Transition of Medicaid Claims Payments to SCEIS Stakeholder Outreach - - PowerPoint PPT Presentation

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Transition of Medicaid Claims Payments to SCEIS Stakeholder Outreach - - PowerPoint PPT Presentation

Nov 26, 2023 28 likes •302 views

Transition of Medicaid Claims Payments to SCEIS Stakeholder Outreach Team RMMIS Program South Carolina Department of Health and Human Services What is SCEIS? Beginning July 2019, the South Carolina Department of Health and Human Services

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Transition of Medicaid Claims Payments to SCEIS

Stakeholder Outreach Team RMMIS Program South Carolina Department of Health and Human Services

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What is SCEIS?

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  • Beginning July 2019, the South Carolina Department of Health and

Human Services (SCDHHS) will issue payment to Medicaid providers through the State of South Carolina’s consolidated accounting system – the South Carolina Enterprise Information System (SCEIS).

  • SCEIS was mandated by the South Carolina General Assembly by Act

151 of 2005.

  • SCDHHS will transition Medicaid claims payments to SCEIS July 2019.
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SCEIS Requirements 1,2,3,4 & 5

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  • 1. SCEIS requires payment be issued to a Taxpayer Identification

Number (TIN) – either a Federal Employer Identification Number (FEIN) or a Social Security Number (SSN).

  • 2. TINs can only be entered into SCEIS once.
  • 3. SCEIS also requires that payment be issued to a single bank account

per TIN.

  • 4. SCEIS assigns each TIN a SCEIS Vendor Number.
  • 5. SCEIS also require IRS validation by participating in the Federal

Agency TIN Matching Program, which matches TINs to the name that’s on file with the IRS.

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  • SCEIS requires payment be issued to a Taxpayer Identification Number (TIN) – either a

Federal Employer Identification Number (FEIN) or a Social Security Number (SSN).

  • Group providers with multiple NPIs or Medicaid Provider Numbers must designate one of

their NPIs/Medicaid Provider Numbers to receive payment from SCEIS. Providers’ internal financial business decision makers are responsible for making this decision.

  • The bank account on file for that selected NPI/Medicaid Provider Number will receive

payments for all the NPIs/Medicaid Provider Numbers who share the same TIN.

  • Each TIN will have 1 SCEIS vendor number assigned to it.

Note: Individual and sole proprietor providers with 1 TIN, 1 NPI, 1 Medicaid Provider Number, and 1 bank account, were not affected by the transition of Medicaid claims payments to SCEIS.

SCEIS Requirements 1,2,3 & 4

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Designation of an NPI/Medicaid Provider Number Combination for Payment

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SCEIS Requirement 5

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  • Providers’ taxpayer identification numbers (either FEIN or SSN) and

name must be validated with the Internal Revenue Service (IRS) prior to SCDHHS issuing Medicaid claims payment.

  • If providers’ information fails IRS validation, providers are

responsible for obtaining a confirmation letter from the IRS and providing this information to Provider Enrollment to correct the mismatch. IRS Validation and the 901 Edit

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SCEIS Requirement 5

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Providers’ taxpayer identification numbers (either FEIN or SSN) and name must be validated with the Internal Revenue Service’s (IRS) prior to SCDHHS issuing Medicaid claims payment. If providers’ information fails IRS validation, providers are responsible for obtaining a confirmation letter from the IRS and providing this information to Provider Enrollment to correct the mismatch. Providers can request a confirmation letter by calling the IRS business & specialty tax line at 800-829-4933, 7a.m.-10.pm., Monday-Friday. Please submit the IRS confirmation letter to Provider Enrollment with a subject line

  • f “IRS Confirmation Letter” by scanning/emailing it to Medicaid.Pets@bcbssc.com
  • r by fax at 803-264-5913. For questions or assistance, please call the Provider

Service Center at 888-289-0709.

What if a provider receives a 901 Edit because of IRS validation failure?

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  • SCEIS does not affect how providers submit claims to SCDHHS today.
  • The Medicaid system will continue to adjudicate claims as they are

processed today.

  • There is no change to the logic used to calculate Medicaid claims

payment.

  • There is no change to how providers access their remittance advices

today.

