El Electr tron onic Visi sit t Verifi ficati tion on and - - PowerPoint PPT Presentation
El Electr tron onic Visi sit t Verifi ficati tion on and and Pe Personal Care Reassessment Pr Process May 16, 2019 Agenda Medicaid 101 and Live Demo eQ Healths Personal Care Reassessment Process Electronic Visit
May 16, 2019
Reassessment Process
Update
Karen Young, Training and Program Developer, MMIS, AFMC
2019 2019
Agenda
Provider Enrollment ht
https://medicaid.mmis.arkansas.gov/Provider/Enroll/Enroll.aspx
Provider Enrollment Information
View or print this required documentation guide!
professionals/arkansas-medicaid-providers/mmis-outreach-specialists/mmis-training-education/mmis- provider-enrollment-revalidation-webinar/
Provider Enrollment Updates
Who’s Who at Medicaid
Billing Matters
Note: PES will be going away soon!
Eligibility Strip
Tools to Determine Eligibility
Benefits (Sec+on II of Provider Manual)
Arkansas Medicaid administers more than 50 50 program
benefits available to eligible beneficiaries (se see Sec+on II of the Physi sician Ma Manual):
Timely Filing
Medicaid requires providers to submit all claims no later than 12 months (365 days) from the date of service. The 12-month (365 days) filing deadline applies to all claims, including:
retroactively
Section 302.000 of the Provider Manual
Timely Filing – Claims With Retroactive Eligibility (Pseudo Claims)
Providers have 12 months (365 days) from the approval date of the beneficiary’s Medicaid eligibility to resubmit a clean claim a>er filing a pseudo claim. A>er the filing deadline (12 months/365 days from the Medicaid approval date), claims will be denied for Dmely 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: “With the claim, proof of the ini7al filing and a le:er or other documenta7on sufficient to explain that administra7ve processes”. Please see SecDon 302.400 for complete details.
DXC Technology AQn: Research Analyst P.O. BOX 8036 LiQle Rock, AR 72203
Healthcare Provider Portal
Healthcare Portal Features
dental, crossover and third-party)
Eligibility Strip
Claim Types Submitted on the Portal
Submi&ng a Crossover Claim on the Portal
Submitting a Third-Party Liability (TPL) Claim on the Portal
TPL Documenta.on/Billing Guidelines
If you ar are e a a provid ider er of ser ervic ices es to a a Med edic icaid aid-elig eligib ible le mem ember er, but t th the e ser ervic ices es you provid ide e ar are e no not covered d by the he Membe ber’s pr primary ins nsur uranc nce compa pany, pl please see be below for do docum umentation n an and billin illing guid idelin elines es.
no payment to provider) or a payment to the provider (EOB with payment). They will need to keep this in the client file for auditing purposes.
They would say yes they billed the insurance using a denial date of in this example 01/01/2018 and $0.00 payment amount. Be sure to include Claim Filing Indicator.
Prior Authorization Process Types on the Portal
On Only the following PA A types s are available on the HealthCa Care Provider Portal:
Training Tools and Resources
www www.med edic icaid aid.mmis is.ar arkan ansas as.gov
Provider Manuals
administrative (and non-compliance) remedies and sanctions, PCP case management program, and required services and activities
and billing procedures
additional or other payment sources, pseudo claims and reference books
Provider Manuals
Things to Know
Refund Checks
Note: Electronic claims cannot be voided or edited on the portal a5er 365
a5er 365 days.
Search Payment History (Portal RA)
Mail paper claims to:
DXC Technology Attn: Claims P.O. Box 8034 Little Rock, AR 72203 Special Claims Attn: Research Analysts P.O. Box 8036 Little Rock, AR 72203 Crossover Claims DXC Technology P.O. Box 34440 Little Rock, AR 72203 Please do not send claims to AFMC
DXC Technology – Provider Assistance Center (PAC) and Electronic Data Interchange(EDI)
Your first point of contact for billing, claim status general questions and technical issues: Monday through Friday 6 a.m.–6 p.m. Toll-free in Arkansas 800-457-4454 Local or out-of-state 501-376-2211
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v Providers will receive notification through the eQHealth provider portal alerting that the independent assessment (IA) needs to be requested within 60 days. v The provider should place an authorization request in the eQHealth provider portal for the next 12 months of services (if indicated). v Upon receiving the authorization request, eQHealth staff will generate assessment referral. v Once IA is completed; the authorization will be reviewed and determination completed.
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awhite@eqhs.org
rmason@eqhs.org
501-725-9412 501-725-9422
Toll free – 888-860-3831 Toll free fax line – 855-997-3707
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Communication Plan Product Features Pilot and Rollout Timeline
> Timeline > Technology features > Product features > What you’ll be responsible for
> Individual providing service > Location of the service (GPS validation) > Member receiving the service > Time service begins & ends > Type of service(s) performed v Offline mode
> View visit information > View providers, caretakers and members > Manage users > Show flags > View, create, download reports > Scheduling component
> Select Providers Using Careify > System Feedback and Improvements > Providers Using Other EVV Systems
Implementation