provider workshops april 2013 - wvmmis.com provider workshops/wv... · january 1, 2013 as long as...

Provider Workshops

April 2013

Martinsburg Morgantown

Wheeling Flatwoods Huntington

Beckley Charleston

Workshop Agenda Welcome and Introductions

Medicaid

Automated Health Systems

Molina

APS

HMS

WV Health Information Network

Q & A

BMS/Molina 2013 Provider Workshops

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General Updates WV Bureau for Medical Services (BMS) aka WV Medicaid

> Website at ww.dhhr.wv.gov/bms

BMS Relationships

> Molina – Fiscal Agent (FA) – claims processing, provider enrollment

> APS – Utilization Management Contractor (UMC) – prior authorization,

case management

> HMS – Recovery Audit Contractor (RAC) & Third Party Liability

(TPL)

> Medicaid Managed Care Organizations (MCOs)

• The Health Plan of the Upper Ohio Valley

• Unicare of WV

• CoventryCares of WV (formerly Carelink)

> Automated Health Systems – Enrollment Broker

> Other WV DHHR agencies such as EPSDT, Family Planning, Children

with Special Health Care Needs


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http://www.dhhr.wv.gov/bms

General Updates cont’d. BMS is working with APS to ensure the list of codes that require prior

authorization is consistent with information in Molina’s system

Changes for Tobacco Cessation CPT Codes 99406, 99407

> Effective February 1, 2013, Medicaid may reimburse physicians and/or

APRNs for tobacco cessation counseling to symptomatic members

> Counseling sessions must be face-to-face, are time sensitive and must be

documented in the member’s medical record.

> Sessions are limited to 2 per calendar year

Nerve Conduction Studies

> Effective May 1, 2013, nerve conduction studies require prior authorization

before services are provided

> Covered in place of service “11” (office setting)

Immunization Code 90474

> Open for each additional vaccine (single or combination vaccine/toxoid) by

intranasal or oral route


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General Updates cont’d. Genetic Testing

> Coverage for BRCA1 and BRCA2 genes is limited to members who meet

the National Comprehensive Cancer Network (NCCN) criteria.

> Prior authorization is required and must be requested by an enrolled

OB/GYN, oncologist or medical geneticist.

> A list of laboratory codes requiring PA is available on the BMS and APS

websites.

2012 ADA Claim Form > Molina evaluating system to accommodate additional fields

> Providers must include the following items on the 2012 ADA Claim Form

for payment consideration:

• Place of Service

• Quantity or number of units

• Diagnosis codes and diagnosis-to-code pointers

• Multiple tooth surfaces

All Medicaid covered dental code descriptions have been updated in

Chapter 505 - Dental Services to match ADA code descriptions.


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General Updates cont’d. 2013 CPT Coding Changes for Behavioral Health Providers

> Several codes deleted

> Significant change was deletion of 90862 – pharmacologic

management

> Evaluation and Management (E/M) codes must now be billed for

some of the services represented by deleted codes

> BMS provided training via webinar on 2013 coding changes for

behavioral health providers; slides on BMS website

> Additional information on national medical association websites • American Psychiatric Association

• American Academy of Child & Adolescent Psychiatry

Ambulatory Surgery Centers

> Effective June 1, 2013, billing form and fee schedule change • ASC services must be billed on CMS 1500 form

• ASC fee schedule based on 90% of Medicare ASC fee schedule


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Enhanced Payments for Primary Care Providers Affordable Care Act (ACA) requires that Medicaid reimburse eligible

primary care providers at parity with Medicare rates in CYs 2013 and

2014 for certain E&M and vaccination codes (42 CFR 447.400(a)).

Eligible primary care providers include physicians and advanced practice

professionals (APPs) in certain specialties/subspecialties that meet

specific criteria.

> Includes Medicaid and MCO-contracted providers

Services provided in Federally Qualified Health Clinics (FQHCs), Rural

Health Clinics (RHCs), as well as clinics and Health Departments, to the

extent that they are reimbursed on an encounter or visit rate, are not

eligible for enhanced payments, nor are services provided in nursing

facilities that are reimbursed as part of the per diem rate.