Some important things about SCEIS

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  • Providers’ TINs are automatically uploaded to SCEIS and assigned a SCEIS vendor
  • number. The SCEIS vendor number will be on the remittance advice, the new

Medicaid Claims Payment Summary Report, and a few other documents in slides 9-24.

  • When providers enroll new NPIs/Medicaid Provider Numbers, the system will

check the Medicaid system to see if the TIN already exists. If it does, it will subordinate it to the record designated by the provider to receive payment. If it does not, it will designate that TIN and NPI/Medicaid Provider Number as the one to receive payment.

  • Providers will not interact directly with SCEIS; they will continue to engage directly

with SCDHHS about anything and everything Medicaid. The Medicaid system interfaces directly with SCEIS about the translation of Medicaid claims payments.

Some more important things about SCEIS

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  • Compliance with the SCDHHS EFT Policy has been required for enrollment since
  • Dec. 2, 2012, in order to continue receiving payment for services provided to

Health Connections Medicaid beneficiaries.

  • Providers who do not have an EFT on file at SCDHHS, will be considered for

administrative action, up to – and including – termination.

  • Providers affected by subsequent termination of enrollment, who wish to continue

providing services to Healthy Connections Medicaid beneficiaries, will be required to re-enroll with Medicaid by visiting https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/.

  • Providers can fill out and fax the EFT form to the Provider Service Center at 803-

870-9022.

EFT Compliance

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  • 1. Transition to Bank of America
  • 2. New report – Medicaid Claims Payment Summary
  • 3. Changes to Important Documents
  • 4. Changes to the Remittance Advice
  • 5. New ACH and Check Format

Changes with the Transition of Medicaid Claims Payments to SCEIS

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  • In July 2019, electronic Medicaid claims payments will be issued to

providers through Bank of America.

  • BOA will transmit providers’ payment information to their financial

institutions in accordance with National Automated Clearing House Association’s guidelines and with the Centers of Medicare and Medicaid (CMS) requirements.

Change 1: Transition to Bank of America

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  • The provider selected by their NPI/Medicaid Provider Number

designated by group providers’ financial business decision makers to receive Medicaid claims payment, will also have access to an additional report on the SC Medicaid Portal.

  • This report is called the Medicaid Claims Payment Summary Report.
  • It summarizes all the Medicaid claims information per payment cycle

per providers’ TINs.

  • This will be delineated by providers’ NPIs or Medicaid Provider

Numbers.

Change 2: New Report - Medicaid Claims Payment Summary Report

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Example of the Medicaid Claims Payment Summary

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Change 3: Changes to Important Documents

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Changes to the 835

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Examples of the changes to 835s

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  • The EDI 820 transaction set establishes the format and content of the Payment

Order/Remittance Advice File used for transmitting information electronically relating to payments.

  • With the transition of payments of Medicaid claims to the South Carolina

Enterprise Information System (SCEIS), there are no changes to the format of this file, but the content of data elements 01 and 02 of the TRN Segment will be changing.

  • In addition, a modification to the ADX segment is being made to correct an

existing issue with the content being provided in that segment.

Change 3: Changes to Important Documents

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Changes to the 820

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Change 3: Changes to Important Documents

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Changes to the 820

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Examples of the changes to 820s

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Two New Fields Added to the Header of the Provider Remittance Advice

  • With the transition of the payments for Medicaid claims to the South

Carolina Enterprise Information System (SCEIS), two new fields have been added to the Provider Remittance Advice to reference vendor and payment information from SCEIS and also to provide information that may be needed by providers to account for and to research issues related to the payment of their Medicaid claims.

Change 4: Changes to the Remittance Advice

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Change 4: Changes to the Remittance Advice

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Change 5: New ACH and Check Format

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Change 4: Changes to the Remittance Advice

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Change 5: New ACH and Check Format

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  • SCDHHS’ SCEIS Information Webpage:
  • https://vip.scdhhs.gov/sceis
  • SCDHHS’ Provider Service Center:
  • 888-289-0709
  • https://www.scdhhs.gov/webform/contact-provider-representative
  • Hours: Monday-Thursday 7:30 a.m.-5 p.m. and Friday 8:30 a.m.-5 p.m.
  • IRS:
  • 800-829-4933
  • https://www.irs.gov/businesses/telephone-assistance-contacts-for-business-

customers

Important Resources

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