1 2 new 10 digit provider id -provider id/service location 123456789a fewer user id numbers today:...
TRANSCRIPT
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2
New 10 digit Provider ID
- Provider ID/Service Location
123456789A
Fewer User ID Numbers
Today: IDs for MMIS, PCSS, APAS, REVS
Tomorrow: NewMMIS: 1 User ID and 1 Password
Key Concepts - Provider
3
Industry Standards
Claim Level Processing - NewMMIS Adjudicate Multi-line Claims as a Single Claim with Multiple Lines: Consistent With Other Major Payers
Real-Time Processing of DDE Claims
NewMMIS Will Utilize the Standard UB-04 and CMS-1500 Claim Forms
Key Concepts - Provider
4
Industry Standards
Ability to “Copy” a Claim Will Be Preserved
NewMMIS Replaces 12-digit TCN with
13-digit ICN (Interchange Control Number)
ICN Format: RR YY JJJ BBB SSS Julian Day Batch SequenceRegion Year
Key Concepts - Provider
5
Electronic Attachments
NewMMIS Replaces Claims Attachment Form (CAF)
Providers can Submit Electronic Attachments with DDE Submissions for PA, PAS, Referrals, Claims, Provider Enrollment, MMQ, SCO/PACE enrollments etc.
Key Concepts - Provider
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Service Authorization Numbers
Service Authorizations Will Now Be Identified by
a 10-character Number: S 07124 0014
1st Character: ‘R’ for Referral, ‘P’ for Prior Authorization ‘S’ for Pre-Admission Screening
1st Character Julian DateUnique Sequential
Number
Key Concepts
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2.0 Access Provider On-Line Service Center
Five Steps in the Provider Scenario
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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A Provider’s Scenario
• How a Provider, Harriet Potter, gets enrolled in MassHealth, submits request for services and submits claims for payment
• How Dr. Potter will access a variety of functions through the NewMMIS Provider on-Line Service Center
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
9
Start an Enrollment Application 2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
10
Continue an Enrollment Application
Certification Provider Relationships
Hospital Affiliation Billing Intermediary
Trading Partner Agreement Background Info
Attachments Summary
Confirmation
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
The Provider ContinuesTo Complete the Application:
Service Locations Address Type
Identification Info Medicare Info Personal Info Specialty Info License Info
5.0 Receive Payment for
Services Rendered
11
Provider Application Workflow
NewMMIS
ProviderApplications
ProviderSubmits
DDE App
As the Provider begins an Enrollment Application, NewMMIS will present specific panels
depending upon the Provider Type Legal Entity, Managed Care or Group details.
An Application Tracking Number (ATN) is generated to
the provider to log onto the Web Portal and save or submit an existing application.
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
12
Provider Application Workflow
NewMMIS
ProviderApplications
Workflow
Workflow
ProviderSubmits
DDE App
Review App
CSTEnters
Application
ProviderSubmits
Paper App
Approve Application
&Generate ID
Notify Providers
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
13
“Search for Active Therapists (192) in Boston?” ………… no problem!
Search by Provider ID
or Legacy ID
or NPI
Search by Provider
Type
Address Type
RemittanceInformationDBABillingCheck Mailing
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Provider Information Panel
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Section 1: Details don’t change with aMulti-Location Provider
Sections 2 & 3 Service Location etc. when a Different Service Location is Chosen From the Drop Down Menu
A - Warren A. Thomas
B- Michael B. Thomas
C- Michael C. Douglas
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Provider Maintenance 2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
16
Provider Maintenance 2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Provider Preferences
Check Mailing
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Provider – Check Mailing Address 2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Key Concepts – Provider
Enter data directly and modify individual transactions (i.e. claims submission, eligibility verification, MMQ, Prior Authorization, Pre-Admission Screening, and Referrals).
View your notifications, contracts, reports, metrics, and financial data. Download most MassHealth forms and publications.
The Provider Online Service Center gives you the tools to effectively manage your business with MassHealth electronically. Use these services to enroll as a MassHealth provider. Manage your profile information and submit and retrieve transactions.
