Classifications FR Full benefits MNLB Medically needy, limited benefits AC Additional cost sharing LB Limited benefits 53

54 Plan Description 01 ARKids First-B Beneficiaries must be age 18 and under. Beneficiaries may have limited services. Beneficiaries may have co-payment requirements. ARKids First-B beneficiaries have a co-pay cap. Co-pay cap is 5%, based on the family s total gross income. 54

55 Plan Description 03 Children s Medical Services (CMS) Services must be prior-authorized. This is a non-medicaid category. 55

56 Plan Description 04 Developmental Disability Services (DDS) This is a non-medicaid category. DDS non-medicaid beneficiary ID numbers begin with DDS non-medicaid provider ID numbers end with 86. Only DDS non-medicaid providers may bill for DDS non-medicaid beneficiaries. 56

57 Plan Description *6 Medically Needy Exceptional These beneficiaries are eligible for the full range of Medicaid services except: Nursing Facility Personal Care 57

58 Plan Description *8 Qualified Medicare Beneficiary For QMB beneficiaries, Medicaid pays Medicare premiums, coinsurance and deductible. If the service provided is not a Medicare-covered service, then Medicaid will not pay for the service under the QMB policy. 18S ARSeniors has full benefits. 58

59 Plan Description 10 Working Disabled Beneficiaries in aid category 10 are part of an employment initiative designed to enable people with disabilities to gain employment without losing medical benefits. Beneficiaries must be ages 16 through 64 and disable as defined by Supplemental Security Income (SSI). There are two levels of cost sharing in this aid category, depending on the individual s income. 59

60 Plan Description 10 Working Disabled 10 R WD RegCo (Regular Medicaid Cost Sharing): Beneficiaries with gross income below 100% of the Federal Poverty Level (FPL) are responsible for the regular Medicaid cost sharing (pharmacy, inpatient hospital and prescription services for eyeglasses). 10 N WD NewCo (New Cost Sharing): Beneficiaries with gross income equal to or greater than 100% FPL have cost sharing for more services. The cost sharing amounts for the WD NewCo eligible are listed in a chart that can be found in Section I of the provider manual. 60

61 Plan Description 58, 78, 88 Specified Low Income Medicare Beneficiary (SLIMB, SMB) Beneficiaries are not eligible for the full range of Medicaid services. Beneficiaries are eligible only for Medicaid payment of their Medicare part B premium. 61

62 Determining If a Beneficiary Is an Arkansas Health Care Independence Program Enrollee 62

63 Determining If a Beneficiary Is an Arkansas Health Care Independence Program Enrollee Beneficiaries who qualify for the Arkansas Health Care Independence Program are placed in aid category 06 and are referred to as the newly eligible population. Providers can determine whether the beneficiary is an Arkansas Health Care Independence Program enrollee by checking eligibility on the Arkansas Medicaid website. Any beneficiary with plan description 06 is Newly Eligible. Approximately 10% will be enrolled in traditional Medicaid. Approximately 90% will be enrolled in a Qualified Health Plan. 63

64 Determining If a Beneficiary Is an Arkansas Health Care Independence Program Enrollee The approximate 10% enrolled in traditional Medicaid will receive Medicaid cards and have regular Medicaid benefits. The approximate 90% enrolled through one of the QHPs (BCBS, Ambetter of Arkansas, QualChoice and United Healthcare) will not receive Medicaid cards but will receive a notice indicating their Medicaid number and describing the following supplemental benefits. Traditional Medicaid benefits provided during the transition time from eligibility determination until QHP coverage starts. Non-emergency medical transportation and EPSDT for individuals between 19 and 20 (to the extent the service is not otherwise included in the QHP benefit). 64

65 Determining If a Beneficiary Is an Arkansas Health Care Independence Program Enrollee Newly Eligible enrolled in Traditional Medicaid 65

66 Determining If a Beneficiary Is an Arkansas Health Care Independence Program Enrollee QHP enrollee In Transition BCBS Ambetter QualChoice United Healthcare 66

67 Determining If a Beneficiary Is an Arkansas Health Care Independence Program Enrollee QHP enrollee with active QHP Coverage BCBS Ambetter QualChoice United Healthcare 67