Qualifying codes and their rates will be published on the BMS website.


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Eligibility for Enhanced Payments for Primary Care

Eligible providers must meet criteria under #1 and #2 below

1. Self-attest to a specialty designation of Family Medicine, Internal

Medicine or Pediatrics, or a related-subspecialty as defined by

American Board of Medical Specialties (ABMS), American

Osteopathic Association (AOA), American Board of Physician

Specialists (ABPS)

2. Be board certified by ABMS, AOA or ABPS in specialty or related

subspecialty to which he/she attests

OR

Have billed E&M and vaccine administration services under the

specified codes that equal at least 60% of all codes billed to Medicaid

during most recent calendar year

Note: If provider has not yet participated in Medicaid for a full year, he/she must self-

attest that 60% of services billed in previous 30-day period were specified codes


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Self-Attestation for Enhanced Payments Qualifying providers will receive retroactive payments dating back to

January 1, 2013 as long as the completed Self-Attestation Form is sent to

BMS no later than December 31, 2013.

Prior to receiving the enhanced rate, eligible physicians and advanced

practice registered nurses (APRNs) must complete a Self-Attestation

Form.

Physician Assistants (PAs) automatically qualify if their supervising

physician qualifies and self-attests.

A self-attestation form must be completed for 2013 and for 2014.

Self-attestation form, Provider Guide and Newsletter will be on BMS

website


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Enhanced Payments for Primary Care Enhanced payments will be retroactively paid when CMS approves

WV’s state plan amendment (SPA)

Frequency of payments may vary between Medicaid and MCOs

> Per claim versus quarterly lump sum

May be lag between payments for services submitted on claims that pre-

date SPA approval versus those submitted after approval

Additional information on CMS website

> November 1, 2012, CMS Press Release titled “ Health Care Law Delivers

Higher Payments to Primary Care Physicians”

> CMS Fact Sheet titled “Increased Medicaid Payment for Primary Care”

> http://www.medicaid.gov/AffordableCareAct/Provisions/Provider-

Payments.html


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http://www.medicaid.gov/AffordableCareAct/Provisions/Provider-Payments.html



General Policy Reminders

For Early Periodic Screening, Diagnosis and Treatment

(EPSDT) services, provider must

> Append -EP modifier to CPT/HCPCS code and

> Enable EPSDT protocol in APS PA system

Maternity Visits

> Procedure code 99213 with modifier -TH (obstetrical

treatment/services prenatal or postpartum) must be billed for each

individual prenatal or postpartum visit.

Mastectomy or Related Reconstructive Procedures

> Prior authorization is not required for individuals diagnosed with or

with history of breast cancer.

> The appropriate breast cancer diagnosis code must be documented on

the CMS 1500 claim form for payment consideration.


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Updates to BMS Provider Manual BMS Provider Manual

> On BMS website at www.dhhr.wv.gov/bms, under “Providers” section

> Proposed changes posted on BMS website for 30-Day Public Comment

Period

Chapter 514 - Nursing Facility Services

> Updated and published on January 1, 2013

> Changes include:

• Fingerprint-based Criminal Background Checks

• All-inclusive rate services have been defined

• Ancillary services have been defined

• Clarification of cost-reporting used in creating the Medicaid nursing facility rate

• Clarification for dispersing Nurse Aide reimbursement

• Requirement to check National Practitioner Data Bank (NPDB) – HOWEVER

this requirement was recently removed from BMS policy

– Providers must review Federal rules to determine requirements for

reporting to/checking NPDB


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http://www.dhhr.wv.gov/bms

Updates to BMS Provider Manual cont’d.

Chapter 517 - Personal Care > Will be released for 30-day comment period within next few months

> Proposed changes include:

• Fingerprint-based Criminal Background Checks

• Prior authorization of all hours

– 60 hours/240 units

» Submit Pre-Admissions Screening (PAS) tool and a

physician certification form to APS HealthCare for

approval.

