Targeted Case Management. March 2016

Transcription

1 Targeted Case Management March 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

3 Provider Training 3

4 Arkansas Medicaid Website 4

5 Provider Training Virtual Classes Arkansas Medicaid Billing 101 (includes Arkansas Medicaid passwords and WebRa) PES Billing 101 (Provider Solutions Software) / DDE Demonstration (Arkansas Medicaid website data entry) 5

6 Provider Training Training Materials Training Materials from Past Workshops Arkansas Medicaid Billing Guides Billing tips 6

7 Provider Training Arkansas Medicaid Website HPE Virtual Training Arkansas Medicaid and BreastCare providers are invited to participate in our virtual training program. HPE has a curriculum targeted specifically for you. Lead by experienced Arkansas-based trainers, these courses deliver information in a convenient, real-time and interactive approach. We offer courses for new billers, therapists, durable medical equipment providers and more. For more information and to sign up for a course, please visit the Provider section of our website at 7

8 Provider Training Provider Workshops Provider workshops will be posted under the Provider Training tab of the Arkansas Medicaid website along 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. 8

9 Provider Manuals 9

10 Provider Manuals 10

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 Advice (RA) and status report, adjustment request, additional or other payment sources, pseudo claims and reference books Section IV Glossary Arkansas Medicaid acronyms and terms Section V Claim Forms Claim forms, Arkansas 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 14

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 16

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 adjustment requests should be mailed to: Arkansas Medicaid Attn: Adjustments P.O. 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 20

23 Provider Electronic Solutions (PES) Software 23

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 28

29 Assisted Living CPT Procedure Codes National Code Modifier U Local Code Description T1017 U21 (Assessment/Service Plan Development) T1017 U2 21+ (Assessment/Service Plan Development) T1017 U5 60+ (Assessment/Service Plan Development) T1017 UA 21+ in ARChoices (Assessment/Service Plan Development) T1017 U4 U21, 21+ (Service Management/Referral and Linkage) T1017 U6 60+ (Service Management/Referral and Linkage) T1017 UB 21+ in ARChoices (Service Management/Referral and Linkage) T1017 U1 U21 (Service Monitoring/Service Plan Updating) T1017 U3 21+ (Service Monitoring/Service Plan Updating) T1017 U7 60+ (Service Monitoring/Service Plan Updating) T1017 UC 21+ in ARChoices (Service Monitoring/Service Plan Updating) 29

30 Assisted Living Place of Service Codes Electronic and paper claims now require the same National Place of Service Codes. Place of Service POS Codes Doctor s Office 11 Patient s Home 12 Other Locations 99 30

31 Timely Filing Medicare/Medicaid Crossover Claims and Claims with Retroactive Eligibility (Pseudo Claims) 31

32 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 32

33 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. 33

34 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. HP Enterprise Services Attn: Research Analyst PO BOX 8036 Little Rock, AR

35 WebRA 35

36 WebRA 36

37 WebRA 37

38 WebRA Your name will appear here after you log on. Let s open WebRA. 38

39 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. 39

40 New Rejection and Denial Codes for ICD-10 40

41 Provider Electronic Solutions (PES) Software Problem: Vendors/Providers receive errors when using PES versions older than Solution: Upgrade to PES Version PES V2.23 allows alphanumeric characters for diagnosis codes (all claim types) and surgery procedure codes (inpatient claim type only). 41

42 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. 42

43 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. 43

44 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: o Both ICD-9 and ICD-10 coding, o ICD-9 coding with DOS on/after 10/1/15, or o ICD-10 coding with DOS before 10/1/15. 44

45 Hewlett Packard Enterprise Contact information

46 HP Enterprise Services 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) HP Enterprise Services PO Box 8105 Little Rock, AR

47 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: Provider Assistance no longer verifies eligibility.

48 Hewlett Packard Enterprise Electronic Data Interchange (EDI) The HP Enterprise Services 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 [email protected]

49 Hewlett Packard Enterprise Research Analyst The HP Enterprise Services 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. HP Enterprise Services Attn: Research Analyst PO Box 8036 Little Rock, AR 72203

50 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.

51 Questions? 51

52 Thank you! 52