68 How the Arkansas Health Care Independence Program affects Medicaid Billing 68

69 How the Arkansas Health Care Independence Program Affects Medicaid Billing All services will be provided through QHPs, except for two services that are not fully covered under the QHP benefit package. Specifically, the State will provide a fee-for-service supplemental benefit for: Non-emergency medical transportation Early Periodic Screening Diagnosis and Treatment for individuals 19 and 20 (to the extent the service is not otherwise included in the QHP benefit) Beneficiaries age 19 and 20 receive coverage for Vision and Dental services. 69

70 How the Arkansas Health Care Independence Program affects Medicaid Billing The newly eligible population placed on traditional Medicaid will receive Medicaid cards and all of their claims will be billed to Arkansas Medicaid. PCP is required for beneficiaries in aid category 06 where Medicaid pays Fee-for Service (not during transition to QHP) beginning June For beneficiaries enrolled in a QHP: All claims are billed to Arkansas Medicaid during the transition period. Once the QHP coverage starts, all claims should be billed to the commercial carrier with the exception of the supplemental services. 70

71 Benefits Overview Arkansas Medicaid administers over 50 programs. Here are just a few of the many benefits available to eligible beneficiaries. Physician services Mental health Inpatient hospital Outpatient hospital Lab/X-ray Prescription Emergency room Long Term Care Hospice Dentistry (under age 21 and for qualifying aid categories for ages 21+) Therapy (OT/PT/Speech) Medical equipment 71

72 Benefit Limits Physician Visits Beneficiary age 21 and over 12 visits per state fiscal year (SFY) Under age 21 not subject to benefit limit Consults beneficiary can receive two consults per SFY regardless of age (Note: Beneficiaries under age 21 in the Child Health Services (EPSDT) Program are eligible for extensions of the physician consultation benefit if the extension is medically necessary) See Section II of the Physician manual 72

73 Benefit Limits Physician Visits The following are included: Physician services in the office, patient s home or nursing facility Rural Health Clinic (RHC) encounters Medical services provided by a dentist Medical services furnished by an optometrist Certified nurse-midwife services Advanced nurse practitioner services 73

74 Benefit Limits Prescription Coverage Beneficiary age 21 and over three per month (without extension of benefits) Under age 21 are not subject to prescription drug limit See Section II of the Physician manual 74

75 Benefit Limits Lab and X-Ray Services Outpatient laboratory and radiology services and machine tests: Beneficiary age 21 and over $500 per SFY Under age 21 no benefit limit See Section II of the Physician manual 75

76 Benefit Limits Lab and X-Ray Services The following are not included: Family planning Emergency services MRIs Cardiac catheterization 76

77 Benefit Limits Inpatient Hospital Beneficiary age 21 and over 24 days per SFY Under age 21 no benefit limit Rehabilitative hospital inpatient services See Section II of the Hospital manual 77

78 Benefit Limits Outpatient Hospital Beneficiary age 21 and over 12 non-emergency outpatient hospital visits per SFY Under age 21 No benefit limit Outpatient hospital and rehabilitative hospital services therapy/treatments services are included in the nonemergency outpatient hospital services Excludes ER services See Section II of the Hospital manual 78

79 Benefit Limits Pregnancy Two ultrasounds per pregnancy Two fetal non-stress tests per pregnancy See Section II of the Physician manual 79

80 Benefit Limits Vision Beneficiary age 21 and over one exam and one pair of glasses every 12 months excluding replacement or repairs Beneficiary under age 21 one exam and one pair of glasses every 12 months (not including replacement or repairs) One visual prosthetic device every 24 months from the last date of service See Section II of the Visual Care manual 80

81 Submitting Claims 81

82 Ways to Submit Claims Paper Direct Data Entry (DDE) Provider Electronic Solutions (PES) Vendor Software 82

83 Types of Paper Claims CMS

84 Types of Paper Claims UB-04 84

85 Types of Paper Claims Dental 85

86 Mail Paper Claims to: Hewlett Packard Enterprise Attn: Claims PO Box 8034 Little Rock, AR

87 Medicare/Advantage Plans and Medicaid (Crossover Claim Submission) 87

88 Crossover Forms Inpatient Crossover HP-MC-001 Long Term Care Crossover HP-MC-002 Outpatient Crossover HP-MC-003 Professional Crossover HP-MC