– Prior authorization for 61 hours/244 units to 210 hours/840

units will remain the same

– Authorizations will be a maximum of 12 months.

– Will be phased in for members who are receiving Personal

Care services prior to implementation date


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Chapter 519 - Physician and Non-Physician Practitioners

> Under revision and will be released for 30-day comment period in

next few months

> Proposed changes:

• Consolidation of Chapter 504 - Chiropractic Services &

Chapter 520 – Podiatry Services into Chapter 519

– When final version of Chapter 519 is published, these 2 chapters will no

longer exist

• Services subject to nationally-accepted, evidence-based medical

necessity criteria

• Hysterectomy Acknowledgement Form revised

– Includes information from Physician Certification for

Hysterectomy form

– Grace period of 6 months will be granted to allow use of

both new and old forms during the transition period


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Chapter 519 – Physician and Non-Physician Practitioner

cont’d.

> Immunizations may be administered via standing orders in local

health departments.

> Drug Screening

• Considered for reimbursement when screening results will alter

patient management decision, deemed medically necessary, and

reasonable within commonly accepted standards of practice.

• Screenings for specific drug(s) must be ordered by treating

practitioner.

• Service limit is 24 screens per calendar year. Prior Authorization

is required for more than 24 screens.


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Chapter 519 – Physician and Non-Physician Practitioner

cont’d.

> Pain Management

• Paravertebral Joint/Nerve Block, Paravertebral Joint/Nerve Denervation

and Trigger Point injections require prior authorization before services

are rendered.

– Covered services may be provided in the office, outpatient hospital,

ambulatory surgical center or pain management clinic.

– Enrolled anesthesiologists, neurologists and physicians with board

certification in pain management may provide services.

> Anesthesiologist Assistants (AA)

• Upon completion of accredited AA program and certified by the

National Commission for Certification of Anesthesiologist Assistants

will be eligible for enrollment.

• Must work under the direction of a licensed anesthesiologist.


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Chapter 531 - Psychiatric Residential Treatment Facility

(PRTF)

> New Chapter (formerly part of Chapter 510 – Hospital Services)

> Effective May 1, 2013

> Staffing composition and staff ratios

• 1:3 Day Services

• 1:6 Overnight Services

> Detailed explanation of Incident/Accident Reporting and Policy

Requirements

> Fingerprint-based Criminal Background Checks

> Out of State Certification/Review Process


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WV Medicaid Program - Take Me Home, WV WV’s Money Follows the Person (MFP) Initiative

Program to move eligible participants from long-term care

setting to home or community-based setting

BMS contracted with Metro AAA and their partners to

provide MFP Transition Navigator services

Take Me Home, WV began accepting referrals on

February 1, 2013

Over 50 individuals determined eligible to participate

Several individuals in process for movement to

home/community-based setting

For more information, call Take Me Home, WV’s office

staff at (304) 356-4926


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WV Medicaid Program - Health Homes Health Homes for members with Chronic Condition

> Program is intended to improve the health of Medicaid members who may

need a variety of services to address primary and acute care, behavioral

health care, and long-term care services.

> BMS has been working with stakeholders across the state

> To be eligible, Medicaid member must have Bipolar Disorder and be at risk

for, or have, Hepatitis B or C.

> Designated primary care physician or advanced practice nurse providers

working with multidisciplinary teams in a variety of possible settings

> Beginning in 6 counties: Cabell, Kanawha, Mercer, Putnam, Raleigh, Wayne

Six defined health home services

> Comprehensive Care Management

> Care Coordination

> Health Promotion

> Comprehensive Transitional Care

> Individual and Family Support Services

> Referral to Community and Social Support Services


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Background Check Project for Long Term Care Providers

Provision under Affordable Care Act for National Background Check

Program

Grant-funded project

Centralized process for fitness determination of potential employee

> Registry Database Check

> State Criminal History Check

> Federal Criminal History Check

WV is one of 22 State Medicaid Agencies participating at this time

BMS and its partners, WV State Police and WV Office of Inspector

General, working with CMS’ Technical Assistance Vendor on system

development


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Provider Enrollment and Screening Provider enrollment and screening requirements mandated by ACA

