interChange aka MMIS Update Parrish Steinbrecher: Deputy Office - - PowerPoint PPT Presentation

▶
interchange aka mmis
SMART_READER_LITE
LIVE PREVIEW

interChange aka MMIS Update Parrish Steinbrecher: Deputy Office - - PowerPoint PPT Presentation

Jan 22, 2023 227 likes •424 views

interChange aka MMIS Update Parrish Steinbrecher: Deputy Office Director, Health Information Office Scott Lindblom: Division Director, Health Information Office 1 We are 51 days in, but why a new system? States are required by CMS to

slide-1
SLIDE 1

interChange aka MMIS Update

Parrish Steinbrecher: Deputy Office Director, Health Information Office Scott Lindblom: Division Director, Health Information Office

1

slide-2
SLIDE 2

We are 51 days in, but why a new system?

  • States are required by CMS to re-procure their MMIS

system every ten years.

  • The new MMIS is modular and interfaces with other

systems, modern, and flexible to make changes

  • It is an Affordable Care Act requirement to

revalidate Medicaid providers every 3-5 years depending on provider type.

2

slide-3
SLIDE 3

How did the Department Communicate the change?

  • Began in September of 2014 with stakeholder engagement
  • External communication began in May of 2015
  • Provider Bulletins, At-A-Glance articles, Stakeholder meetings,

email assistance

  • Emails Blasts to providers
  • Association and stakeholder meetings
  • Letters to revalidate sent in five “waves”
  • Facebook
  • Daily Webinars
  • And more….

3

slide-4
SLIDE 4

System Testing

  • 3190 test cases completed
  • Testing claim scenarios and provider types
  • The delay in go-live allowed for additional tests re-

tests

  • System testing
  • End-to-End
  • Soft go live on 2/27/17
  • Identify any claims issues
  • Hospital, clearinghouse, providers

4

slide-5
SLIDE 5

Enrollment

  • 44,709 providers enrolled currently
  • Since go live on March 1, DXC is processing 50%

more enrollments than the monthly enrollment average before March 1

  • Enrollment related questions account for 60% of the

escalated items DXC and the Department receive

5

slide-6
SLIDE 6

Claims Processing

  • We have processed 6,459,374 claims to date
  • On par with average weekly payments in legacy Xerox system
  • The interChange has paid $1.08 billion in claims to

date

  • This is on par with our payments issues when Xerox was the Department’s

fiscal agent.

  • Two additional weekly financial cycles were run in

March to ensure providers received payments timely

  • The number of paid claims processed has increased

from 40-60% weekly

6

slide-7
SLIDE 7

Claims Processing

  • Most recent financial cycle: $120,556,000
  • The first financial cycle happened three days after

go-live

7

slide-8
SLIDE 8

8

37.6% 48.6% 49.6% 53.8% 58.4% 55.9% 58.4% 59.7% 42.7% 45.6% 44.7% 41.0% 36.6% 40.8% 38.1% 37.6% 19.7% 5.8% 5.6% 5.2% 5.0% 3.2% 3.5% 2.6% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 3-Mar 10-Mar 17-Mar 24-Mar 31-Mar 7-Apr 14-Apr 21-Apr

Weekly Claims Adjudication Averages

Paid Denied Suspended

slide-9
SLIDE 9

DXC call center

  • Call volume to HPE is 25-50% higher on average

than the call volume Xerox experienced

  • We are seeing a decline in the number of calls each week
  • ASA is 26:51 for all queues.
  • Claims queue average speed of answer is 86 minutes
  • Member eligibility is 3 seconds
  • Prior authorization inquiry is 1 second
  • Provider Enrollment is 12 seconds
  • EDI is 52 minutes
  • Provider Services (all others) is 19 seconds