89 Crossover Claims If the beneficiary has Medicare and Medicaid, and Medicare pays or applies money toward the deductible/co-insurance, then the claim can be billed as a crossover on PES, DDE, vendor software or the appropriate red and white crossover claim form. Hewlett Packard Enterprise Attn: Claims PO Box 8034 Little Rock, AR

90 Crossover Claims If the beneficiary has Medicare and Medicaid, and Medicare denies the claim, then the claim must be billed on a red and white claim form (CMS-1500 or UB-04) with the Medicare denial attached. Attach a cover letter of explanation. Do NOT mix in with other claims you are sending in for regular processing. Hewlett Packard Enterprise Attn: Research Analyst PO Box 8036 Little Rock, AR

91 Crossover Claims If the beneficiary has Medicare, TPL and Medicaid, and Medicare denies the claim and TPL paid, then the claim must be billed on a red and white claim form (CMS-1500 or UB-04) with the Medicare and TPL EOB attached. Attach a note stating this is for Medicare override. Do NOT mix in with other claims you are sending in for regular processing. Hewlett Packard Enterprise Attn: Research PO Box 8036 Little Rock, AR

92 Crossover Claims If the beneficiary has Medicare, TPL and Medicaid, and Medicare pays but the TPL denies the claim, then the claim can be billed as a crossover claim through PES software or be billed on the appropriate red and white crossover claim form with the TPL and Medicare EOB attached. Hewlett Packard Enterprise Attn: Claims PO Box 8034 Little Rock, AR

93 Crossover Claims If the beneficiary has Medicare, TPL and Medicaid, and both Medicare and the TPL deny the claim, then the claim must be billed on a red and white claim form (CMS-1500 or UB-04) with the Medicare and TPL denial EOBs attached. Attach a note stating this is for Medicare override. Do NOT mix in with other claims you are sending in for regular processing. Hewlett Packard Enterprise Attn: Research PO Box 8036 Little Rock, AR

94 Paper Adjustments 94

95 Paper Adjustments A legible signature must be on the adjustment form. This form can be found in Section V of your provider manual. 95

96 How to Order Forms from Hewlett Packard Enterprise/Arkansas Medicaid 96

97 Claim Order Form 97

98 Claim Order Form Please indicate on the claim order form how many forms you are ordering. Mail request to: Hewlett Packard Enterprise Forms Request PO Box 8033 Little Rock, AR Fax:

99 Return to Provider 99

100 Return to Provider Paper claims with errors are returned to provides on three forms according to the type of claim submitted: CMS-1500 UB-04 Crossover The PO Box to return a corrected claim is given at the bottom of each form. On the RTP forms, the reason(s) the claim is being returned will be indicated. Please make needed corrections and resubmit claim. 100

101 Direct Data Entry (DDE) 101

102 Direct Data Entry (DDE) Once you are logged on, your provider name will appear under Welcome back. To start a new claim, click on Professional claim. To void or adjust a previous claim, click on Professional claim reversal. 102

103 Direct Data Entry (DDE) 103

104 Direct Data Entry (DDE) 104

105 Provider Electronic Solutions (PES) Software 105

106 Provider Electronic Solutions (PES) Software Provider Electronic Solutions software is HPE s free eligibility and claims submission software. It is available for download from the Arkansas Medicaid website. 106

107 PES and the Submitter ID TOOLS/OPTIONS/BATCH PES 2.12* and greater users must key their Submitter ID and new secure password in the Web Logon ID and Web Password fields located on the Batch tab. *You should be on PES Version NOTE: The password that you enter to open the PES software is not affected by these instructions; you will continue to use your existing password to open the PES software. 107

108 Submitter ID Submitter ID Password Requirements Minimum of 8 characters Contain at least 1 uppercase alpha character Contain at least 1 lowercase alpha character Contain at least one number Contain at least one special character Passwords will be locked after 90 days if there are no changes, requiring the provider to contact EDI for assistance. Starting at 60 days, you will get an alert to change your password. 108

109 Submitter ID Submitter IDs let you do business electronically with Arkansas Medicaid Providers must obtain a Submitter ID and password to conduct business with Arkansas Medicaid electronically outside of the Provider Portal. Whether you submit claims and verify eligibility through the Provider Electronic Solutions software or through a vendor system, you will need a Submitter ID and password. 109