> CMS continues to provide guidance to states

• Guidance remains pending on Criminal Background Check and Fingerprinting

> Enrollment and screening requirements apply to providers, owners,

managing employees, subcontractors

> Database checks

• OIG’s List of Excluded Individuals & Entities (LEIE)

• Excluded Parties List System (EPLS); effective November 2012, exclusion list

now part of the Federal System for Award Management (SAM)

https://www.sam.gov/portal/public/SAM/

• SSA Death Match File (SSA DMF)

• State Medicaid Exclusion Lists

• State Licensing Boards

> Providers must check databases for employees

> Site visits for certain providers as part of enrollment screening


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Provider Re-Enrollment/Revalidation Update

All WV Medicaid providers must be re-enrolled by end of 2015

Moving to web-based provider enrollment application program (PEAP)

Re-enrollment to begin summer 2013

> Phased-in approach by provider type/risk level

> First phase will be physicians (aka direct provider in Molina’s system)

Phase schedule will be placed on the web portal and banner pages

Providers will receive re-enrollment letter with case number (PEAP access

code) no less than 15 days prior to re-enrollment start date

Provider has total of 60 days from start date to re-enroll

30 days after re-enrollment start date, providers will receive reminder letter

that re-enrollment must be completed within the next 30 days

45 days after re-enrollment start date, providers will receive reminder that if

re-enrollment is not completed within next 15 days BMS may place provider

on pay hold


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National Correct Coding Initiative (NCCI)

Mandated by the Affordable Care Act of 2010 to incorporate NCCI into

Medicaid claims processing

> Procedure to Procedure (PTP) Edits

> Medically Unlikely Edits

WV Medicaid implemented NCCI edits in summer 2012

Quarterly updates > Approximately 300,000 new edits coming in July 2013 re: same day surgery

Applies to CMS 1500 and outpatient hospital claims

Appeals > Appeals for PTP edits must be directed to CMS

> CMS permits BMS to review appeals for MUEs

> MUE Appeals should be sent to Molina

For more information on Medicaid NCCI, go to

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-

and-Systems/National-Correct-Coding-Initiative.html


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http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-Correct-Coding-Initiative.html



















ICD-10

Providers and Payers must be compliant by October 1, 2014!

Centers for Medicare and Medicaid Services, if non-compliant then:

> Claims may not be paid

> Face possible sanctions and/or penalties from Federal Office of E-Health

Standards and Services (OESS) for non-compliance with HIPAA

BMS workgroup currently assessing system, mapping logic, policy, etc.

CMS has ICD10 website

> Guides for providers and payers recently released

> http://www.cms.gov/Medicare/Coding/ICD10/

Check BMS website and newsletters in future for additional information


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http://www.cms.gov/Medicare/Coding/ICD10/

http://www.cms.gov/Medicare/Coding/ICD10/

WV Payment Error Rate Measurement (PERM) 2013

PERM was created and authorized to comply with

> Improper Payments Information Act (IPIA) of 2002 and

> Office of Management and Budget (OMB) guidance

CMS conducts PERM reviews of each State Medicaid Agency every

three (3) years

Last review of WV Medicaid was in 2010

Additional information on PERM 2013 on CMS website at:

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-

Programs/PERM/index.html


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http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/index.html











WV PERM 2013 cont’d. Two (2) CMS contractors working with WV Medicaid:

> Statistical Contractor (The Lewin Group)

• Gathers all paid claims data for FFY 2013

• Chooses sample of claims to be reviewed

> Review Contractor (A+ Government Solutions)

• Requests and gathers documentation from WV Medicaid providers

• Review documentation for adherence to federal and state policies and

regulations

The Lewin Group currently working with BMS to create

sample of paid claims from the entire universe of paid claims

for FFY 2013.

Once claims sample selected, A+ Government Solutions will

begin sending record requests to providers


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WV PERM 2013 cont’d.

