2018 fall provider workshop provider workshops/wv provider... · 2018. 9. 27. · 11 the unenrolled...
TRANSCRIPT
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WV Bureau for Medical Services
WV Children’s Health Insurance ProgramMolina Medicaid Solutions
2018 Fall Provider Workshop
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Molina Medicaid Solutions website & EDI Web Portal provides significant
functionality for the WV Medicaid and WVCHIP provider community.
www.WVMMIS.com
Web portal for WV Medicaid and
WVCHIP.
Provides information to
providers, trading partners,
and some information for the
public.
Contains many useful website
links and documents.
Latest news and
announcements.
Billing Instructions, User
Guides, Companion Guides.
Molina Website and EDI Portal
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In the Health PAS-Online banner
click the ‘Sign In’ hyperlink.
Enter the trading partner:
User Name
Password
Read the ‘Attention HIPAA PHI’
statement and select the check
box.
Click ‘Sign In’
If an incorrect password is entered
five times, the account will be
locked out.
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If your account becomes
locked, the Account Self
Unlock and Reset
Password “Click here” link
will assist with unlocking
your account or you may
contact the EDI Helpdesk.
Health PAS-OnLine Sign In
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Checking Member Eligibility
It is a best practice to verify
eligibility for all Medicaid
participants before a service
is rendered by a provider.
This ensures the provider
that the participant is eligible
on the date the services will
be rendered.
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Eligibility continued… Always make certain that the
correct Billing Provider is
selected. This is important for
TPA accounts that manage
multiple billing providers.
Find Member:
Enter two of the following
criteria:
Member Identification
(ID)
Name (Last and First
Name)
Date of Birth
Social Security Number
After the search criteria has
been submitted, the Eligibility
Verification screen appears.
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Eligibility continued…
After the search criteria
have been submitted, the
Eligibility Inquiry section
verifies whether a member
was eligible for a Medicaid
program on the date(s) of
service submitted in the
request. This information
does not guarantee
eligibility or payment for
the service rendered.
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Eligibility continued…
According to the selected
coverage code, the details
of the coverage code are
listed. If further clarification
is needed, call Provider
Services between 7:00a.m.
to 7:00p.m.
Link to the WV User Guide for
Eligibility Verification:
https://www.wvmmis.com/User%20Guides/West%20Virginia%
20Trading%20Partner%20Account%20-%20Eligibility%20Verification%20User%20Guide.pdf
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https://www.wvmmis.com/User Guides/West Virginia Trading Partner Account - Eligibility Verification User Guide.pdfhttps://www.wvmmis.com/User Guides/West Virginia Trading Partner Account - Eligibility Verification User Guide.pdf
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Effective January 1, 2018, all providers ordering, referring,
prescribing, or rendering services to WV Medicaid members must
be actively enrolled in the Molina system. This includes services
provided to Medicaid members in an MCO. If you are a Medicaid
provider, you must enroll with Molina or your claims submission and
payment will be impacted.
All MCO “only” provider applications will follow the same federal and
state enrollment guidelines currently in place for WV Medicaid and
WVCHIP providers.
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PEA Portal
To access the enrollment application links, sign into the trading
partner account (TPA) located at www.wvmmis.com
Click Account Maintenance for a drop-down list and click Provider
Enrollment hyperlink
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http://www.wvmmis.com/
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Provider Enrollment Updates
Effective August 1, 2018: BMS implemented an update to the
enrollment application. WV Medicaid/CHIP now have a combined
provider agreement signature page.
Enrollment Tool: We have an email address just for enrollment
questions or assistance:
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mailto:[email protected]
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The Unenrolled Prescriber Edit applies to all providers who prescribe medications to WV Medicaid members.
WEST VIRGINIA MEDICAID will no longer pay for
Prescriptions for Opioid Pain Medications written by
Unenrolled Prescribers
beginning on July 18, 2018
Your pharmacist will NOT be able to get
an override for your prescription.
