HP Enterprise Services Hometown Health Presentation November 16, 2010 Partnering for Success!
Mar 18, 2016
HP Enterprise Services
Hometown Health Presentation
November 16, 2010Partnering for Success!
2 / Georgia MMIS Presentation November 2010 HP Enterprise Services
Agenda
Web Portal
Claims Processing
Provider Assistance
PO Boxes
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Web Portal Web Portal Address
www.mmis.georgia.gov
Unable to access: Make sure you have entered the above address ACS is no longer rerouting to the new web portal Close all browsers and then try again
Web Portal Navigational CBT Provider Information>>Web Portal Training
Provider Web Portal Navigational Guide Provider Information>>Provider Manuals
Web Portal User Account Management Guide Provider Information>>Provider Manuals
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EDI Helpdesk EDI Services Phone Number
770-325-9590 or toll free 1 877-261-8785
EDI Email Address: [email protected]
HP staff may begin sending web portal PIN letters via email. The email address to send the PIN request is above. When requesting a PIN via email, the following information must be included:
• Individual providers: Provider name and ID, location address, date of birth and SSN
• Facility providers: Provider name and ID, and tax ID
Indicate on subject line PIN REQUEST Because of the sensitive information being sent, the email should be
encrypted (secure email).
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835 and 277U TransactionsHP Enterprise Services is sending 835 and 277U transactions
to the Provider Payee ID.
For any Provider that is receiving their 835 and/or 277U transactions through a Trading Partner (i.e. Clearing House, Billing Agent etc), those Providers must:
1. Activate the PIN based on the letter received for the Payee
Provider ID.
2. Log into the account and delegate the Trading Partner expected to receive the 835 and/or 277U for that Payee Provider ID.
After the weekly cycle is complete, EDI will automatically route the 835 and/or 277U to the TP that was delegated.
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835 Crosswalk
• The EOB / Adjustment Reason / Remark Codes crosswalk has been loaded for HIPAA transactions. The information is located on the web portal
Provider Information>>Provider Notices
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Remittance Advices• At this point HP Enterprise Services has loaded all of the Remittance
Advices (RA) that were provided by the previous Fiscal Agent. HP Enterprise Services does not anticipate getting any additional RAs.
Providers can obtain claim status information through the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov.
NOTE: Please be aware that if the RA image is not present on GAMMIS then it was not received from the previous Fiscal Agent.
• Recommend for ACS last cycle using a range of dates on panel to pull the RA from web portal. Recommend span of Friday to Monday.
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Paper RAsIn cooperation with the Department of Community Health
(DCH), HP Enterprise Services will no longer provide a paper Provider Remittance Advices (RA).In order to obtain your RA, Providers can log into the secure web portal Georgia Medicaid Management Information System (GAMMIS) https://www.mmis.georgia.gov with your payee identification number and follow the steps below:
1. Click on Reports2. Then click on Financial Reports3. Click on the drop-down tab and select Remittance Advice 4. Enter the From Date and To Date5. Click Search
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Payments AmountsWhere do providers find payments not the RA just
payment amounts?
This is the payment summary page that used to be on the GHP site but was never a requirement or request to add on the new site until it was mentioned during the BETA session. Post go live recommendation from BETA.
IVRS• The previous Interactive Voice Response System (IVRS) with
Affiliated Computer Services (ACS), required Healthcare providers to enter their Rendering Identification Number to check the status of their weekly payment check. The new HP Enterprise Services IVRS requires Healthcare providers to enter their Payee Identification Number to gain access to their weekly payment check status.
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Web Portal Procedure SearchIn the GHP portal it indicated if a CPT/HCPCS was covered or non-
covered. Where is this located on the HP portal?
The Procedure Code Search panel allows providers and billing agents to perform searches for procedure code information in relation to Georgia Medicaid.
The Categories of Service panel allows providers and billing agents to view detailed restrictions for the procedure code based on the search criteria entered on the procedure code search panel. An exact match must be identified before displaying results on the panel. The detailed information includes restrictions based on a provider's category of service.