Review Steps:

> Contractor analyzes documentation and determines appropriateness of paid claims in accordance with applicable policies.

• Additional documentation may be requested from provider

> If payment is not justified BMS is notified of the error.

> If BMS disagrees with findings of Review Contractor, BMS prepares a defense of the billing.

• BMS may request additional documentation from provider at this time

> Once defense is submitted by BMS, Review Contractor will re-review the claim and make a final decision.

> If payment error is upheld by CMS, BMS will inform provider in writing and require reimbursement for billing(s) found in error.

> Providers retain all rights of appeal as stated in BMS Provider Manual.


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WV PERM 2013 cont’d. In 2010, most claims found in error were due to providers not responding

to documentation requests, or not producing additional documentation

requested by the Review Contractor.

BMS will be working closely with providers in 2013 to ensure that all

document requests are provided to the Review Contractor within required

timeframes.

The documentation request letter in 2013 will contain BMS contact

information in order for providers to have an additional contact person if

they are having difficulty in obtaining requested documentation.

WV Medicaid PERM Contact:

Scott Winterfeld, Office of Quality and Program Integrity

Telephone: 304-558-1700 or email: [email protected]


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Strengthening and Enhancing West Virginia’s

Medicaid Program:

Overview of the 2013

Managed Care Organization (MCO) Program

Pharmacy Expansion


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Overview of the Current MCO Program Expansion Overview

Low-income pregnant women, children, and healthy adults in all of West Virginia’s 55 counties are eligible to enroll in the MCO program

Beneficiaries can choose among two or three MCOs in almost every county

The three participating MCOs have demonstrated an ongoing commitment to improving access and quality of care for Medicaid beneficiaries and have developed a strong partnership with the State

MCO Number of Counties

Served

CoventryCares of West Virginia 52

The Health Plan of the Upper Ohio

Valley (THP) 30

UniCare Health Plan of West Virginia

(UniCare) 53

*As of February 2013. In April, CoventryCares will expand to all 55 counties and THP will

expand to six additional counties.


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Services Covered by the MCO Program Expansion Overview

Services Covered by the MCO Program

• Ambulatory surgical center services

• Children with Special Health Care Needs services

• Clinic services

• Cardiac rehabilitation (children < 21)

• Diabetes education (children < 21)

• Durable medical equipment

• Emergency dental services (adults)

• Early and Periodic Screening, Diagnostic and Treatment

Services (EPSDT)

• Family planning services and supplies

• Hearing services and supplies (children < 21)

• Home health care services

• Hospice

• Hospital services, inpatient

• Hospital services, outpatient

• Laboratory and x-ray services

• Nurse practitioner services

• Speech therapy

• Physical therapy

• Occupational therapy

• Physician services

• Prosthetic devices

• Pulmonary rehabilitation (children < 21)

• Rural health clinic services (including federally qualified

health centers)

• Tobacco cessation programs (children < 21)

• Transportation, emergency services

• Vision services

Services Covered by the Fee-for-Service Program

• Long-term care services

• Non-emergency transportation

• Behavioral health services

• Children’s dental services

• Pharmacy

To date, beneficiaries have been receiving a majority of services through their MCOs:


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Expansion Overview

Expansion Overview

Medicaid beneficiaries currently enrolled in the MCO program will

begin receiving pharmacy services through their current MCOs as of

April 1, 2013.

Beneficiaries will continue to access the following services through

the fee-for-service Medicaid program:

Non-emergency transportation

Long-term care

Behavioral health

Children’s dental


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Pharmacy Transition Period

MCO Program Post-Implementation

MCOs networks have 520 of the same pharmacies that were currently in the fee-

for-service network as of December 2012

MCOs will be allowed to continue the pharmacy lock-in program Medicaid

currently uses or develop their own criteria

Mail order pharmacies will not be allowed in the MCO networks

During the 90-day transition period, the MCOs will be required to:

