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HP Enterprise Services Hometown Health Presentation. November 12, 2009 Partnering for Success!. Introduction/Background Project Phases Testing Approach Claim Submission Provider Assistance Questions. Agenda. History in Georgia Georgia MMIS Fiscal Agent

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HP Enterprise Services Hometown Health Presentation

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Hp enterprise services hometown health presentation

HP Enterprise Services

Hometown Health

Presentation

November 12, 2009

Partnering for Success!


Agenda

Introduction/Background

Project Phases

Testing Approach

Claim Submission

Provider Assistance

Questions

Agenda


We re excited to be back

History in Georgia

Georgia MMIS Fiscal Agent

July 1, 1987 – March 31, 2003

Georgia Immunization Registry System

May 2003 – Present

Data Broker

March 2008 – Present

We’re Excited to be Back…


Project phases

EDS System Development Life Cycle

√ Startup

√ Design

√ Development

√ System Testing

User Acceptance Testing

Implementation

Project Phases


Testing timeframes

User Acceptance Testing

December 2009 – June 2010

DCH subject matter experts will create and execute test cases designed to thoroughly test the new MMIS.

Provider Beta Testing

March 2010 – April 2010

Selected provider’s will have an opportunity to participate in testing the new MMIS solution.

Electronic Data Interchange Testing

February 2010 – May 2010

All providers who submit claims electronically will be required to submit test claims to EDS to ensure they can successfully submit claims prior to July 1, 2010.

All clearinghouses, billing services and vendors will be required to submit test claims to EDS to ensure they can successfully submit claims prior to July 1, 2010.

Testing Timeframes


Testing timeframes1

Operational Readiness Testing

March 2010 – May 2010

DCH subject matter experts will create and execute test cases designed to thoroughly all operational areas of the EDS Account.

EDS Account staff participate in Operational Readiness Testing, including:

Provider Enrollment

Member Enrollment

Call Center

Data Entry

Resolution

Electronic Data Interchange

Mailroom

Buy In

Teaming Partners

Testing Timeframes


Claim submission

Web Portal

HIPAA X12 837 Format

Electronic Data InterChange

Clearinghouses

Vendors

Billing Services

EDS Software

interChange accepts multiple media, including:

Magnetic Tape

CD

FTP

Bulletin Board via PC modem dial up

POSnet

Internet

Paper UB04

Claim Submission


Provider assistance

Web Portal

Computer Based Training

Contact Us

Claim Status

Claim Submission

Eligibility verification

Provider Enrollment

Remittance Advices

FAQ

Manuals

Workshop Locations/Data

Provider Assistance


Provider assistance1

Provider Enrollment Team

Enrolling Providers

Web Portal applications

Paper applications

Workflow

Instant identification of enrollment application in process

Automatic routing to next step in enrollment process

Provider Enrollment Assistance

Member Enrollment Team

Enrolling Members

Presumptively eligible pregnant women

Presumptively eligible newborns, including multiple births

Provider Member Enrollment Assistance

Provider Assistance


Provider assistance2

EDI Helpdesk

Web Portal Password Resets

Enrolling Providers in Electronic Claim Submission

Testing Provider and Vendors prior to Electronic Claim Submission

Assistance

EDI related questions

Transmission questions

WinASAP will no longer be accepted; providers must transition to PES or other electronic software. EDI related questions

Provider Assistance


Provider assistance3

Contact Center

Automated Voice Response

Claim Status

Check Amounts

Prior Authorization Status

Member Eligibility

Member Contact Center 1-866-211-0950

Provider Contact Center 1-800-766-4456

Written Correspondence Team

Field Representatives

11 Field Representatives – 1 Hospital Field Representative

Attend provider association meetings

Presenting training seminars to providers requesting such training

Offering on-site visits and training to providers and office billing staff

Offering on-site visits for claims resolution assistance

Billing Manuals

Provider Assistance


Field representative territories

Field Representative Territories


Provider training

Provider Training

Statewide April 2010 – June 2010

 166 Workshops Total

 28 Institutional Workshops

Ongoing training throughout life of contract

Association Meetings

Medicaid Fairs

Provider Training


Tentative april workshop schedule

Tentative April Workshop Schedule


Tentative may workshop schedule

Tentative May Workshop Schedule


Tentative june workshop schedule

Tentative June Workshop Schedule


Hp enterprise services hometown health presentation

The EDI cut off is noon each Friday.

EDS will process fee for service claims each week and continue to issue payments on a weekly basis

Each individual working for a provider must have their own password to access the web portal

Other Information


Transition items

HP Enterprise Services will mail new Member ID Cards in June 2010

HP Enterprise Services will mail Web Portal PIN letters to providers May/June 2010

Transition Items


Tentative timeframes

ACS

 Last Claims Cycle - June 25, 2010

Last day to submit electronic claims for processing -

June 25, 2010

Last day paper claims are received for processing -

June 18, 2010

 Last day to receive calls - June 30, 2010

HP Enterprise Services

 First Claims Cycle - July 2, 2010

First day to submit electronic claims for processing –

June 28, 2010

 First day paper claims are received for processing -

June 21, 2010

 First day to receive calls - July 1, 2010

Tentative Timeframes


Hp enterprise services hometown health presentation

Any questions?

[email protected]


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