Download HomeTown Health Webinar 09082010

HP Enterprise Services
HomeTown Health Presentation
September 9, 2010
Partnering for Success!
BETA Testing and Workshops
Provider Beta Testing
August 16 – August 20
August 30 – September 3
Tucker
Cordele
Feedback from Participants?
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
Web Portal PIN Letters
• Each current Georgia Medicaid provider will receive a Georgia
Health Partnership Web Portal registration information letter,
mailed last week, indicating their login and temporary password.
• The Georgia Health Partnership Web Portal registration
information letter will be sent to the “mail to” address on file.
• Each provider must create a username and password prior to
accessing the Georgia Health Partnership Web Portal for any
claims related functionality available via the secure area of the
Georgia Health Partnership Web Portal.
• Web Portal User Account Management Guide
• Provider Change of Information Form available on readiness
website.
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
Provider Assistance
EDI Helpdesk
EDI Services Phone Number
Available after September 1, 2010
770-325-9590 or toll free 1 877-261-8785
EDI Email Address:
[email protected]
EDI PES CBT will be on readiness website by end of week
PES software will be available on readiness website on October
1, 2010
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
Claims with Two Precerts
• The new MMIS will not allow for two prior authorizations to
be submitted on the same claim. However there are
changes associated with the submission of these claims.
• DCH and GMCF have added an additional prior
authorization code ZT for Physical Therapy, Speech Therapy
and Occupational Therapy. ZD is the prior authorization
code for Drug Therapy.
• Providers must use the condition code GO ‘distinct medical
visit on same day’ (FL 18-28) on both claims. The new
MMIS has been designed to recognize the GO condition
code and will not deny the second claim as a duplicate of
the first claim. The appropriate PA is placed in FL 63
Treatment Authorization Codes.
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HP Enterprise Services
Transition Information
Billing Manuals will be available via the
web portal. The current billing
information contained in the DCH
Part I Policy and Procedures Manual
will be removed.
The UB-04 Billing Manual is on the
readiness website for review.
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Institutional
Institutional Header (NEW)
• Release of Information values removed, leaving I
(Informed Consent) and Y (Yes) as the only values per
5010.
• Admission Type will be required for all Institutional claim
types.
• Admit Source will be required on all IP and OP claims.
• Patient Status will be required for all Institutional claims
types.
• Remove Covered and Non Covered Days fields from the
header. This will be sent through the value panel only.
Value 80 (Covered Days) Value 81 (Non Covered Days)
• Other Physician 2 will be removed.
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HP Enterprise Services
5010 and Web Portal-Institutional
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Institutional
Institutional Diagnosis Changes
• Increasing the allowance of E-Codes to be sent to 12.
• Increasing the allowance of Patients Reason for Visit to be
sent to 3.
• Patient Reason for Visit will be required on an OP claim.
New error message "Patient's Reason for Visit is Required
for Outpatient" (STILL IN DISCUSSION WITH EDI)
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Institutional
Institutional Detail (NEW)
• Accommodation Rate removed.
• Drug Unit Count and Drug Unit of Measure fields being
added.
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Professional
Professional Header (NEW)
• Related Cause Code 3 Removed.
• Release of Information values removed, leaving I
(Informed Consent) and Y (Yes) as the only values.
• Accident Date will be required if Related Cause Code = AA
(Auto Accident) or OA (Other Accident).
• Accident State will be required if Related Cause Code = AA
(Auto Accident).
• Related Cause Code will be required if Accident State or
Accident Date are entered.
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Professional
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Professional
Professional Detail (NEW)
• Medicare Allowed Amount field removed. This value
is being pre-calculated by the system.
• Drug Unit Count and Drug Unit of Measure fields are
being added.
• Diagnosis Pointer values changed from 1-8 to 1-12.
5010 will now allow up to 12 diagnosis codes on
professional.
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Professional
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-Professional
Member Professional Detail (NEW)
• Medicare Allowed Amount field removed. This value is
being pre-calculated by the MMIS. Value cannot be
displayed that isn’t permitted by HIPAA.
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-All Claim Types
Other Payer Header - all claim types (NEW)
•
Date of Birth, Gender and Allowed Amount removed. Allowed
Amount is pre-calculated by the MMIS.
•
Insurance Type Code removed from Institutional. Values are
changing.
•
Payer Responsibility with 5010 will allow more values. For 4010,
we display Primary, Secondary, Tertiary. 5010 expands that to
fourth, fifth, sixth, etc.
•
Group or Policy Number is becoming an optional field.
•
Insurance Company Name is becoming an optional field.
•
Relationship and Claim Filing values changing.
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-All Claim Types
Institutional
Professional
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services
5010 and Web Portal-All Claim Types
Member Other Payer Header - all claim types (OLD)
Member Other Payer Header - all claim types (NEW)
Medicare Allowed Amount field removed. This value is being pre-calculated by
the MMIS. A Value cannot be displayed that isn’t permitted by HIPAA.
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HP Enterprise Services
Any questions?
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/ Georgia MMIS Presentation September 2010
HP Enterprise Services