Molina Healthcare of Illinois Provider Summit 2019 October 10 th , 2019
Table of Contents Molina Healthcare of Illinois, pages 3-5 Quality Improvement Programs, pages 29-43 Provider Resources, pages 6-15 • 2019 P4P Program • Behavioral Health Excellence • Provider Network Manager Assignments • Achieving HEDIS Goals • Provider Email Alerts and Memos Utilization Management, pages 44-59 • Online Provider Resources • Provider Web Portal • Process Overview • Credentialing and Effective Date • Submissions • Provider Changes • Concurrent Reviews and Denied Authorizations Billing and Claims Support, pages 16-22 Care Coordination, pages 60-67 • Identification Card Examples • Case Management • IAMHP Billing Guide • Transition of Care • Provider Billing Webinars Community Engagement, pages 68-71 • MLTSS Billing • Community Engagement Goals • The Molina Approach to Identify Billing Errors • Outreach Events • Most Common Issues & Billing Mistakes • Helping Hands Claims Appeals and Disputes, pages 23-26 • Provider Disputes/Adjustments Value Based Contracting, pages 27-28 • Overview of Offerings
Presence in Key Medicaid Markets 3
Molina Healthcare of Illinois Provider Network Medicaid MMP Provider Type Count Count Hospitals 200 159 Primary Care Providers 21,815 16,484 Specialist Physicians 54,719 38,398 WHCP 3,100 2,233 Behavioral Health 7,581 6,731 FQHC 358 258 Molina Healthcare has been happily serving its Illinois members since 2013 4
Molina Healthcare of Illinois Pam Sanborn Plan President Karen Babos, DO, MBA Chief Medical Officer Matt Wolf VP, Network and Operations Kris Classen AVP, Healthcare Services Vijay Parthasarathy Regional Chief Financial Officer David Vinkler VP, Government Contracts Kim Blackwell AVP, Compliance 5
Provider Resources Natalie Kasper, Director Network Mgt. Mike Manade, Mgr. Provider Network LaTasha Smith, Mgr. Provider Network 6
Provider Network Managers In 2018 Molina changed our staffing model with a focus on creating end-to-end relationship management and accountability of provider relationships by eliminating handoffs that have been problematic. Staffing assignments are separated by provider types and regions. Benefits: • End-to-end relationship management - eliminates confusion of roles and responsibilities for provider changes • Elimination of unnecessary handoffs • Servicing is specialized with narrow focus on relationship building, education, billing and configuration requirements • Specialization will allow for increased provider satisfaction and understanding of Molina processes • Specialization will allow for better understanding of provider loading requirements/configuration • Dedicated 1 position to creating/reviewing provider communication 7
Provider Network Managers Hospitals/Healthcare Systems Our up to date territory maps can be found on our provider website. As staffing changes are made or territories are changed, we update our online maps to align with the correct managers and contact information 8
Provider Network Managers Ancillary Providers • Long Term Care • Supportive Living Facilities • Skilling Nursing Facilities • Dialysis • Emergent Transportation • Waiver Services • DME • Lab • Home Health • SUPR & CMHC 9
Provider Network Managers FQHC/RHC/ERC • Federally Qualified Health Centers • Rural Health Clinic • Encounter Rate Clinics 10
Provider Email Alerts and Memos New Feature! To help keep providers informed of Molina updates we created a new feature in 2019 giving providers the ability to receive email alerts. Providers no longer have to check our website to see if we made an update, get the latest information delivered right to your inbox. To receive email alerts from Molina providers can sign up by visiting www.molinahealthcare.com/providers/il 11
Online Provider Resources • Provider manual • Fraud, Waste & Abuse information • Provider online directories • Communications & Newsletters • Web portal • Member Rights & • Frequently used forms Responsibilities • Preventive & clinical care • Contact information guidelines • News & Updates • Prior authorization information • Service area maps • Advanced directives • Model of Care training • Pharmacy information • HIPAA • Webinar & Events 12
Provider Web Portal • Why register for Molina’s Provider Web Portal? – Easy-to-use online tool designed to meet your needs • Web Portal features – Search for member details, including eligibility status and covered benefits – Create, submit, correct and void claims; submit attachments and receive notifications of status changes – Check current claim status and print claims – Submit disputes online – Create, submit and print Service Requests with notifications of status changes – View Service Request approval status – Track required HEDIS services for members and compare your scores with national benchmarks – View member Personal Health Record – Access account information, manage and add users and update your profile – Update provider demographics 13
Provider Changes As of January 1, 2019 Molina contracted providers are required to submit provider information via the universal roster template issued by the Illinois Association of Medicaid Health Plans (IAMHP). Use the Universal IAMHP Roster Template to: – Add – Terminate or – Update a provider • This process applies to – Pay To information – Servicing location – Rendering Provider 14
Provider Effective Date A provider’s effective date as a participating provider under the HealthChoice Illinois program is noted as the following: Molina will load a provider’s effective date at the later of: • The execution date of Molina and provider’s contract • The date the provider submits to Molina a complete and accurate IAMHP roster form for the provider in the format approved by HFS • The provider’s effective date contained within HFS provider enrollment subsystem with the IMPACT system • Provider may submit to Molina the IAMHP roster at the same time that the provider submits an enrollment application to HFS through IMPACT 15
Provider Billing Support
IAMHP Billing Guide • The Illinois Medicaid Managed Care Organizations (MCOs), in collaboration with the Illinois Association of Medicaid Health Plans (IAMHP), have developed a Comprehensive Billing Guide for Medical Assistance Program providers. This billing guide is designed to help providers who are contracted with the MCOs understand the general MCO billing requirements. • MCOs have different policies and procedures related to billing. With this manual, the MCOs have created a single source of information for all claims regardless of provider type. • IAMHP Comprehensive Billing Guide 17
Provider Billing Webinars • Each month Molina reviews claims denial trends and creates an educational billing webinar based on key findings from that review • We’ve completed over 35 billing webinars this year and had over 400 providers registered • These webinars are recorded and posted online so they can be available for 24/7 access • All webinars are available to both contracted and non-contracted providers Providers can sign up at any time by visiting www.molinahealthcare.com/providers/il 18
Managed Long Term Services and Supports (MLTSS) • HealthChoice Illinois also covers Medicaid Long Term Services and Supports (MLTSS) enrollees who qualify for Medicaid and Medicare, but have opted out of Medicare-Medicaid Alignment Initiative • MLTSS includes Long-Term Care (LTC) and Home and Community Based Services (HCBS) • Medicare remains the primary payer for the dual-eligible beneficiaries enrolled in HealthChoice Illinois MLTSS – LTC is for an individual living in a facility-based care setting (such as nursing home or intermediate care facility) – Home and community-based services provide supportive services in community so individuals can continue to live in their home and empower them to take active role in their health care 19
Managed Long Term Services and Supports (MLTSS) Helpful tips when submitting claims: • Medicare-covered services must be billed to the patient’s Medicare carrier. • Non-Medicare covered long-term-care services, home and community-based waiver services, non-Medicare behavioral health services, and non-emergency transportation services must be billed to the Medicaid MLTSS MCO. • All other non-Medicare covered services covered by Medicaid (e.g., non-Medicare Durable Medical Equipment, prescription drugs, inpatient hospital, dental services, vision services, Medicare rollover services, etc.) should be billed to Medicaid FFS unless they are covered as part of a long- term-care facility per diem. • Claims questions or appeals should be sent to the entity responsible for covering the service (Medicare, HealthChoice Illinois MLTSS MCO or the Medicaid FFS). 20
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