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CGI Ohio RAC Medicaid UpdateJune 2012

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Agenda

• Similarities to the ODJFS Medicare RAC Program• Differences to the ODJFS Medicare RAC Program• Medicaid RAC Operations• Provider Assistance and Online Tools

• Customer Service• Ohio RAC Website

• Credit Balance Reviews• Open Question and Answer

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Similarities to the Medicare RAC Program

• Execute an Education and Outreach program• Provide Customer service via a toll-free telephone number

• Compile and maintain provider-approved addresses and points of contact

• Mandatory acceptance of provider submissions of electronic medical records on CD/DVD or via facsimile

• Notification to providers of overpayment findings within 60 calendar days

• A five-year review period for provider claims• A 45-day timeline to submit medical records to the RAC

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Differences to the Medicare RAC Program

• CGI Federal will be responsible for the first two levels of the appeals on overpayments with the CGI Medical Director responsible for the second level of appeal.

• Postage and copy fees are not paid by ODJFS or CGI.

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Medicaid RAC Operations

Types of Reviews• ODJFS will approve CGI Federal-selected areas of review. CGI Federal will review for:

• Coverage Determinations• Be included as a covered service, as described in Ohio Administrative Code 5101:3• Be medically necessary, as defined in OAC 5101:3-1

• Coding Determinations• CGI Federal will perform both Automated and Complex reviews.• Project scope is being modified to include Credit Balance Reviews.

Medical Record Submission• Medical Record submission standards will be posted on CGI’s Ohio Medicaid RAC Web

Portal.

Letters• CGI Federal will issue the following letters according to the program timelines:

• Medical Record Request Letter• Review Results• Demands

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Provider Assistance and Online Tools:Customer Service

• CGI’s existing Call Center Team will be servicing ODJFS Medicaid RAC provider calls. Benefits of this approach include:• Familiarity with the Ohio Provider community• Existing knowledge of systems and processes• Expedited training program

• The CGI Ohio Medicaid Call Center hours of operation are from 8:00 a.m. to 4:30 p.m.

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Provider Assistance and Online Tools:Ohio RAC Website

• CGI Federal has implemented a website for Providers, similar to the CGI Medicare RAC Region B Web Portal.

• Providers can use the website to accomplish the following:• View audit findings• View audit status• Update contact information• View Medical Record Submission and Contact Information• View general program information

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Provider Assistance and Online Tools:Ohio RAC Website (cont’d.)

• The Ohio RAC website: http://odjfs.cgicleve.com• Providers authenticate by clicking on the Providers link and

entering their Provider Number, NPI or other information listed.

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Provider Assistance and Online Tools:Ohio RAC Website (cont’d.)

• A Bulletin Board is available for communicating important updates to the Provider community.• Once authenticated to the website, click on the Home link to

view the Bulletin Board. Important information is located in the What’s New box.

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Overview and Update: RAC B WebsiteClaim Status

• Providers can view the status of their RAC cases from the Claim Status link.

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Overview and Update: RAC B WebsiteClaim Status Details

• Detailed information on cases is available from the Claim Audit Details link.

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Overview and Update: RAC B WebsiteAddress Maintenance

• Providers can update their contact information.• Providers can only update contact information for addresses

entered for the logon identity.• Click on the link in the ‘Provider Number’ column to open the

Address Maintenance.

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Credit Balance Reviews

• Approval has been received by ODJFS to increase the scope to include Credit Balance Reviews.

• CGI is currently working to get the necessary subcontractor agreement in place to start this scope of work.

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Contact Information

Call Center for CGI Medicaid RAC Ohio

Toll Free: 1-855-210-3438, Option 1

E-mail: rac.medicaid@cgifederal.com

Website: http://odjfs.cgicleve.com/

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Questions