9

slide-10
SLIDE 10

Current Call Center Stats

10

slide-11
SLIDE 11

DXC Call Center

  • What are we doing about the high hold times?
  • DXC call center: 18 agents on March 1
  • 26 agents by the end of March
  • 45 agents in early April
  • 51 agents currently
  • Xerox had 12 call agents for comparison
  • Opening an hour early 3 days a week
  • Monday, Tuesday, and Thursday open at 7:00 instead of 8:00

11

slide-12
SLIDE 12

DXC Call Center

  • Call center opens Wednesday and Friday at 10:00 to

allow time to call back providers

  • Priority Queuing:
  • Callers no longer have to wait at the back of queue if the wrong queue is selected, DXC

will priority transfer the call to the front of the correct queue

  • Initially there were two issues contributing to hold

times and “dropped calls”

  • Cut phone line in Florida
  • Telephone software problem causing calls to drop when holding for extended periods
  • Problem resolved in less than 10 business days for large volume of dropped calls
  • Monitoring the issue

12

slide-13
SLIDE 13

Department Operations

  • We are working with providers through our established

escalation channels

  • Top 3 escalated issues are
  • 1) enrollment
  • 2) Provider Portal
  • 3) Claims
  • The Department and DXC have an escalation process and teams for urgent provider needs
  • Department Command Center began 2/23 and will continue as

needed

  • 8:00-5:00 daily:
  • 8:30 Escalated Issues
  • 9:00 claims
  • 10:00 Defects/Issues
  • 11:00 HCPF Program, Policy, and System open issues
  • 12:00 – 5:00: Escalation teams

13

slide-14
SLIDE 14

Department Operations

  • HCPF HCBS SME’s Outreach to HCBS clients
  • Outreach to providers with high claims denial % from

denied claims report

  • Review incoming call report: identify high call numbers

and outreach caller

  • Transitioned staff
  • To assist PAR entry
  • To assist outreach to providers
  • Escalated issue management

14

slide-15
SLIDE 15

Updates

  • Staffing: 81 new staff
  • Including 8 Provider Field Representatives to assist with

claims and enrollment issues and training

  • Timely filing change from 120-240 days
  • RA’s available on weekend
  • Option on IVR for Provider to select if experiencing

Financial Hardship.

15

slide-16
SLIDE 16

Issues/Fixes

  • Known Issues Web Page: https://www.colorado.gov/hcpf/known-issues
  • EOB 1504 (Rendering Provider Number Not Found) / EOB 0952 (Multiple

Provider Locations)

  • In Production 4/27/17
  • Claims Will be resubmitted
  • Timely Filing
  • 120 to 240 days through October.
  • In production 5/11/17
  • EOB Codes
  • Provider Portal – MO and UAT 5/11/17
  • RA – TBD
  • Revisions being made to make descriptions more accurate - Ongoing
  • Update field length in the Provider Portal - TBD

16

slide-17
SLIDE 17

Issues/Fixes

  • Vision Codes
  • Provider contract updated for 101 procedure codes. 4,366 claims resubmitted
  • Backdate – No contract
  • 600,000 claims impacted. Reprocessing date TBD
  • CLIA
  • End dates open ended. Claims reprocessing this weekend
  • Providers with no CLIA on file need to add it

17

slide-18
SLIDE 18

Resources

  • The Department and DXC have developed resources that can help providers with these

frequent questions about using the new system.

  • Overview of Online Resources for interChange
  • Revalidation and Enrollment and Online Provider Enrollment Tool
  • Training Page
  • Cheat Sheets
  • FAQs
  • Frequent Updates on Provider Resources page
  • Go-Live Transition Special Bulletin
  • And many more...
  • The Provider Portal and Provider Resources pages are updated as soon as new materials are

available, providers can sign up for our e-newsletter to receive updates, along with accessing billing manuals and provider bulletins. Visit these pages on colorado.gov/hcpf/our-providers

  • ften for updates. Providers should also be sure that they are signed up to receive

Department publications and that their contact email in the Provider Portal is correct.

18