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Claim Search
• Should claims that have been billed show up in the web portal? We are unable to see the claims.
Navigational Path: Claims - Search (Void, Adjust)
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Web Portal_Password Resets
• Challenge Question• EDI Helpdesk
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Provider Enrollment
• Applications pending at close of ACS• Questions about enrollment
– Contact Us_Secure portal– Phone Call; select enrollment option
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Web Portal_Claims
Case Sensitivity for Web claim Submissions
• Due to case sensitive issues, HP Enterprise Services recently became aware of some Provider web portal claim denials. When entering an online claim, Providers must be aware of how a Members name is entered into the Georgia Medicaid Management Information System (GAMMIS).
In order to avoid denial of the claim, capitalization of Members names must appear in the same format as the name on file with HP Enterprise Services. If Providers have any questions about the correct capitalization of a Members name, please visit the eligibility section on GAMMIS https://www.mmis.georgia.gov. HP Enterprise Services is currently working to resolve the issue.
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Claim POA• Edit 4754 Present on Admission
(POA)– Edits inactivated Friday 11/12– Claims Scheduled for Reprocessing
11/19
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Inpatient Claim Revenue Codes
• Add revenue codes 110, 120, 130, 140, 150, 170– Corrected– Claims Scheduled for Reprocessing
11/19
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DRG Information
• Providers need to know the calculated DRG to know if a claim has been denied erroneously.
• Currently the remits are only showing the DRG assigned if the claim is in a paid status. – TBD
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Billing Change_Swingbed
• A Level 1 PASSAR screening must be completed prior to a patient being admitted to Swing Bed. The information will be entered as a prior authorization. DCH will begin editing this information on January 01, 2011.
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ACS Denied Claims_Last Cycle• Legacy edit 9856
– HP will convert these claims and begin reprocessing cycle dated 11/20
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Provider Assistance• Contact Center
– Busy Phones• Getting assistance on basic calls from other
accounts• Adding additional staff on temporary basis• Option to call other phone number for
eligibility information– 877-843-9024 – 800-766-4456
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Member Related Data
• Member ID Cards– If members have not received their new ID
card they can contact either of the numbers to request a reissue.
• PMP Assignment– If hospital authority is showing as some
patients PMP on the web portal, you can request the member to contact HP to select a new PMP.
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Post Office BoxesACS
Current POST OFFICE BOXES
HP Enterprise ServicesFuture
POST OFFICE BOXES
Member Correspondence PO Box 3000
Member & Provider CorrespondencePO Box 105200Tucker, GA 30085
Provider Enrollment PO Box 4000
Provider Enrollment & EDI ServicesPO Box 105201Tucker, GA 30085
Claims PO Box 5000
CMS 1500 Claims PO Box 105202Tucker, GA 30085
Crossover ClaimsPO Box 105203Tucker, GA 30085
UB04 Claims PO Box 105204 Tucker, GA 30085
Adjustments & Voids PO Box 105206Tucker, GA 30085
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Post Office Boxes continued
ACSCurrent
POST OFFICE BOXES
HP Enterprise ServicesFuture
POST OFFICE BOXESSpecial Projects PO Box 6000 No Corresponding PO BoxNurse Aid Registrations & PAs
PO Box 7000No Corresponding PO Box
Returned Mail PO Box 9000 No Corresponding PO Box
Finance PO Box 888386
TPL/ Finance/ Buy-in PO Box 105207Tucker, GA 30085
Retro Claims/Certified Mail PO Box 888347
Special Handling Documents Part B Claims & OutliersPO Box 105208Tucker, GA 30085
Non-Claim (miscellaneous) DocumentsPO Box 105209Tucker, GA 30085
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Medicare Part B Inpatient Only Claims• Medicare EOB attached and should
not be handled like regular claims therefore PO Box to send these claims is Special Handling Documents
• PO Box 105208Tucker, GA 30085
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Any questions?