October 2006 page 1 First Steps Presentation Presentation by the EDS Provider Field Consultants First Steps Presentation October 2006 page 2 Agenda Overview Provider Enrollment Provider Profile Billing Guidelines Voids and Replacements Web interChange Screens Helpful Tools Questions Welcome and Announcements First Steps Presentation October 2006 page 3 Overview EDS The First Steps claims processor. IndianaAIM Indiana Advanced Information Management system. This is the name of the system EDS uses to process claims. Web interChange A secure Web site offered by EDS that allows providers to inquire about claim information, submit electronic claims, and maintain provider information. Terms First Steps Presentation October 2006 page 4 EDS assumed the claims processing responsibility for First Steps on February 1, This change impacts the following: Provider enrollment and updates Claim submission Claim payment A Provider Service Matrix is located on the following Web site: https://www.infirststeps.comOverview First Steps Presentation October 2006 page 5 Provider Enrollment Enrolls new providers Services providers undergoing a change of ownership Maintains and updates the provider file Performs credentialing and re-credentialing Contact the EDS Provider Enrollment Helpdesk at Role of EDS Provider Enrollment Unit First Steps Presentation October 2006 page 6 Provider Enrollment To participate in the First Steps program, providers must enroll with the EDS Provider Enrollment Unit. First Steps provider enrollment information and the required provider enrollment forms are available on the First Steps Web site at https://www.infirststeps.com. https://www.infirststeps.com Providers must use these forms to submit a new enrollment or update provider profile information. Providers must complete these forms on paper and mail them to EDS for processing. New Enrollment and Update Forms and Procedures First Steps Presentation October 2006 page 7 Provider Enrollment Providers must mail all provider enrollment forms, update forms, and supporting documentation by U.S. mail to: EDS Provider Enrollment P.O. Box 7263 Indianapolis, IN Provider Enrollment completes new enrollments and updates within 10 days of receipt. If documentation is incomplete, Provider Enrollment returns the submitted form to the provider with a return to provider (RTP) letter stating what information is missing from the form. Enrollment and Update Processing First Steps Presentation October 2006 page 8 Provider Enrollment If a form is returned, the provider must resubmit the form and the missing information to Provider Enrollment to complete the original request. When Provider Enrollment receives the completed form, it reviews the enrollment form to ensure proper enrollment requirements are met. The enrollment requirements are defined in the Early Intervention Personnel Guide and the provider enrollment application instructions. These documents are posted on the First Steps Web site at Note: The provider enrollment process also applies to credentialing and re-credentialing. Enrollment and Update Processing First Steps Presentation October 2006 page 9 If the enrollment requirements are met, the provider is enrolled and assigned a provider identification number(s) based upon how the provider has elected to enroll. If a provider is enrolling as a individual provider, one provider identification number is issued for billing and rendering services. Note: Providers that were enrolled in the First Steps Program prior to February 1, 2006, shall continue to have two numbers; one number for billing services and one number for rendering services. Provider Enrollment Enrollment and Update Processing First Steps Presentation October 2006 page 10 Provider Enrollment If a provider enrolls as a group provider with rendering providers, one provider identification number is issued for the billing entity and one rendering provider identification number is issued for each servicing provider. Provider Enrollment mails a confirmation letter to the provider with the provider identifications number(s), information about the First Steps program and the provider profile information for verification. The provider uses its provider identification number to enroll in Web interChange. Enrollment and Update Processing First Steps Presentation October 2006 page 11 Provider Enrollment Providers are also required to credential with the First Steps program after enrollment. The enrollment confirmation letter supplies the required date to obtain the credential. Additional letters are sent to notify the provider of the upcoming credentialing date. If the provider has not responded, a final notice is sent to the provider terminating participation in the First Steps program. When the provider meets the credentialing requirements, an approval letter is sent to the provider along with a certificate. Credentialing requirements are included in the Early Intervention Personnel Guide which is posted on the First Steps Web site atEnrollment and Update Processing - Credentialing First Steps Presentation October 2006 page 12 Provider Profile Provider Profile allows providers to view the following information on file with EDS: Provider name Current addresses Phone numbers Type and specialties Groups can view all of the rendering providers associated with their practice. Note: A group is defined as a payee and rendering is defined as the person who provides the service. Using Web interChange First Steps Presentation October 2006 page 13 Provider