Connecticut Medical Assistance Program Workshop for Professional Claim Billing Providers
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1 Connecticut Medical Assistance Program Workshop for Professional Claim Billing Providers Presented by The Department of Social Services & HP Enterprise Services HP Restricted 2009 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
2 Training Topics Introduction to HIPAA 5010 Implementation Implementation Schedule Web Claim Submission Web Client Eligibility Verification Provider To Do List Resources Questions 2 2 March 2011
3 Introduction to HIPAA 5010 Implementation The Department of Social Services (DSS) is implementing the new 5010 version of the HIPAA Transaction and Code Set Standards. HIPAA rules mandate that by January 1, 2012, all covered entities must submit transactions in the 5010 version. The new 5010 version impacts all electronic transactions, including client eligibility verification, and Web and paper claim submissions. DSS will stagger the implementation of the new 5010 transactions. 3 2 March 2011
4 Implementation Schedule Transactions Implementation Dates X12 270/271 Eligibility Verification - Batch 1/26/2011 X Acknowledgement 1/26/2011 Web Claim Submission and Web Eligibility Verification 3/9/2011 Provider Electronic Solutions (PES) 4/27/2011 Paper Claims Changes - Professional 4/27/2011 X Professional 4/27/2011 X Institutional 4/27/2011 X Dental 4/27/2011 X Remittance Advice 4/27/2011 X12 276/277 Claim Status 4/27/2011 Paper Claim Changes Institutional 6/29/2011 Paper Claim Changes - Dental 7/27/ March 2011
5 Web Claim Submission A new field titled 837 Version will indicate the claim s HIPAA version. Claims submitted via the Web prior to March 9, 2011 will display Any and all future adjustments to these claims will retain this 4010 version. Claims submitted via the Web on or after March 9, 2011 will display All diagnosis panels will display version ICD-9 until the implementation of ICD- 10 scheduled for Medical Record Number will be added at the header. EPSDT Referral field will be added to the header. Diagnosis Panel will be updated to allow the entry of up to 12 diagnosis codes. Diagnosis code pointer field will be expanded to 2 digits. Medicare Allowed Amount field at the detail level will be renamed as Medicare Calc Allowed Amt. This field will no longer be sent from Medicare to HP on crossover claims. Therefore, HP will calculate this amount. Providers will still be required to enter the Medicare Allowed Amount in this field on Web claims. 5 2 March 2011
6 Web Claim Submission (Cont.) 6 2 March 2011
7 Web Claim Submission (Cont.) 7 2 March 2011
8 Web Claim Submission (Cont.) 8 2 March 2011
9 Web Claim Submission (Cont.) 9 2 March 2011
10 Client Eligibility Verification The client s address will be added to the eligibility response. The following data will no longer be provided in the eligibility response: Medicare coverage effective date Medicare coverage end date HIC PDP name PDP Plan ID Third Party Liability (TPL) Policy Number Policy Holder name TPL Coverage Type TPL Effective date TPL End date 10 2 March 2011
11 Client Eligibility Verification (Cont.) The Automated Voice Response System (AVRS) will continue to return TPL information in the client eligibility verification response. Providers can access AVRS by dialing or locally to Farmington, CT at (860) Select option 1 for Self Service Options, enter the AVRS ID and PIN, and then select option 1 for Eligibility Verification. The provider may also contact the insurer to obtain policy related information March 2011
12 Client Eligibility Verification (Cont.) The eligibility response will include the program in which the individual has coverage in the Connecticut Medical Assistance Program along with the following service type codes if they are covered services for the client s benefit plan. 1 - Medical 86 - Emergency Services 4 - DX X-Ray 88 - Pharmacy 5 - DX Lab 93 - Podiatry 33 - Chiropractic 98 - Professional (Physician) Visit-Office 35 - Dental AD - Occupational Therapy 42 - Home Health Care AF - Speech Therapy 45 - Hospice AL - Vision (Optometry) 47 - Hospital DM - Durable Medical Equipment 54 - Long Term Care MH - Mental Health 56 - Medically Related Transportation PT - Physical Therapy 75 - Prosthetic Device RT - Residential Psychiatric Treatment 82 - Family Planning UC - Urgent Care 12 2 March 2011
13 Client Eligibility Verification (Cont.) 13 2 March 2011
14 Client Eligibility Verification (Cont.) 14 2 March 2011
15 Client Eligibility Verification (Cont.) 15 2 March 2011
16 Provider To Do List Contact your billing agency, software vendor or clearing house to ensure that they are upgrading their products to support HIPAA Providers with subparts who have enumerated NPI(s) must use the NPI assigned to each subpart when submitting claims to all payers. Upgrade your HP Provider Electronic Solutions software now to the current 3.76 version to ensure a smooth transition to the upcoming version of the software. Make sure your Primary Address does not include a P.O. Box and your zip code is a full nine digits. Stay informed!! View Important Messages on the home page of to obtain updates to DSS HIPAA 5010 implementation plan March 2011
17 Resources (Cont.) Home page HIPAA 5010 Implementation Important Message HP Provider Assistance Center (PAC): Monday through Friday, 8 a.m. to 5 p.m. (EST), excluding holidays (in-state toll free) (860) (local to Farmington, CT) HP EDI Help Desk: Monday through Friday, 8 a.m. to 5 p.m. (EST), excluding holidays (in-state toll free) (860) (local to Farmington, CT) 17 2 March 2011
18 Connecticut Medical Assistance Program Workshop Tim e for Questions
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