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Verify Member Eligibility
POTTER, HARRIET MD
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Verify Eligibility – Member Info
Bailey, Mary011 11 1111
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Verify Member - Eligibility Panel 2.0 Access
Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Verify Member –
Eligibility Restrictions 2.0 Access
Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Submit A Pre-Admission Screening
Dr. Potter Submits a
PAS for George Bailey
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Submit A Pre-Admission Screening
Drop Down to Select PAS AssignmentDropdown to
Select Dr. Potter’s Choices
Potter Harriet MD
Search Button to Find Facility or
Attending Physician
Bedford Falls Rehab Hospital
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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10000555555
Search Button to Find Diagnosis
Code
Length of Stay in Days
7871 = Heartburn
Submit A Pre-Admission Screening
Request has been saved with this PAS# S08000000BS08000000B
Save & System Returns PAS #
After Edits
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Adding a Line Item:
RequestedLevel of Care
& Admission
Type to PAS
PAS 2.0 Access
Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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PAS Confirmation
Bedford Falls Rehab
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Update a Pre-Admission Screening
S08000000B
S08000000B 100023924251 Bailey, George 01/30/08
Entering PAS Number
Produces Link to PAS Base
Information
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
30
Update a Pre-Admission Screening 2.0 Access
Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Update Pre-Admission Screening
Bedford Falls Rehab
George Bailey
Harriet Potter, MD
Modify Reopens Modify Reopens the the PAS Base
Information Panel for Changes
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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PAS Flow
NewMMIS
TransactionAssignment
SubmitsPAS Workflow
MassPRO
PAS Unit
Approved Denied
Modified
Approved Denied Modified
Notification
Notification
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Submit Prior Authorization 2.0 Access
Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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PA – Enter Base Information
100023924251
POTTER, HARRIET MD
7871
DIAGON ALLEY CLINIC AND EMPORIUMTEST
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
35
PA – Enter Line Items 2.0 Access
Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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PA – Line Items – Basic Medical Details
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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PA – Submit for Confirmation
Request has been saved with this Tracking# 103,401,225
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Enter PA Request - Confirmation
Request has been saved with this Tracking# 103,401,225
You are about to submit a Prior Authorization request for Member 1234443212 for the following procedures. Please verify the data and the click “Submit”.
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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PA Flow
NewMMIS
TransactionAssignment
SubmitsPA’s
Workflow
PAUnit
Approved, Denied, ModifiedNotification
Workflow
PAUnit
PAUnit
Workflow
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
40
Submit A Referral for George Bailey 2.0 Access
Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
41
Submit A Referral for Harry Bailey
POTTER, HARRIET MD
BEDFORD FALLS PSYCHIATRY
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
42
Referral Confirmation
George Bailey
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
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Inquire About a Referral – 3 Ways
1. Inquire by the Referral
Number:e.g.
R08035001F
2. Search for Referrals
Submitted to Bedford Falls
Psychiatry3. Search for
Referrals Submitted by Bedford Falls
Psychiatry to Another Provider
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
44
Referral Information – Update
Potter, HarrietBedford Falls Psychiatry
BaileyGeorge Male
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
45
Submit A Claim – Billing & Services
011000001111 – Bedford Falls PsychiatryDropdown of
Billing Provider ID Numbers
Member Member InfoInfo
COB AttachmentsProcedure ConfirmationBilling and Service
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
46
Service Service InformationInformation
Diagnosis Codes
Submit A Claim – Billing & Services
Place of Service
Total Charges
Billing and Service
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
47
Submit A Claim – Billing & Services
Extended ServiceInformation
Service Facility Provider
List of Claim Notes
Ambulance Transport and Certification
Home Healthcare Plan
Coordination of Benefits
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
48
Submit Claim – Coordination of BenefitsCoordination of Benefits (COB) Detail
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
49
Submit Claim – Procedure
Procedure
Professional Service Detail
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
50
Submit Claim – Procedure (cont’d)
Durable Medical Equipment Service
Ambulance Service
Home Oxygen Therapy Information
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
51
Inquire A Claim Status
011000001111 – Bedford Falls Psychiatry
Enter Member IDProcedure Code etc. to Narrow
Search
Inquire By ICN
2208036600010
Bailey, George
Inquire by Date of Service Range
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
52
Questions &
Answers
53
Inquire A Claim Status
George Bailey01/20/1946Male
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
54
TPL Claims – Key Concepts
RecoveryRecovery
Cost AvoidanceCost Avoidance
Matching with Multiple CMS/SSA Files and Third Party Carriers
Automated TPL Verification Process
User Maintained Other Insurance Plans Replacing TPL Matrix
Retro-active, Pay & Chase & User Defined Recovery
Enhance Up-front Cost Avoidance Capabilities
Comprehensive Tracking and A/R System Re-pricing Methodologies
Integration of MA21/MMIS TPL Data
Table Driven Re-pricing Methodologies
2.0 Access Provider On-Line Service Center
1.0 Enroll a Provider &
Maintain Profile
3.0 Submit Requests
for Service Authorization
4.0 Submit a Claim for
Services Rendered
5.0 Receive Payment for
Services Rendered
55
5555
Getting Ready
KickKickOffOff
MeetingsMeetings
InformationalInformational Meetings Meetings
Communications:Communications:Newsletters etc.
NewMMIS Overview & NavigationNewMMIS Overview & Navigation
E-Learning E-Learning
Classroom TrainingClassroom Training
SeptemberSeptember20072007
September 2007 September 2007 thru Go Livethru Go Live
Communications Center:http://newmmis-communication-center/http://newmmis-communication-center/
4-6 Weeks 4-6 Weeks BeforeBeforeGo-LiveGo-Live