110 Submitter ID Getting your Submitter ID for new PES users Click Provider, HIPAA, and New Submitters Registration. Click the New Submitter Registration Form link. Complete the New Submitter Registration Information form. Click NEXT. Select a question and complete the answer for Security Questions until you complete five questions and answers. Click NEXT. Enter your billing provider 9 digit Medicaid ID number. Click ADD. Click NEXT. Enter the number of submitter IDs you want, click FINISH and PRINT THIS PAGE showing your MC number. 110

111 Submitter ID Getting your Submitter ID Click VIEW PASSWORD to view your Temporary Password (example: Abc!23De). PRINT this page. Create a new secure password. Click HIPAA, then click Submitter Self Service Area. Enter your submitter ID (example: MCXXXXXX) and your temporary password and click LOG IN. Click Change Password tab. In the New Password field, enter your new secure password. In the Confirm Password field, re-enter your new secure password. Click Submit. 111

112 Provider Electronic Solutions (PES) Software Password requirements: Enter HP-pes as the initial password. Set a new password after the initial login. Passwords are not case-sensitive. Password can be any combination of alpha, numeric, and special characters. A password must have at least 5 characters but no more than 10 and can be reused. PES passwords must be updated at least every 99 days. You can use the same password. Setting a new PES password 112

113 Claim Status 113

114 Claim Status Claims Adjudication Cycle Electronic claims are typically adjudicated on the next remittance advice. Paper claims that could have been sent electronically typically adjudicate days after submission. Claims that must be sent on paper typically adjudicate 2-3 weeks after submission. 114

115 Claim Status Five Ways to Check Claim Status Verify claims on the remittance advice PES software Medicaid website VRS Provider Assistance Center (800) or (501)

116 WebRA 116

117 Arkansas WebRA Overview Effective July 2011 ALL Providers should be retrieving WebRAs from the Arkansas Medicaid website. Remittance Advices (RAs) are in a PDF format, referred to as WebRAs. WebRAs will only be available on the website for 35 days. A charge will apply for RAs requested after the 35 day period. For WebRA training refer to the Provider Training link on the Medicaid website. 117

118 WebRA Password Your WebRA We encourage all providers to register for and receive your remittance through the Provider Portal to reduce paper use and lower costs for the program. Remittances are downloaded through the Portal and you can share your remittance with business partners. 118

119 WebRA Password Registering and receiving your WebRA Password requirements: Click Provider, log into the Portal, and select WebRA in the Available tools menu. Minimum of 8 characters Contain at least 1 uppercase alpha character Contain at least 1 lowercase alpha character Contain at least one number Contain at least one special character Cannot contain the same character more than twice You will be prompted to change your password for WebRAs every 90 days. 119

120 WebRA Password Your passwords are your responsibility. Keep them safe. Log them in a password protected spreadsheet for easy access! Copyright 2013 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 120

121 Forgotten Passwords If you need assistance with any of these passwords, please contact Hewlett Packard Enterprise s EDI helpdesk at: 1 (800) Ext 300, option 1 or (501) Ext 300, option 1 121

122 Billing Tips 122

123 Provider Electronic Solutions (PES) Software Problem: Vendors/Providers received errors when using any PES version lower than Solution: Upgrade to PES Version PES V2.24 allows alphanumeric characters for diagnosis codes (all claim types) and surgery procedure codes (inpatient claim type only). 123

124 Provider Electronic Solutions (PES) Software New Edit Clarification for Electronic Claims (TANDEM) Edits Y830 and Y831 (#7 & 8) All claims go through this logic. Edit Y830 Claims containing mixed ICD-9 or ICD-10 SURG or DIAG codes will reject for this edit. Edit Y831 Claims containing ICD-9 and ICD-10 AND spanning 10/1/15 will reject for this edit. Edit Y832 (#5) Only Inpatient Claims with DOS spanning 10/1/15 AND ICD-9 present will reject for this edit. Edit Y833 (#6) Only Professional Global OB Claims with DOS spanning 10/1/15 AND ICD-9 present will reject for this edit. 124

