ARChoices. HPE Fiscal Agent for the Arkansas Division of Medical Services. September 2016

Transcription

1 ARChoices HPE Fiscal Agent for the Arkansas Division of Medical Services September 2016

2 Topics for Today Provider Training Provider Manuals Submitting Claims Claim Adjustments and Voids Current CPT Codes and Place of Service Codes Timely Filing WebRA ICD-10 Provider Enrollment Frequently Asked Questions Hewlett Packard Enterprise Contacts Questions 2

3 Provider Training

4 Arkansas Medicaid Website 4

5 Provider Training Arkansas Medicaid Website - 5

6 Provider Training Virtual Classes Arkansas Medicaid Billing 101(includes Arkansas Medicaid Passwords and WebRA) PES Billing 101 (Provider Solutions Software)/DDE Demonstration (Arkansas website data entry) 6

7 Provider Training Training Materials Training Materials from Past Workshops Arkansas Medicaid Billing Guides Billing Tips 7

8 Provider Training Arkansas Medicaid Website - 8

9 Provider Training Provider Workshops Provider workshops will be posted under the Provider Training tab with a link to register for the workshop. Workshops are usually posted days before the workshop date. Workshop invitations are also mailed to providers days before the workshop date. 9

10 Provider Manuals

11 Provider Manuals 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 11

12 Provider Manuals Sections Section III Billing Information General information, Remittance Advance (RA) 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 12

13 Provider Manuals Sections Appendix A Update Log Number and release dates for updates Transmittal Letters, Official Notices, RA Messages 13

14 Submitting Claims

15 Ways to Submit Claims Claims on Paper Direct Data Entry (DDE) Provider Electronic Solutions (PES) Your Vendor Software 15

16 Claims Adjustments and Voids

17 Paper Adjustments A legible signature must be on the adjustment form. 17

18 Paper Adjustments Paper adjustment request forms are found on the Arkansas Medicaid website in the Section V provider manual. You may print adjustment forms as needed. Paper adjust requests should be mailed to: Arkansas Medicaid Attn: Adjustments PO Box 8036 Little Rock, AR

19 Direct Data Entry (DDE) Arkansas Medicaid Website - 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. 19

20 Direct Data Entry (DDE) Arkansas Medicaid Website

23 Provider Electronic Solutions (PES) Software Provider Electronic Solutions software is HP s free eligibility and claims submission software. It is available for download from the Arkansas Medicaid website. You may do submits, adjustments and voids using PES. 23

24 Provider Electronic Solutions (PES) Software 24

27 Provider Electronic Solutions (PES) Software When submitting, adjusting and voiding claims in PES, be sure to pull back your response report to see rejections and claims accepted. 27

28 Current CPT Procedure Codes and Place of Service Codes

29 ARChoices CPT Procedure Codes Adult Family Homes Procedure Code Modifier Description S5140 U1 Adult Family Homes Level A S5140 U2 Adult Family Homes Level B S5140 U3 Adult Family Homes Level C 29

30 ARChoices CPT Procedure Codes Attendant Care Services Procedure Code Modifier Description S5125 U2 Attendant Care Services S5125 Attendant Care Self-Directed Model 30

31 ARChoices CPT Procedure Codes Hot Home-Delivered Meals Procedure Required Description Code Modifier S5170 U2 Hot Home-Delivered Meal S5170 Frozen Home-Delivered Meal S5170 U1 Emergency Home-Delivered Meal 31

32 ARChoices CPT Procedure Codes Personal Emergency Response System Procedure Required Description Code Modifier S5161 UA PERS Unit S5160 PERS Installation 32

33 ARChoices CPT Procedure Codes Adult Day Services Procedure Code Required Modifier Description S5100 U1 Adult Day Services, 2-4 Hours Per Date of Service S5100 Adult Day Services, 5-10 Hours Per Date of Service 33

34 ARChoices CPT Procedure Codes Adult Day Health Services (ADHS) Procedure Code Required Modifier Description S5100 TD, U1 Adult Day Health Services, 2-4 Hours Per Date of Service S5100 TD Adult Day Health Services, 5-10 Hours Per Date of Service 34

35 ARChoices CPT Procedure Codes Respite Care Procedure Code T1005 S5135 S5150 Description Long-Term Facility-Based Respite Care Short-Term Facility-Based Respite Care In-Home Respite Care 35

36 ARChoices Place of Service Codes Place of Service Paper Claims Electronic Claims Inpatient Hospital 1 21 Patient s Home 4 12 Day Care Facility 5 99 Nursing Facility 7 32 Other Locations

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

38 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 38

39 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. Claims for services provided to recipients with joint Medicare/Medicaid eligibility 39

40 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

41 WebRA

42 WebRA 42

43 WebRA 43

44 WebRA Your name will appear here after you log on. Let s open WebRA. 44

45 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. 45

46 New Reject and Denial Codes for ICD-10

47 Provider Electronic Solutions (PES) Software Problem: Vendors/Providers receive errors when using any PES version earlier than Solution: Upgrade to PES Version 2.23 PES V2.23 allows alphanumeric characters for diagnosis codes (all claim types) and surgery procedure codes (inpatient claim type only). 47

48 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. 48

49 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. 49

50 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 ICD-10 coding with DOS before 10/1/15 50

51 Provider Enrollment FAQs

52 Frequently Asked Questions Q: What is the reason for the application fee? A: This federally-mandated fee will be used to offset the cost of conducting new screening activities associated with the ACA. 52

53 Application Fee On July 1, 2013, Arkansas Medicaid adopted new enrollment application fee requirements. The Centers for Medicare & Medicaid Services (CMS) sets the application fee amount, which may vary or be adjusted from year-to-year and is payable every five (5) years. 53

54 Providers Required to Pay Fee 54

55 Application Fee Is subject to change each year. Proof of payment must accompany the application. Must be paid by credit card, debit card, or electronic funds transfer through the Medicaid website. 55

56 Application Fee 56

57 Frequently Asked Questions Q: How do I apply for a Provider Number? A: Applications may be completed electronically through the Medicaid website or on paper. 57

58 Medicaid Application 58

61 Frequently Asked Questions Q: Who should I talk to for questions or concerns with my application? A: The Provider Enrollment Department 61

62 Hewlett Packard Enterprise Contacts

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

64 Hewlett Packard Enterprise Provider Assistance Center (PAC) 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: PAC no longer verifies eligibility. 64

65 Hewlett Packard Enterprise Electronic Data Interchange (EDI) The Hewlett Packard Enterprise EDI Support Center assists providers with electronic claim submission issues, 997 batch responses, PES software delivery and setup support, software training, and data transmission failures. Monday through Friday (8 a.m. 5 p.m.) Toll-free in Arkansas (800) Local or out-of-state (501) address ARKEDI@HP.COM 65

66 Hewlett Packard Enterprise Research Analyst The Hewlett Packard Enterprise Research Analyst answers s sent to region mailboxes, researches claim 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 below address. Hewlett Packard Enterprise Attn: Research Analyst PO Box 8036 Little Rock, AR

67 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. Don t know who your Provider Representative is? On the Medicaid website, click on Meet your HP Enterprise Services Provider Rep and then click on your county. 67

68 Questions?