Welcome! Medicaid Operations Conversion Go-Live: August 1 , 2 0 1 5 - PDF document

6/5/2015 Better Health | Better Care | Better Cost Medicaid Operations Conversion Provider W orkshop PR3170_Plan Approved 06032015 2015 Medicaid Conversion Welcome! Medicaid Operations Conversion Go-Live: August 1 , 2 0 1 5 2015 Medicaid Conversion 1

6/5/2015 Agenda 1 New member ID card 2 Claim submission 3 Sterilization and Hysterectomy Process 4 Explanation of Payment/ 835/ EFT 5 PCP Change Form 6 LineFinder tool 7 InTouch for Providers 8 Referrals and preapprovals 9 PCP Capitation Rules [ YYYY Presentation Name] New Member ID Card 2015 Medicaid Conversion 2

6/5/2015 New Member ID Card Issuing Dates • Members eligible as of July 1, 2015 will be mailed an old ID card on July 7, 2015. • Members who enroll after July 1 st may have a delay in receiving their new member ID card. – During this time, providers should use the member’s Medicaid ID to verify eligibility. • ALL members will be issued there new ID cards on or around July 17 th . 2015 Medicaid Conversion New Member ID Card New Information • The new ID cards will include: – OHP issued enrollee ID number – New PacificSource member ID number (begin with an “8” and are nine numerical digits in length) – Primary care provider (PCP) name – Dental plan – Pharmacy information – Customer Service contact information – Electronic claims payor ID number 2015 Medicaid Conversion 3

6/5/2015 New Member ID Card Sample ID card Front Back 2015 Medicaid Conversion Claim Submission 2015 Medicaid Conversion 4

6/5/2015 Claim Submission Electronic claims New electronic claim s payor I D: 2 0 4 1 6 • New affiliated clearinghouses include: – Affiliated Network Services; Emdeon; Trizetto Provider Solutions; HeW (Health E-Web); MCPS; Office Ally; Payer Connection; RelayHealth • Begin using new payor ID on July 1 0 , 2 0 1 5 – DO NOT USE PRI OR TO THI S DATE – Claims submitted to an old payor ID after November 1, 2015 will be rejected. • Claims will be accepted with either member ID number (OHP assigned/ PacificSource assigned) 2015 Medicaid Conversion Claim Submission Paper claims (UB-04/CMS 1500) New paper claim s m ailing address: PacificSource Community Solutions, Inc. PO Box 7068 Springfield, OR 97475-0068 • Begin submitting paper claims to this address on July 1 0 , 2 0 1 5 . – Paper claims submitted to the old address after November 1, 2015 will be returned. 2015 Medicaid Conversion 5

6/5/2015 Claim Submission Other important dates • 7 / 1 0 / 1 5 – Claims received via new payor ID or new claims address will be held. • 7 / 2 0 / 1 5 – Held and transferred claims will load into Facets. • 7 / 2 8 / 1 5 – Last check run by PH Tech. • 8 / 9 / 1 5 – First check run in Facets. 2015 Medicaid Conversion Claim Submission Secondary Claims • If PacificSource Medicare/ commercial is prime: – Claim will crossover automatically in Facets. – Do not submit a secondary claim. • If submitted, the claim will deny as a duplicate. • When any other payor is prime: – Claims accepted electronically or via paper. – If submitting paper, include primary EOB. 2015 Medicaid Conversion 6

6/5/2015 Claim Submission Corrected Claims • Institutional claims (UB-04) can be submitted electronically with bill type indicating claim is corrected (xxx7). • Professional claims (CMS 1500) must be submitted via paper with corrected claim form attached. – Begin using the corrected claim form on July 1 0 , 2 0 1 5 . – The corrected claim form can be found on our website at CommunitySolutions.PacificSource.com/ Providers/ Docu mentsAndForms. • All claims reprocessing will occur in Facets, regardless if it originally processed through CIM. 2015 Medicaid Conversion Sterilization/Hysterectomy Process 2015 Medicaid Conversion 7

6/5/2015 Sterilization/ Hysterectomy Process Reminder • PacificSource Community Solutions requires the completion of the appropriate consent forms: – DMAP Consent to Sterilization form (DMAP 742) for all sterilizations. – DMAP Hysterectomy Consent form (DMAP 741) prior to surgery. • For more details and instructions, please review our Medicaid Provider Manual. 2015 Medicaid Conversion Sterilization/ Hysterectomy Process Reminder • Access the manual on our website at CommunitySolutions.PacificSource.com/ Prov iders/ DocumentsAndForms. • Submit the completed consent form to PacificSource Community Solutions prior to billing or attached to the claim. • Incomplete forms will result in claim denial. 2015 Medicaid Conversion 8