Provide any previously approved prescriptions

Allow members to use out-of-network pharmacies

Assist members with transitioning to a network pharmacy


33

Pharmacy Services


Almost all prescriptions, including behavioral health prescriptions, will be

included in the MCO benefit package beginning April 1, 2013

Prescriptions will be covered through the member’s MCO regardless of

whether the prescribing provider is included in the MCO’s network

Hemophilia medications will continue to be covered through fee-for-service


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Impact on Prescribing Providers

MCO Program Post-Implementation MCOs will follow all criteria on the State’s Preferred Drug List (PDL)

Information on the PDL can be accessed at: http://www.dhhr.wv.gov/bms/Pharmacy/Pages/pdl.aspx

Prescribing providers will need to follow the prior authorization and utilization management guidelines of each MCO for drugs not on the PDL

The MCO’s criteria for drugs on the PDL will be the same as the criteria used by BMS for FFS, but the MCO will be responsible for approving any requests. MCO call centers will be available on April 1st to assist prescribing providers with MCO prior authorization requests and procedures

CoventryCares:

Phone: 1-877-215-4100

Fax: 1-877-554-9137

THP:

Phone: 1-800-624-6961 ext. 7914

Fax: 1-888-329-8471

UniCare:

Phone: 1-877-375-6185

Fax: 1-800-601-4829


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http://www.dhhr.wv.gov/bms/Pharmacy/Pages/pdl.aspx

Impact on Pharmacies


Each of the MCOs will use the same Prescription Benefits Manager – Express

Scripts, Inc. (ESI)

Beginning on April 1st, pharmacies may call ESI’s Eligibility Verification Line at 1-866-641-1112 if they do not know which MCO the member is enrolled in

The central number will route providers based on the member’s plan

Each MCO has slightly different procedures for electronic processing of claims.

Please contact the MCOs for additional details

Pharmacies will be required to provide emergency 3-day prescription fills in

accordance with Federal regulation

No copays will be required for any services


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CoventryCares Contact Information


Pharmacy Providers (ESI Help Desk): 1-800-922-1557

Prescribing Providers: 1-877-215-4100

Hours: Calls are answered 24 hours a day, 7 days a week

Additional Information Available at:

www.express-scripts.com/services/pharmacists/


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http://www.express-scripts.com/services/pharmacists/



THP Contact Information



Prescribing Providers: 1-800-624-6961 ext. 7914



www.medco.com/rph


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http://www.medco.com/rph

UniCare Contact Information



Prescribing Providers: 1-877-375-6185

Email: [email protected]



www.express-scripts.com/services/pharmacists/


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mailto:[email protected]






Provider Outreach and Education Provider Outreach

Contact Automated Health via the specialists listed below or at 304-345-

0436 or 1-800-449-8466

Region I – John Buzzard

[email protected]

304-552-1426

Region II – Debbie Hon

[email protected]

304-549-9420

Region III – Marjorie Burdick

[email protected]

304-395-0567

Region IV – Michelle Zierer

[email protected]

304-395-0566


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We appreciate your help and support in ensuring that West Virginia Medicaid beneficiaries have access to

quality health services!

If you have any additional questions on the planned MCO program expansion, you may contact Brandy Pierce at 304-558-1700 or email [email protected]

If you would like to schedule an on-site outreach and education training provided by the State’s enrollment broker, Automated Health Systems, please call 304-345-0436 or 1-800-449-8466.

All pharmacy outreach materials, including this presentation, can be accessed at http://www.dhhr.wv.gov/bms/mco/

Questions?


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http://www.dhhr.wv.gov/bms/mco/

Provider Notifications

Hospice Related Services

Beginning 2/1/2013 denial reasons became more specific for hospice claims related to the terminal illness.

• Claims denied because the service provided is related to the terminal illness of a member enrolled in the Hospice program, will now reflect:

HIPPA compliant Claim Adjustment Reason Code 97 – “The benefit for this service is included in the payment / allowance for another service / procedure that has already been adjucated.”

Transportation Providers

The billing practice of utilizing line 19 for ‘Local Business Use’ on a CMS 1500 Claim form for the transport reason is acceptable for the billing of Medicaid claims.