125 New Denial Codes for ICD-10 Descriptions EOB 713 Dates of service spanning 10/1/15 must be split billed Rebill (Bill ICD-9 prior to 10/1/15; Bill ICD-10 on/after 10/1/15). EOB 714 Inpatient Claim must contain only ICD-10 surgical procedure and diagnosis codes when dates of service span 10/1/15. EOB 715 Professional Global OB Claim must contain only ICD-10 diagnosis codes when dates of service span 10/1/15. EOB 717 Claim must not mix ICD-9 and ICD-10 diagnosis codes; Must bill ICD-9 prior to 10/1/15; Must bill ICD-10 on/after 10/1/15 Rebill with only ICD-9 codes/dates of service or only ICD-10 codes/dates of service. 125

126 New Denial Codes for ICD-10 Descriptions EOB 725 Claim must not mix ICD-9 and ICD-10 surgical procedure codes; Must bill ICD-9 prior to 10/1/15; Must bill ICD-10 on/after 10/1/15 Rebill with only ICD-9 codes/dates of service or only ICD-10 codes/dates of service. A mixed claim could be any of the following: Both ICD-9 and ICD-10 coding, ICD-9 coding with DOS on/after 10/1/15, or ICD-10 coding with DOS before 10/1/

127 Billing Tips - Remittance and Status Report Check your remittance and status report (WebRA) each week for: Paid Claims Denied Claims Adjusted Claims Pending Claims Recoupments Claims Payment Summary HEOB Codes/Messages 127

128 Timely Filing Medicare/Medicaid Crossover Claims and Claims with Retroactive Eligibility (Pseudo Claims) 128

129 Timely Filing Medicaid requires providers to submit all claims no later than 12 months from the date of service. The 12- month filing deadline applies to all claims, including: Claims for services provided to recipients with joint Medicare/Medicaid eligibility. Adjustment requests and resubmissions of claims previously considered. Claims for services provided to individuals who acquire Medicaid eligibility retroactively. 129

130 Timely Filing Medicare/Medicaid Crossover Claims Federal regulations dictate that providers must file the Medicaid portion of claims for dually eligible beneficiaries within 12 months of the beginning date of service. The Medicare claim will establish timely filing for Medicaid if the provider files with Medicare during the 12- month Medicaid filing deadline. Medicaid may then consider payment of a Medicare deductible and/or coinsurance, even if more than a year has passed since the date of service. Federal regulations permit Medicaid to pay its portion of the claim within six (6) months after notice of the disposition of the Medicare claim. Providers may not electronically transmit any claims for dates of service over 12 months. 130

131 Timely Filing Claims with Retroactive Eligibility (Pseudo Claims) Retroactive eligibility does not constitute an exception to the filing deadline policy. If an appeal or other administrative action delays an eligibility determination, the provider must submit the claim within the 12- month filing deadline. If the claim is denied for recipient ineligibility, the provider may resubmit the claim when the patient becomes eligible for the retroactive date(s) of service. Medicaid may then consider the claim for payment because the provider submitted the initial claim within the 12-month filing deadline and the denial was not the result of an error by the provider. To resolve this dilemma, Arkansas Medicaid considers the pseudo recipient identification number to represent an...error originating within (the) State s claims system. Therefore, a claim containing that number is a clean claim if it contains all other information necessary for correct processing. 131

132 Timely Filing Claims with Retroactive Eligibility (Pseudo Claims) Providers have 12 months from the approval date of the patient s Medicaid eligibility to resubmit a clean claim after filing a pseudo claim. After the 12-month filing deadline (12 months from the Medicaid approval date) claims will be denied for timely filing and will not be paid. It is the responsibility of the provider to verify the eligibility approval date. Once a beneficiary receives retro eligibility, the provider must submit a paper claim, proof of the pseudo claim, and a cover letter to Research for special processing. Hewlett Packard Enterprise Attn: Research Analyst PO BOX 8036 Little Rock, AR

133 Hewlett Packard Enterprise Monday through Friday (8 a.m. 5 p.m.) Toll-free in Arkansas (800) Local or out-of-state (501) Dedicated fax (501) Hewlett Packard Enterprise PO Box 8105 Little Rock, AR

134 Questions? 134

135 Thank You