The IHCP implementation of the CoreMMIS portal has not gone without any glitches. Dr. Leila Alter has been keeping IDA and its members up to date on progress and performance.
The search payment history module was fixed 02/23 and providers can now get their RAs. If they submitted 837 (electronic claims through a clearinghouse) providers were able to view the RA through the 835 report that is sent to the provider from the clearinghouse. (Only portal and paper claims were affected by the RA issue.)
Also EFTs posted correctly and providers received checks.
Little trivia…. 10 billion data records were transferred with this implementation.
Electronic Fund Transfer (EFT) and Checks:
Providers should see the EFT payment post to their account today and checks should arrive in the mail.
They are loaded in the system, however offices have had difficulty retrieving this information. It will spin and give you an error code. As a reminder, claims process in real time now and after you submit a claim on the web portal you can go to search claim to make sure the claim processed correctly. I also attached the dental presentation that was given at the annual provider seminar this past fall. Go to slide 40 for information on how you can search for claims and correct claims if information was incorrectly submitted. This presentation can be printed.
Patients Showing Eligible in CoreMMIS and not in the DentaQuest or Envolve Portals:
With the transition to CoreMMIS, there were suspension of some data transfers to the MCEs (Anthem, CareSource, MDwise and MHS). This data transfer should be completed by the end of this week and the MCE files will then be caught up on current eligibility. As a reminder, if a patient shows that they are eligible in CoreMMIS, services can be completed for this patient. If your claim denies because of eligibility, please contact me or your provider representative for information on how this can be reprocessed.
Dental Service Limitations:
Previous dental history that was paid by Hewlett Packard has been downloaded for Traditional (Fee-for-Service), Hoosier Healthwise Pkg A and Hoosier Care Connect. Hoosier Healthwise Pkg C is still not available.
1. Remittance Advice (RA)
This will not be loaded into CoreMMIS until Wednesday Feb. 22nd and can be found in the Search Payment section under the Claims Menu. The RA pdf will be located to the right of the screen. For providers that need RA for previous weeks financial cycle, this information is still available in Web Interchange.
2. Lack of Dental Benefit Limitations
Only traditional (Fee-for-Service) members have information available at this time. Sorry, they are working on this and hope to have resolution by this evening’s conference call. 6114 DME limited to $5000 per member per lifetime refers to Durable Medical Equipment.
3. For Providers who have not Registered for the health portal and do not know how to obtain a Legacy Provider Number
If you need your provider ID, log into Web Interchange, go to Administrative Menu on the left column, click on Administrative Groups and look for the number under Provider Association. This is your provider ID (LPI) that will be required when you register for the portal.
To register for the portal, copy and paste in your internet browser:
4. Rendering Provider with Indianapolis listed as city
When data was transferred to the new system, it was discovered that many offices did not have an address for their rendering providers. In order to load this information, Hewlett Packard had to give these providers had to add Indianapolis as the city to load the data, however these providers are still linked correctly to your billing NPI address.
5. Training Materials are located on the Indiana Medicaid website
Copy and paste in your internet browser to access training materials:
6. What does No coverage details available mean when completing a member eligibility search?
This would mean that the patient is not eligible however I would enter the patient’s member ID (RID) or enter name and date of birth again to make sure information was correctly entered.
CoreMMIS was very unstable on Friday, February 17. The problem was identified and the system has been more stable. Any claims that were submitted through Saturday, February 18 through 5PM were included in the financial cycle and payment will be released this week on Wednesday for those claims.
STATUS OF FUNCTIONS:
TIP: You do not have to go back to the drop down menu when searching for a new member. By clicking the small eligibility word that is under the menu bar, this will take you back to the eligibility verification search screen. Also, you do not have to click on the reset button, but just enter the new member ID.
Once you click on Package A, Package C or Full Medicaid, this will take you to Limit Details and Managed Care Assignment and by clicking on these buttons additional information can be obtained.
Benefit Details (Dental Service History): Only Traditional (Fee-For-Service) members have information loaded into the system at this time.
Submit Dental Claims: Working
Only the boxes that have a red asterisk need information entered, however in the Provider Information Box, both rendering provider and taxonomy code will need to be entered. This is required by HIPAA billing requirements. Also, remember to enter your office fee for each dental code.
Remember, only Traditional (Fee-for-Service) claims should be submitted on the portal.
Search Claims History: Working
Search Payment History: Working
The Remittance Advice pdf has not been loaded for the 2/22/2017 payment (check or EFT).
Update 02/16/17 1:20 PM
1. Eligibility: Providers should continue to see improvements with speed. Also, there have been no issues with searching by Member ID (RID).
2. Benefit Limits: Dental Benefit limits are still not available
3. Claims Submission via Portal: This is now available. If your office has any issues with providers not being recognized or missing information for your billing location, please email Dr. Leila Alter with a short comment about the situation along with your billing and rendering NPI numbers. She then can forward to the triage center so they can figure out what is causing the issue.
4. For providers that see patients in a hospital setting: Information of the delivery systems (Managed care networks) can be obtained by calling the following:
Anthem HHW (866) 408-6132
Anthem HIP (800) 345-4344
Anthem HCC (844) 284-1798
CareSource (844) 607-2831
MDwise (800) 356-1204
Managed Health Services (MHS) (877) 647-4848
5. Prior Authorization submissions via the Portal for Traditional (Fee-for-Service) patients: Available to providers as of February 15th
6. Qualified Medicare Beneficiary (QMB): In Web Interchange this category was listed QMB ONLY which meant that the member did not have dental benefits or QMB ALSO which meant that the member has dental benefits. In CoreMMIS this will only be listed as QMB. If you see full Medicaid as the program description this means that the patient does have dental benefits.
7. Pharmacy Rx Prior Authorization for Hoosier Healthwise, Hoosier Care Connect and HIP:
If you would need a prescription for prior authorization, you will need to submit the appropriate form that are attached to this email to the MCE (Anthem, MDwise, or MHS) that the member is assigned to. CareSource information will be sent next email update.
- The system was very unstable the morning of Tuesday, February 14. By noon it was working more efficiently.
- Hewlett Packard currently has additional staff at the provider call center. The majority of the calls and voice mail messages inquiries are currently regarding how to reset passwords and forgotten user IDs. If you been unable to log onto CoreMMIS or need help registering, please call (800) 577-1278.
- The target date for benefit limitations to be available on the health care portal is by February 16th. A defect was discovered that Hewlett Packard has been working on fixing, in addition to more testing tonight and tomorrow. Benefit limitations will only be current for Traditional (Fee-for-Service) Medicaid patients and for Hoosier Healthwise patients through December 31, 2016. Service history for HIP and Hoosier Care Connect can be found on the dental benefit administrators portals. Hoosier Healthwise will only show service history from January 1, 2017 on the dental benefit administrator portals.
- The managed care networks will not be available in CoreMMIS. Dr. Alter has reached out to the dental benefit administrators to see if this information can be readily added to their portals or if dentists can have access to Anthem, MDwise, MHS or CareSource’s portals for this information. A managed care network is a network of hospitals within a managed care entity. More information to come….
- Any claims that were submitted last week through February 8th have been processed and payment will be released February 15. Any electronic claims (EDI37) that have been sent by clearinghouses have begun processing. The goal is later this week to open up claims submissions via the portal.
- It is anticipated that prior authorizations submitted through the web portal will be available sometime today (February 15th) as long as there are no issues that occur during testing tonight.
For additional information on CoreMMIS progress, visit the Indiana Medicaid website>>>