Profile To view Provider Profile information online, providers must enroll in Web interChange. To enroll in Web interChange, providers must complete and submit the application located at https://interchange.indianamedicaid.com. https://interchange.indianamedicaid.com Providers can view their provider profile information (read-only) through Web interChange. Providers may print copies of the Provider Profile information from Web interChange. Using Web interChange First Steps Presentation October 2006 page 14 Provider Profile First Steps Presentation October 2006 page 15 Provider Profile First Steps Presentation October 2006 page 16 Provider Profile First Steps Presentation October 2006 page 17 Billing Guidelines All First Steps providers must sign up for electronic funds transfer (EFT) upon enrollment. The EFT form is part of the Provider Enrollment Application. EFT begins 18 days following completion of the enrollment process. EFT payments occur each Wednesday. The time of day when payment appears in an account depends on the financial institution. Providers should direct questions about the posting of an EFT to their financial institution. Enrollment And Update Processing - Electronic Funds Transfer First Steps Presentation October 2006 page 18 All services provided to First Steps members require a prior authorization (PA) from the system point of entry (SPOE). To obtain PAs, the provider completes an evaluation form during an initial assessment with the member. The provider faxes the completed evaluation form to the intake coordinator within two business days of completing the assessment. If the child qualifies for First Steps services, an initial Individualized Family Service Plan (IFSP) is developed with the family and the appropriate provider(s). Billing Guidelines Prior Authorization First Steps Presentation October 2006 page 19 The intake coordinator enters the PA at the SPOE based on the information on the Evaluation Report within two business days of receiving the report. Providers should allow five to seven days from the time the authorizations are entered to view PAs on the EDS Web interChange system. If a PA is not on Web interChange, the provider must fax all pertinent information to the SPOE office and request that the SPOE ensure that the PA is entered. Changes to PAs must be coordinated through the service coordinator and approved by the parent, primary care physician before changes can be entered into the SPOE computer system. Billing Guidelines Prior Authorization First Steps Presentation October 2006 page 20 Billing Guidelines Providers must bill for services using the Current Procedural Terminology (CPT ) and Healthcare Common Procedure Coding System (HCPCS) codes for First Steps services. A list of the proper codes is posted on the First Steps Web site at https://www.infirststeps.com https://www.infirststeps.com All providers must be enrolled in the First Steps program as valid providers. Providers must always bill the First Steps program for services rendered before billing any other entity. Claim Submission Current Procedural Terminology 2004 American Medical Association. All Rights Reserved. First Steps Presentation October 2006 page 21 Billing Guidelines First Step claims cannot be submitted for payment with a claim for Medicaid or services for any other Indiana Health Coverage Programs (IHCP). Claims for First Steps should never indicate a third party liability (TPL) paid amount. First Steps claims must be submitted with the unique First Steps member identification number (child ID number) that begins with 950. Claim Submission First Steps Presentation October 2006 page 22 Billing Guidelines All First Steps claims must be submitted electronically, using Web interChange or the 837P transaction. Providers may submit claims 24 hours a day, seven days a week. Clean claims submitted by 4:30 p.m. on Friday will be adjudicated and appear on the following weeks remittance advice (RA). All First Steps claims submitted on paper are returned to the provider. Each claim submitted electronically is assigned a unique Internal Control Number (ICN). Claim Submission First Steps Presentation October 2006 page 23 Billing Guidelines A 13-digit ICN is assigned to each claim after it is processed in IndianaAIM. Claim Submission - Internal Control Number RegionYearJulian DateBatch RangeSequence First Steps Presentation October 2006 page 24 Billing Guidelines All First Step procedure codes must be billed with the modifier TL (early intervention/individualized family service plan). When billing for services that are measured in minutes, the 52 (reduced services) modifier must also be included. When billing for services measured in minutes, one unit equals 15 minutes. When billing for services that are provided in a group setting the modifier HQ must also be included on the claim. Claim Submission - First Steps Modifiers First Steps Presentation October 2006 page 25 Billing Guidelines A provider renders 45 minutes of treatment for speech language, voice communication. The provider bills First Steps as follows: CPT Procedure CodeUnits billed TL 52 3 First Steps Modifiers Example First Steps Presentation October 2006 page 26 Billing Guidelines Taxonomy is required on all claim submissions (using Web interChange or the 837P 4010 version) except for assistive technology services. Taxonomy is a unique 10-digit alphanumeric code. The code is structured into the following three distinct levels: Provider type Classification Area of specialization