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Provider Billing Discussion

Provider Billing Discussion. Overview of Recent Changes. 5010 Updates TennCare – Direct Payments Detailed Billing Increased Claims Frequency. Monthly Billing VS. Bi-Weekly Billing.

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Provider Billing Discussion

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  1. Provider Billing Discussion

  2. Overview of Recent Changes 5010 Updates TennCare – Direct Payments Detailed Billing Increased Claims Frequency

  3. Monthly Billing VS. Bi-Weekly Billing In the past, DIDD has always operated on a single monthly billing cycle. Providers now have the flexibility to determine how frequently they submit their billing. Provider Claims Processing (PCP) system open all month long. DIDD sweeps claim submissions on a bi-weekly schedule. TennCare processes and pays claims in the following week. Providers that wish to continue billing on a monthly cycle are only required to submit billing once per month. Providers that wish to bill more frequently can submit billing as often as they choose.

  4. Payment & Processing Schedule

  5. Billing Issues • Loss of Mid-Month Payment Process • Remittance Advice issues • Paper Remittances • Reconciliation between TennCare RA and DIDD reports • Data discrepancies • Volume of report data • Voided Cost Plans • System Performance Issues • Reports and Views within PCP

  6. Recent Enhancements • Adjudicated Claims Report (ACR) • NOTE: TennCare’s Paper Remittance is still the document of record. DIDD’s ACR report should reconcile to the paper remittance on a claim by claim level; however, the paper remittance may contain records that did not originate from DIDD and will not be included in DIDD’s ACR report. • Provider Late Billing and Adjustments Data Entry • Enhancements to PCP to allow for period specific views • Online Training Documentation : http://www.tn.gov/didd/web_applicaions/pcpi/PCP%20Training%20Manual.pdf

  7. Future Enhancements • ACR Reports: DIDD to send ACR to providers via secure email within three business days of payment. • Visual Indicators in PCP • Sweep Date Indicator – to show when/if a claim has been swept by DIDD for processing. • Payment Status Indicator – to show current claim status • Additional Reporting Features • Individual Claim History Report • Payment Summary Report (Period Specific) • Adjustment Report • General Improvements • Enhancements to address system performance • Continuing efforts to resolve system errors and consistency of data

  8. Project Titan • Project Overview and History • Goals & Objectives • Establish the necessary infrastructure and common framework needed to support a single integrated application system; • Ensure access and interoperability between DIDD and Providers’ computer information systems; • Deploy the first modules of the new application, which will replace DIDD’s current financial applications (CS Tracking, Provider Claims Processing, and PTABS) and the Incident & Investigations system, and establish an electronic Individual Support Plan. • Current Project Status & Estimated Timeline • Impact to Providers

  9. Questions? Any additional comments or feedback can be directed to the DIDD Business Services staff at: DIDD_Monthly.PRA@tn.gov

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