6/5/2015 Explanation of Payment 835 and EFT 2015 Medicaid Conversion Explanation of Payment Sample EOP 2015 Medicaid Conversion 9

6/5/2015 Payment History Accessing historical claims data • To access historical claims payment information previously available through CIM, please contact Customer Service. • Customer Service can answer questions regarding claim detail and/ or provide a copy of the payment voucher. • Historical claims data will not be accessible through InTouch. • CIM will be turned off August 1, 2015 2015 Medicaid Conversion 835 and EFT Electronic remittance file and funds transfer • If you currently receive 835/ EFT from PacificSource for other lines of business, you will automatically be enrolled for the Medicaid line of business. • To sign up for 835/ EFT: – Complete the enrollment form and return it to Provider Network. – Takes approximately two weeks to process. 2015 Medicaid Conversion 10

6/5/2015 PCP Change Request 2015 Medicaid Conversion PCP Change Request New Form • Providers can continue to submit a PCP Change Request on a member’s behalf. • Beginning July 2 7 , 2 0 1 5 submit requests via fax or email, not through CIM. – Complete the PCP Change Request form available (July 24 th ) on our website at CommunitySolutions.PacificSource.com/ Providers/ Docu mentsAndForms. – Obtain member signature. – Fax or email the form to Customer Service. 2015 Medicaid Conversion 11

6/5/2015 LineFinder T ool 2015 Medicaid Conversion LineFinder Tool • New LineFinder tool is available now • Go to Intouch.PacificSource.com/ LineFinder/ 2015 Medicaid Conversion 12

6/5/2015 LineFinder Tool Instructions 2015 Medicaid Conversion LineFinder Tool Instructions Search results appear 2015 Medicaid Conversion 13

6/5/2015 LineFinder Tool Instructions Expand the line details 2015 Medicaid Conversion Prioritized List To access the current prioritized list go to: Intouch.PacificSource.com/ LineFinder/ 2015 Medicaid Conversion 14

6/5/2015 InT ouch for Providers 2015 Medicaid Conversion InTouch for Providers Secure online provider portal I nTouch – Replacing CI M • Use InTouch to: – Verify member eligibility and PCP – View member benefits – View and submit referral/ preapproval requests (medical, behavioral health, and pharmacy) – Check claim status – View/ print your Explanation of Payment (EOP) • CIM will be turned off August 1, 2015 2015 Medicaid Conversion 15

6/5/2015 InTouch for Providers Secure online provider portal • Providers can access InTouch through OneHealthPort. – Web portal that provides access to secure health plan websites with a single user ID and password. • If you are already a OneHealthPort user, you do not need to register again to access InTouch. • To register for OneHealthPort access, go to www.OneHealthPort.com/ content/ registration- overview. • Your clinic will need to assign an administrator to manage multiple user log-in’s. – Administrator registration can take up to 72 hours from completion of application. 2015 Medicaid Conversion InTouch for Providers Secure online provider portal Access InTouch log-in through our website at CommunitySolutions.PacificSource.com/ Providers 2015 Medicaid Conversion 16

6/5/2015 Referrals and Preapprovals Referrals and Preapprovals • There are no changes to the current guidelines for referrals/ preapprovals. • We will continue to allow subreferral authority. • Authorizations for advanced imaging services should be subm itted through I nTouch . – AIM will not be used for Medicaid. 2015 Medicaid Conversion 17

6/5/2015 Referrals and Preapprovals • Referrals and preapprovals will not be accepted in CIM after July 24, 2015. • Online submissions will not be accepted July 25 th - 26 th in InTouch due to system load. Options for submitting requests during this time include: – Hold request submission until July 27 th . – Submit hardcopy request form via fax to (541) 382-6898. • Forms can be found on our website at CommunitySolutions.PacificSource.com/ Providers/ Documen tsAndForms 2015 Medicaid Conversion Referrals and Preapprovals • Historical referral and preapproval data will be loaded into InTouch from CIM and accessible to view on July 27, 2015. – Each one transferred will receive a new InTouch reference number. – You can search by CIM reference number or newly assigned InTouch reference number. • New online submissions must be submitted through InTouch beginning July 2 7 , 2 0 1 5 . 2015 Medicaid Conversion 18