Specialty Care Providers Office Staff Meeting June 29, 2017 - PowerPoint PPT Presentation

Specialty Care Provider’s Office Staff Meeting June 29, 2017

Provider Relations Meet our Provider Relations Team! Teresa Hebert, Director Christine Owens, Manager Sylvia Carrizales, Analyst Martha Dixon, Coordinator Mona Ogas, Coordinator

Cook Children’s Health Plan Overview CCHP Total Membership (through May 2017) 132,109 • Children’s Health Insurance Program (CHIP)/Perinatal • may have co-pays based on income • through age 18 • State of Texas Access Reform (STAR) Medicaid • Medicaid-managed care • all ages • STAR Kids • launched November 2016 • aged 20 and younger with disabilities • Care Management/Service Coordination program

CCHP Provider Website Website: www.cookchp.org  Provider Directory and on-line lookup  Provider Website Resources • Provider Manual • Prior Authorization Lookup • Therapy Guidelines • Resources – useful links for providers

CCHP Provider Website • Provider News  Current news – updates that may affect you  Current newsletter  Archived newsletters • Education and Training  Training formats • In-person (group and individual) • Web-based training modules (self-paced) o Videos o PDFs of Powerpoint Presentations

CCHP Provider Website

CCHP Provider Website • Forms  Access and submit Provider Data Information Change Request Form: (Providers / Forms) • service or billing address • group or individual practice name • hospital affiliation • specialty • tax identification number (TIN) • W9 form must be submitted with all Tax ID updates

CCHP Provider Secure Portal Secure Portal:  Verify Member eligibility  Confirm Service Coordinator for STAR Kids  Submit and/or check status of authorization  Obtain claim status and payment information  File claim appeals and check status Reminder Multiple staff members can have an account; however, each user must create a unique user name and password

CCHP Provider Secure Portal

CCHP Provider Secure Portal

Interpreter Services in Provider’s Office  Do not have anyone to translate for Member during their appointment? • CCHP provides via CyraCom or face-to-face interpreter services • 2 day advance notice required  call Member Services Department at (800)964-2247 or (682)885-2247 • If Member has to cancel, please call to cancel the interpreter services

Electronic Claim Submission Electronic Claim Submission:  Batch claims through Availity  Single claims can be submitted electronically through Availity at no cost  Register https://www.availity.com/resources/support/web-portal-registration  Login https://apps.availity.com/availity/web/public.elegant.login  Use the following EDI payor IDs: • CHIP/CHIP Perinate: CCHP1 • STAR/STAR Kids: CCHP9

Electronic Fund Transfer and Remittance Advice Electronic Fund Transfer (EFT) • improved cash flow • no lost checks in the mail • reduced paperwork and expedited account reconciliations Electronic Remittance Advice (ERA) • following EFT enrollment, may elect ERA through Availity * visit Electronic Submission Services on our website

Claims Billing Tips  All Claims must include: • Rendering Provider NPI • Rendering Provider Taxonomy Code • Billing Provider NPI • Billing Provider Taxonomy Code • Supervising, Referring, and Ordering Provider NPI and Taxonomy, if applicable • Modifiers as required, such as AM, SA, and 25  Authorization dates of service and codes must match services on the claim

More Billing Tips  New and Established Patient Services • New Patient • has not received any professional services from a physician or from another physician of the same specialty who belongs to the same group practice, within the past three years • limited to one every three years, per client, per provider • Established Patient • has received professional services from a physician or from another physician of the same specialty who belongs to the same group practice, within the past three years

Value Added Services  Effective September 1, 2016 – August 31, 2017 • 24-hour Nurse Advice Line at 1-866-971-2665 • Structured Health and Wellness Program through Weight Watchers for Members suffering from obesity • Boys & Girls Club basic membership per family where available for Members age 6 through 18 • Up to $100 per program for childbirth, Lamaze and breastfeeding classes * visit Value Added Services on our website

CCHP Therapist Reviewers  Sandra Heaslet, MS, CCC-SLP sandra.heaslet@cookchildrens.org  Isabel Garcia, MS, CCC-SLP isabel.garcia@cookchildrens.org  Angie Boisselle, OTR, Ph.D. angie.boisselle@cookchildrens.org

Can You Hear (with those ears?) Hearing screenings and evaluations

Pure Tone Audiometry  Hearing screening tool that is the “Gold Standard” for hearing testing per American Audiology Association and American Speech- Language-Hearing Association  Presents the “beeps” at different frequencies (pitches) to test hearing at these levels.

Hearing Screenings CCHP follows Texas Health and Human Services Commission’s recommendation for demonstrating passing hearing : Criteria for passing: 25 dB or less at 1000, 2000, 4000 Hz in at least one ear

What if…  The child cannot participate in pure tone audiometry, we strongly suggest they be referred to a pediatric audiologist who will use all the tools at their disposal to get as much hearing information as possible. CCHP can then review the info submitted and request the Medical Director make an exception.

How to contact CCHP 682-885-2247 or 1-800-964-2247 • Christine Owens 682-885-7049 • Sylvia Carrizales 682-885-7048 • Martha Dixon 682-303-8798 • Mona Ogas 682-303-8804