Example Provider type Physical therapist Area of specialization pediatrics Taxonomy 2251P0200X Claim Submission - Taxonomy First Steps Presentation October 2006 page 27 Billing Guidelines Providers may have one or more than one taxonomy. First Steps providers may access the First Steps code crosswalk to determine taxonomy and procedure code combinations. A list of the proper current taxonomy and procedure code combinations is posted on the First Steps Web site at https://www.infirststeps.com. https://www.infirststeps.com. Claim Submission - Taxonomy First Steps Presentation October 2006 page 28 Billing Guidelines Procedure code TL (other EI services or OEIS) is manually priced. Claims submitted with procedure code TL will suspend for explanation of benefits (EOB) 6000, manual pricing. All claims will suspend to an analyst for the claim to be priced from the authorization on file. All claims will be finalized within 21 days from the date of receipt of the claim. Claim submission - OEIS First Steps Presentation October 2006 page 29 Billing Guidelines All First Steps claims must include the proper place of service (POS). POS is used to determine pricing for the claim. If the POS is missing, the claim will deny. POS codes are listed in Chapter 8, Section 3, of the IHCP Provider Manual, which is available atClaim Submission - Place of Service First Steps Presentation October 2006 page 30 Billing Guidelines Providers must submit claims for First Steps within 60 days of the date of service. Claims submitted on the 61 st day following the date of service will deny with the following EOB: 512 Your claim was filed past the filing limit without acceptable documentation The filing limit is strictly enforced. Claims past the 60-day filing limit must be approved by the First Steps Program to be processed. First Steps contact for past filing limit approval: Julie Escue Assistant to Jerry Allen First Steps CRO Financial Manager (317) Claim Submission - Filing Limitations First Steps Presentation October 2006 page 31 Voids and Replacements Non-check related Mass Types First Steps Presentation October 2006 page 32 Voids and Replacements Void and replacement region codes: 50 Non-check-related adjustment 56 Mass adjustment initiated by EDS 62 Provider-initiated replacement with no attachments and/or claim notes 63 Provider-initiated void 80 Claim reprocessed by EDS Region Codes First Steps Presentation October 2006 page 33 Void or Replacement Providers have 180 days from the date the initial claim was processed to replace claims. Voids can be performed on PAID claims only. Voids and replacements can be performed to correct an incorrect or partial payment, including zero dollar amount. Denied line items may be billed as a new claim, but may also be submitted as a replacement claim. A void and replacement can be completed on the same day, or in the same week as a claim submission or after the claim has been finalized. New region codes are assigned to post financial claims for electronic voids or replacements. A void or replacement must be submitted through Web interChange. Guidelines First Steps Presentation October 2006 page 34 Voids and Replacements A void is a cancellation of an entire claim. A denied claim cannot be voided. If the original claim being voided is in a paid or suspended status and it is the same day or same week: A new claim is not created. The same ICN is used. The original claim denies with EOB 0120 Claim denied due to an electronic void request. If the original claim being voided is a historical claim: A new claim is created. The new ICN starts with 63. Definition of a Void First Steps Presentation October 2006 page 35 Voids and Replacements Pre-FinancialPost-Financial Paid Provider voids the claim. Denied with EOB Paid Todays date: 10/02/ Denied with EOB 0120 RA/835 shows: Claim shows on the denied page only same ICN. RA/835 shows: and on the adjustment page. Void Examples First Steps Presentation October 2006 page 36 Voids and Replacements Replacement is a change to an original claim, whether same day, same week, or post financial. Original claim indicates the most recent ICN assigned to that claim. An electronically-submitted replacement claim can be for a previously-submitted electronic claim. First Steps replacements are only accepted electronically. Definition of a Replacement First Steps Presentation October 2006 page 37 Voids and Replacements If EDS receives a replacement claim for an original claim that has been through a financial process (has appeared on an RA), the replacement claim ICN starts with the following: 62 Provider initiated replacement with no attachments and/or claim notes Replacements First Steps Presentation October 2006 page 38 Voids and Replacements Pre-FinancialPost-Financial Paid Replacement request submitted and claim is denied with EOB 0121 Claim resubmitted New ICN RA/835 shows: Original claim ICN On denied page with EOB 0121 Replacement claim ICN On paid or denied page Mother claim Daughter claim Both ICNs appear on the adjustments page of the RA Replacement Examples First Steps Presentation October 2006 page 39 Voids and Replacements 0120 Claim denied due to an electronically submitted void Claim denied due to an electronically submitted replacement. EOBs First Steps Presentation October 2006 page 40 Voids and Replacements There is no filing limit for void requests. There is a 180 days filing limit for replacement requests. Filing Limits The system compares the last date of claim activity and the date of