First Quarter Updates First Quarter 2014 Managed Health Services - - PDF document

First Quarter Updates

First Quarter 2014

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Managed Health Services (MHS) is a health insurance provider that has been proudly serving Indiana residents for nearly two decades through Hoosier Healthwise and Healthy Indiana Plan. We provide coverage for doctor visits and immunizations, regular check-ups, health screenings, and other medical services. Our members include children, pregnant women, and adults to age 64. MHS also offers a qualified health plan through the Health Insurance Marketplace called Ambetter from MHS. Ambetter offers comprehensive medical care with plans that fit your health needs as well as your budget. MHS is your choice for affordable health insurance. Learn more at mhsindiana.com.

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Agenda

• Billing Updates
• Secure Portal Eligibility Functions
• Resources

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Claim Updates

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Billing Updates – Revised CMS 1500

• Required for claims submitted 4/1/2014 and later.
• Both versions of the CMS-1500 will be accepted from

1/6/2014 – 3/31/2014.

• For additional information regarding the revised

CMS-1500 please refer to IHCP Bulletin BT201353.

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Billing Updates – CLI A

• Effective January 1, 2014, providers billing CLIA services to

MHS must include a valid and appropriate CLIA number.

• For paper claims, a valid and appropriate CLIA number must be

included in Box 23 of the CMS-1500 form.

• For EDI claims, if a single claim is submitted for those laboratory

services for which CLIA certification or waiver is required, report the CLIA certification or waiver number in: X12N 837 (HIPAA version) loop 2300, REF02. REF01 = X4. If a claim is submitted with both laboratory services for which CLIA certification or waiver is required and non-CLIA covered laboratory test, in the 2400 loop for the appropriate line report the CLIA certification or waiver number in: X12N 837. (HIPAA version) loop 2400,

• REF02. REF01 = X4. Valid and appropriate CLIA numbers must

be provided.

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Billing Updates – CLI A continued

• Claims for CLIA certified or waived tests that do not

contain a valid CLIA number will be rejected.

• This applies to all MHS products (Medicaid, Hoosier

Healthwise, HIP, and Ambetter from MHS).

• For a list of CLIA Waived services, Provider Performed

Microscopy Procedures, tests subject to CLIA edits and tests excluded from CLIA edits, please visit: http://www.cms.gov/Regulations-and- Guidance/Legislation/CLIA/Categorization_of_Tests.html

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Billing Updates – OPR

• Claims submitted on or after 3/1/2014 will require the

NPI of the ordering, prescribing, or referring provider (OPR).

• For additional information please refer to IHCP

Bulletin BT201233.

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Billing Update - NDC

• January 1, 2012, providers must submit the product

NDC, the NDC unit of measure (UOM), and NDC quantity of units, along with the procedure code, when submitting claims to IHCP MCEs for certain procedure- coded drugs.

• A list of the procedure codes that require NDCs is

located on indianamedicaid.com. This list is updated quarterly.

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Billing Updates – ACA I ncrease

• The increased payment is applicable to certain physician

specialties for Primary Care Evaluation & Management (E/M) codes 99201–99499 when providing primary care services. The increase is also applicable to services related to immunization administration for vaccines and toxoids, and Administrative codes 90471-90474.

• Payments will be made on a quarterly basis. All payments will

include claim detail and explanation separate from your regular claims remittance. The EX code will read, “Provider allowable adjusted to include parity payment”.

• For additional information please refer to IHCP Bulletin

BT201247.

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Secure Web Portal

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MHS Provider Portal Home Page

• The MHS logo links back to the home page.

Click on the logo to go to your home page.

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MHS Provider Portal Home Page

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MHS Member Eligibility Check

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I ndividual Patient Record

• The Patient list will pull up all MHS

members for the currently selected tax ID number

• The list can be filtered by

– Provider’s NPI – Provider’s Medicaid Number – Member’s Last Name – Disease Management

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Patient List

Patient List

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Patient List

• In the patient list, you can click on a

members name to open the Individual Patient Overview.

Click on the name, it will be in blue

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I ndividual Patient Overview

• This screen lists a member’s:

– Date of birth – ID number – Address – PMP information – Eligibility Information and History – PMP History – Care Gaps – Clinical Information

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I ndividual Patient Overview

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Need to Know

MHS Website

• mhsindiana.com

– Provider directory search. – Provider manuals, guides, and tutorials. – Provider and member forms. – Member brochures. – Health Library with over 4,000 free, printable health information sheets available in English, Spanish, and other languages.

• MHS Secure Provider Portal – mhsindiana.com/login

– Account Manager access allows facilities to set up multiple users. – Access for both contracted & non-contracted groups. – Enhanced claim detail. – Submit claims / adjust submitted claims. – Printable explanation of payments. – Submit prior authorization. – Claim auditing tool. – Eligibility verification/listings including TPL information. – View patient care gaps (patients needing services).

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Questions and Answers

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