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Paper Billing Tips

Paper Third-Party Liability (Secondary) Claims

Each claim must have an EOB attached Alternative to paper, Direct Data Entry

(DDE) with Trading Partner Account at: www.wvmmis.com.

Paper Claims Requiring Documentation

Supporting documentation must be printed clearly.

Paper Claims – Most Common Rejected Returns

All claim fields required are complete;

Members Medicaid ID

NPI and taxonomy

Diagnosis codes

Legibility

Alignment of information within claim form fields


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http://www.wvmmis.com/

Electronic Billing Issue Causing Rejected Claim – Return to Provider Letters

Referred to as ‘One to many (OTM)’ provider records

This means one NPI to multiple Medicaid provider ID numbers.

To help ensure that WV Medicaid providers do not experience denials of claims or delays in claims processing and payment, BMS/Molina encourages each of its enrolled health care providers to obtain a unique NPI.

Sub-Part Enumeration

An organization is a subpart, when the lines of business is multi-disciplinary. This is a provider who is enrolled under more than one (1) provider type. An example would be a community mental health center which is owned by the same entity as a behavioral rehabilitation provider.

Separate NPI number can be obtained by NPPES through sub-part enumeration.

https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

Benefits Eliminates the use of taxonomy.

Reduces delay of claims processing.

Facilitates electronic enrollment.

Electronic Billing Tips


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https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

NEW Molina Medicaid Solutions Web Site & EDI Portal Coming in 2013


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New Molina Medicaid Solutions Web Site & EDI Portal Molina Medicaid Solutions is pleased to announce the implementation a new web site & EDI Web Portal that will provide significant enhancements and functionality in 2013.

Improved Functionality – Real Time Capabilities

Fully automated Trading Partner registration and administration.

WVMMIS trading partner accounts support multiple users in compliance with HIPAA security regulations.

Multiple billing providers can be linked to one account.

Real-time claims Direct Data Entry (DDE) will include the following:

Edit & correct on non-finalized claims Real-time adjudication of claims Real-time claim adjustments, reversal and reversal/replacement of claims Upload of Electronic claim attachments and documentation

Real time Direct Data Entry of: Claims Submission Eligibility Verification Claim Status Referral Status Prior Authorization Status Payment Status

Improved Patient/Member Roster Set-up and Editing


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Molina’s Web Site - www.wvmmis.com

Advantages of Having a Web Portal Account Eliminate paper claim forms Saves time and money Updates and Important Billing Information Newsletters & Bulletins Forms Contact information User Guides & Training Documentation

Electronic Data Interchange (EDI) Transactions – (Free of Charge) Access to submit all claims through DDE (Direct Data Entry), or batch upload 837 transaction. Receipt of Electronic Remit in an 835 transaction with ability to auto-post payments in provider systems

(dependent on provider’s system capabilities) Receipt of Electronic version of Paper Remittance Advices Access to submit & receive Member Eligibility Requests through DDE, batch upload 270/271 transactions –

5 megabyte file NEW – You can now upload claim status inquiries and receive a response the same day, 276/77

transactions – 5 megabyte file Access to Provider’s Medicaid Training Center currently in development


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Registering For Current Web Portal Account

1. Complete Trading Partner Agreement (TPA) with EDI Transaction form

2. TPA & EDI Transaction form is located on the Molina website, www.wvmmis.com.

3. HealthPAS Online Registration

After receipt of completed TPA forms, Molina’s EDI Helpdesk staff will contact you by email with a link to set up username and password through the HealthPAS Online Registration.

For assistance with registering, contact the EDI Helpdesk at 1-888-483-0793 option 6.

After Molina implements the NEW Website & EDI Portal in 2013 Providers will have the capability of registering themselves for a portal account.


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Web Portal Training & Provider Field Representatives

Beth Roach

[email protected]

304-348-3291

Carrie Blankenship

[email protected]

304-348-3292


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provider workshops april 2013 - wvmmis.com provider workshops/wv... · january 1, 2013 as long as...

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