ohio hospital association and  caresource  collaboration

ohio hospital association and caresource collaboration PowerPoint PPT Presentation

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Our Heartbeat . HeartbeatMaking a difference in the lives of underserved people by improving their health careVision CareSource will be an innovative national leader in the management of quality public-sector health care programs. 2. Goal: Providers as Partners. By the Numbers. Operations: Ohio And MichiganEmployees: 920 EmployeesMembership: 850,000 12 Million Medical Claims Processed97.0% Of Claims Paid Within 30 DaysMajority, Slightly More Than 2 WeeksEDI Rate 82%-National Rate 215

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1. Ohio Hospital Association and CareSource Collaboration September 15, 2010 1

2. Our Heartbeat Heartbeat Making a difference in the lives of underserved people by improving their health care Vision CareSource will be an innovative national leader in the management of quality public-sector health care programs 2 Goal: Providers as Partners

3. By the Numbers 3 Goal: Providers as Partners

4. Membership Growth 4 Goal: Providers as Partners

5. Account Receivables OHA Problem Statement: Hospitals Report Unacceptably High Levels Of Care Source AR Inconsistent With Levels Reported To ODJFS Prompt Pay Rate Computed Based On Date Received To Date Paid-MCP must pay 90% of all submitted clean claims within 30 days of the date of receipt and 99% of such claims within 90 days of the date of receipt. Provider Days In AR (DAR)-date Of Posting Charges To Date Payment Is Posted 5 Goal: Providers as Partners

6. Prompt Pay Statistics 6 Goal: Providers as Partners

7. Top 5 Denial Reasons by FacilityPeriod: 4/1/10 thru 6/30/10 7 Goal: Providers as Partners

8. Coordination of Benefits OHA Problem Statement: Lack Of Clarity Of The COB Process And Update On The Progress Of Improvements To COB Data Improvements To The Data Base And Information Available On The Caresource Provider Portal: Increase In Accuracy And Timeliness Of Coverage Term Information Contract/Policy Numbers Complete Where Available Information Being Re-verified On An Annual Basis Automatic Processing For COB Cases When Policies Are Retro Termed. Expanded Requirement By ODJFS: ODJFS Requires The MCP To Pay As Primary For Cases In Which The Member Does Not Provide Requested Other Insurance Information. Denials By The Primary Carrier For Timely Filing, Prior Authorizations, Referral From PCP 8 Goal: Providers as Partners

9. Service Improvements Provider Relations Staff Active Monitoring Of Performance Metrics For The Provider Relations Staff: E-mails & Letters Phone Calls Issue Resolution Well Defined Tools And Visit Schedules For PR Staff Creation Of Multidisciplinary Joint Operating Committees 9 Goal: Providers as Partners

10. CareSource Initiatives-2010 10 Completed Modifications To Select Claims Edits Automated Appeals Process-Claims Timely Filing-Increase to 365 Days Automatic Processing For COB Cases When Policies Are Retro Termed. Online Medical & Pricing Policies Goal: Providers as Partners

11. Open Issues Raised by OHA Review Of The Medicaid Enrollment Process: CareSource ODJFS OHA Continued Refinement of the COB Process Between The Managed Care Plans, Hospitals and ODJFS Short Stay Authorization Process Common Methodology To Measure Days In A/R 11 Goal: Providers as Partners

12. Future Considerations Electronic COB Claims Submission Via The Portal Automated Appeals Process-Medical Implement Claims Pre-Pricing Capabilities 5010 & ICD-10 Preparation Recontracting Process Care Source Fee Schedule APS Grouper for Facilities Professional Fee Schedule 12 Goal: Providers as Partners

13. Recontracting Process:Current Situation Dependent Upon The States For Fee Schedules Ohio Medicaid Fee Schedules DRG Grouper Version-15 Michigan Medicaid Fee Schedule APCs DRG Grouper Version-27 Retroactive Changes To The Fee Schedules By The States No Commercial Fee Schedule Minimal Consistency In Provider Contracts 13 Goal: Providers as Partners

14. Recontracting Process:Strategic Positions Us For Expansion And Health Care Reform Medicaid Medicare Commercial Not Dependent Upon State Medicaid Fee Schedules Easy To Support And Based On National Standards Address The Organizational Needs To Comply With National Trends On Data Capture And Reporting 5010 ICD-10 14 Goal: Providers as Partners

15. Implementation Plan: Strategy Provider Trade Associations Ohio Hospital Association Ohio State Medical Association Other Provider Associations Development Of The Discussion Tools Narrative On Reason For The Change Fee Schedule Information Provider Specific Impact Analysis Frequently Asked Questions Provider Specific Contacts Hospitals Professional Groups 15 Goal: Providers as Partners

16. Opportunities For Partnerships Orientation Sessions With OHA Sponsored By Care Source Local Office Manager Forums Hospital Advisory Council Pre-Meetings With OHA To Endorse Processes Quarterly Or Semi-Annual JOC Meetings With OHA Commitment To Performance Standards 16 Goal: Providers as Partners

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