You will need to have your prescriptions
written by a prescriber enrolled with
West Virginia Medicaid.
Starting 10/17/18: All prescriptions for WV Medicaid patients must be written by enrolled prescribers.
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Week Ending 09/01/2018 Average Weekly Statistics
Paper Checks Issued Weekly 282
Electronic Fund Transfers Issued Weekly 2,935
Claim $ Amount Paid Weekly $188,066,602.10
Number of Claims Processed Weekly 651,951
Percent of Claims Denied Weekly 14.4%
Total Enrolled Medicaid Providers 33,741
Dual Enrollment Applications Received 394
Provider Call Inquiries Received Weekly 1,562
Member Call Inquiries Received Weekly 500
Provider Enrollment Inquiries Received Weekly 577
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Long Term Care:
Members eligible for Long Term Care services will have a
different eligibility coverage code.
LTC claims will be denied if the member is not eligible for either of
the following two Rate Codes:
AMLTN
AMLTI
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Worker Compensation Claims
Effective 10/1/2018: Claim edit 366 will be changed to a DENY status
for all BMS State Programs. Please refer to Molina’s Web Portal
announcements for a more detailed description.
WV Nursing and Long Term Care facilities – “M1” Condition code
requirement to bill partial resources
Effective July 1, 2018: Claims with the above condition code will
return the WARN status on the remittance advice. Providers currently
using “M1” condition code should change to Value Code “D3”. During
this notification period, Molina’s system will accept both “M1” and “D3”
codes and will return a WARN edit.
Effective October 1, 2018: Claims will DENY unless billed with the
“D3”. No retro claim adjustments will be processed.
Please call Molina’s Long Term Care
Provider Service or email
[email protected] with questions. 15
mailto:[email protected]
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On June 27, 2018, Molina announced it entered into an agreement to
sell Molina Medicaid Solutions (MMS) to DXC Technology, a respected
IT services company in the Medicaid market.
DXC Technology provides health and human services to government
agencies across the U.S. through more than 8,000 professionals,
offering fiscal agent services, Medicaid Management Integrated Systems
(MMIS), program integrity, care management, immunization registry, and
eligibility services.
For Molina Medicaid Solutions, this transaction represents an exciting
opportunity to grow under new ownership. As part of DXC, we will
continue to serve our existing state partners. The transaction is expected
to close in the third quarter of this year, and it is subject to the
satisfaction of customary closing conditions and the receipt of certain
third party consents and regulatory approvals.
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Q: When will the transition to DXC occur?A: The transaction is expected to close in the third quarter of this year, subject to the satisfaction of customary closing conditions and the receipt of certain third party consents and regulatory approvals. Please keep in mind that MMS will remain completely independent of DXC and must continue to exercise its own business judgment until the deal is closed. ***No requirements will be needed from our provider community during this transition. Please continue business as usual providing healthcare to the WV Medicaid and CHIP population.
Q: Will we maintain contracts with all of our state clients under this new ownership?A: Yes, MMS holds the contracts with our state clients, and the contracts will remain with MMS through the transition.
Q: Will contact information for email, phone, or mailing change?A: At this time we do not anticipate changes with our current mailing addresses and call center phone numbers. Any changes in this information will be communicated to the provider community.
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Our website provides valuable
contact information as well as
office hours and office closures.
Phone support: Local and toll-free
phone numbers (304)348-3200
(888)483-0793
Secure Messaging: Send a
secure email
Call Back: request a call back
from a call rep who can review
the issue ahead of time
Web Chat: chat real time via the
internet with a call rep during
business hours
Grievance & Appeals: submit
online, by mail, or fax
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Contact Us
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Provider Field Representative Map
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2019 Spring Provider Workshop
Dates and Locations
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April 1, 2019 – Martinsburg
April 2, 2019 – Wheeling
April 3, 2019 – Morgantown
April 4, 2019 – Vienna
April 8, 2019 – Stonewall
April 9, 2019 – Charleston
April 10, 2019 – Beckley
April 11, 2019 - Huntington