the current activity to make sure that a 180 days has not passed. If the replacement is greater than 180 days, Web interChange will not display a replacement button on claims. These replacements must be submitted to the First Steps Program for approval. First Steps Presentation October 2006 page 41 Web interChange Web interChange features: Is HIPAA compliant Allows providers to submit professional First Steps claims Allows providers to inquire on claims status Allows providers to inquire on the status of authorizations Note: Authorizations must be submitted through the System Point Of Entry (SPOE) applications. To use Web interChange, providers must: Be enrolled as a First Steps provider and have a provider ID Complete a new application to obtain a logon ID and password (if not already enrolled to use Web interChange) Overview First Steps Presentation October 2006 page 42 Web interChange Providers may download the Web interChange enrollment form at https://interchange.indianamedicaid.com https://interchange.indianamedicaid.com This form is only available from the Web interChange Web site. Each provider must assign an Administrator. In addition to the enrollment form, providers must send a note of acknowledgement on company letterhead indicating the owner approves the person completing the request form as an Administrator for the organization. By signing, the owner acknowledges reading and understanding the document and agrees to the terms and conditions as they describe the role that the owner performs for the organization. First Steps Presentation October 2006 page 43 Web interChange Creates new users Creates, maintains, and deletes user groups Resets passwords Modifies user information Administrator Functions First Steps Presentation October 2006 page 44 Web interChange Screen Overview First Steps Presentation October 2006 page 45 Web interChange Web interChange Logon Screen First Steps Presentation October 2006 page 46 Web interChange Administrator Main Menu First Steps Presentation October 2006 page 47 Web interChange Create a User First Steps Presentation October 2006 page 48 Web interChange Maintain User Information First Steps Presentation October 2006 page 49 Web interChange Create User Groups First Steps Presentation October 2006 page 50 Web interChange Create, Maintain, and Delete Users From A User Group First Steps Presentation October 2006 page 51 Web interChange Reports First Steps Presentation October 2006 page 52 Web interChange Password Reset (By Administrator) First Steps Presentation October 2006 page 53 Web interChange Password Reset (By User) First Steps Presentation October 2006 page 54 Web interChange Password Reset (By User) First Steps Presentation October 2006 page 55 Web interChange Home Page First Steps Presentation October 2006 page 56 Web interChange Check Inquiry Window First Steps Presentation October 2006 page 57 Web interChange Claim Inquiry Window First Steps Presentation October 2006 page 58 Web interChange Claim Inquiry Window Copy Function First Steps Presentation October 2006 page 59 Web interChange Claim Inquiry Window Copy Function Show Me More Button First Steps Presentation October 2006 page 60 Web interChange Claim Inquiry Window Copy Function Old Claim ICN Information First Steps Presentation October 2006 page 61 Web interChange Claim Inquiry Window Copy Function New Claim ICN Information First Steps Presentation October 2006 page 62 Web interChange Claim Submission Professional Billing First Steps Presentation October 2006 page 63 Web interChange Professional Billing Header Information First Steps Presentation October 2006 page 64 Web interChange Professional Billing Detail Information-Taxonomy First Steps Presentation October 2006 page 65 Web interChange Voids and Replacements First Steps Presentation October 2006 page 66 Web interChange List Function First Steps Presentation October 2006 page 67 Web interChange List Function-Procedure/HCPCS Information First Steps Presentation October 2006 page 68 Web interChange List Function First Steps Presentation October 2006 page 69 Web interChange 278 Prior Authorization Inquiry First Steps Presentation October 2006 page 70 Web interChange 278 Prior Authorization Search First Steps Presentation October 2006 page 71 Web interChange 278 Prior Authorization First Steps Presentation October 2006 page 72 Claim Submissions Providers that wish to submit batch claims for services provided to First Steps members should communicate directly with their vendor to ensure First Steps claims are submitted appropriately to EDS for processing. Batch Claims First Steps Presentation October 2006 page 73 Select Help from Web interChange Contact the EDI Solutions Help Desk Indianapolis area (317) Toll Free Select Option 2 for First Steps technical calls Helpful Tools Technical Assistance First Steps Presentation October 2006 page 74 Helpful Tools Avenues of Resolution First Steps Web site: https://www.infirststeps.com.https://www.infirststeps.com First Steps Provider Billing Manual IHCP Web site:Customer Assistance Indianapolis area (317) Toll Free Option 1, Member calls (family) Option 2, Provider calls Written Correspondence P.O. Box 7263 Indianapolis, IN Provider Field Consultant First Steps Presentation October 2006 page 75 Questions October 2006 page 76 EDS 950 N. Meridian St., Suite 1150 Indianapolis, IN Presentation by the EDS Provider Field Consultants EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation. 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