ihcp eligibility and portal overview - indiana...ihcp eligibility and portal overview annual...
TRANSCRIPT
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Indiana Health Coverage Programs
DXC Technology
IHCP Eligibility and Portal
Overview
Annual Provider Seminar ‒ October 2019
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Agenda• Eligibility Verification
• Eligibility- Special Programs
• Provider Enrollment
• Portal Overview
• Member Focused Viewing
• Prior Authorization ‒ FFS
• Claims ‒ FFS
• Search Payment History
• Reminder
• Helpful tools
• Q&A
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Verify Member Eligibility
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Verify Eligibility
• Interactive Voice Response (IVR) system
at 1-800-457-4584
• IHCP Provider Healthcare Portal (Portal)
at portal.indianamedicaid.com
• Electronic 270/271 interactive or batch
transactions
Verification options
Verify eligibility on every visit!
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Verify Eligibility on Portal
To access the Eligibility Verification Request function, log in to the
Provider Healthcare Portal and click Eligibility on the menu bar.
• Eligibility can only be verified as of provider effective date
• Eligibility cannot be verified for future dates
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Verify Member Eligibility
To perform a search, the Effective From date is required, in addition to
one of the following:
• Member ID
• Social Security number (SSN) and birth date
• Last name, first name, and birth date
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Verify Member Eligibility
The Effective From field is always
required.
– If a date is not entered, the Portal defaults this field to the current date.
– This field accepts only current and previous dates.
The Effective To field is optional.
– The date entered must be on or after the Effective From date and must be within the same calendar month as the Effective From date.
– If a date is not entered, the Portal defaults to the Effective From date.
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Verify Member Eligibility
When an eligibility search returns no results, qualified providers (QPs)
see an additional option below the message to complete a Presumptive
Eligibility for Pregnant Women (PEPW) or Presumptive Eligibility (PE)
application for the patient.
No Results Found:
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Presumptive Eligibility
Presumptive Eligibility (PE) is a IHCP process by which individuals are
deemed to be presumptively eligible for temporary coverage, until the
Family and Social Services Administration (FSSA) determines official
eligibility.
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Some members may have more than one coverage type listed. Each
benefit plan plays an important role, depending on provider type.
Verify Member Eligibility
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Eligibility − Managed Care
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Southeastrans is the managed care entity for nonemergency
medical transportation (NEMT) for fee-for-service (FFS)
members.
Eligibility − Fee-For-Service
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Right Choices Program
Members identified with high utilization are assigned to primary
lock-in providers, such as:
• One primary medical provider (PMP)
• One pharmacy
• One hospital (for non-emergent visits)
• Approved specialty providers
Members should be referred to their lock-in provider.
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Right Choices Program
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Right Choices Program
Contact the Right Choices Program member’s PMP to be added to
member’s panel.
PMP adds providers to
member’s panel here
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Retroactive Eligibility
• 180 days to bill claims from the date the member becomes retroactive
− Add claim note: “Retroactive Eligible”
• Payments made by retroactively approved members should be refunded to the member and claims billed to the payer
• Member is responsible for notifying providers of retroactive eligibility
• Retroactive eligibility for sterilization should follow IHCP sterilization guidelines to be reimbursed
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Eligibility Special Programs
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Eligibility − Special Programs
The following are Medicare premium benefits only and do
not require a waiver to bill member:
• Specified Low Income Medicare Beneficiary (SLMB)
Medicare Part B premiums only
• Qualified Individual (QI)
Medicare Part B premiums only
• Qualified Disabled Working Individual (QDWI)
Medicare Part A premiums only
These members do not have any Medicaid benefits.
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Eligibility − Special Programs
For QMB-ONLY, a waiver is required to bill a member for
Medicare noncovered services.
Qualified Medicare Beneficiary (QMB)
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• PASRR for nursing homes are the only payable codes
• No other benefits when PASRR is the only coverage
• Waiver not required to bill a member for a noncovered service
• Provider must be a PASRR enrolled provider
Eligibility − Special Programs
Preadmission Screening Resident Review (PASRR)
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Medical Review Team (MRT)
• Disability-determining codes only, per the Code Set
• Provider must be an MRT provider
• No other benefits when MRT is the only coverage
• No waiver form required when MRT is the only coverage
Eligibility − Special Programs
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Eligibility − Special Programs
590 Program members reside in a State institution.
• Full array of benefits, except transportation
• Claims for $150 or less − billed to institution
• $150 or more − billed to IHCP
• $500 or more − requires prior authorization
• Provider must be enrolled in 590 program
590 Program
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Provider Enrollment
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Provider enrollment transactions
can be done right on the portal
- New Enrollments
- Revalidation
- Profile Updates
Provider Enrollment
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Watch for your revalidation period on your home page.
Revalidation warnings post 90 days before the revalidation is
due. Failure to complete revalidation can result in enrollment
termination.
Provider Enrollment
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IHCP Portal Overview
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Portal Home Page
Ask your administrator to give you full access to these features.
Claim administrative review
requests,
Submit third-party liability (TPL)
updates, Portal assistance
DXC contact
information
(phone, fax, mail)
Sign up to receive
important emails
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Portal Resources
Quick access to the
IHCP Fee SchedulesClaim adjustment
forms, TPL forms,
provider
correspondence
forms
Workshop
registration,
presentations,
webinar training
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Switch Providers
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Member Focused Viewing
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Member Focused Viewing
allows quick access to:
• Member details
• Coverage details
• Claim search and submission
• Prior authorization search
and submission
Member Focused Viewing
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Member Focused Viewing
Same search criteria as the Eligibility screen.
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Prior Authorization
Fee-for-Service
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Access the PA function from the Care Management drop-down menu.
Prior Authorization (PA)
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Complete the
required
information
and submit
the request
by clicking
Confirm.
Prior Authorization (PA)
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• The authorization request is assigned an authorization number.
• Results list the first 20 authorizations with beginning service dates of today
or greater.
• Results list only authorizations for which the viewing provider was on the
request as the requesting provider.
Click to view the
authorizationMember name and
ID are displayed
Requesting provider
is listed
Viewing Prior Authorization Status
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ClaimsFee-for-Service
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Search Claims
When searching for claims, you have the option to search by:
• Claim ID
• Member information and date of service
• Type of claim and claim information
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To view the claim summary, click the plus sign (+) next to the Claim ID.
To view the claim explanation of benefits (EOBs), click the Claim ID.
Choose most recent claim when
attempting a claim correction.
Claim Search Results
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Claim Updates
Click COPY when
rebilling a denied claim.
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Claim Updates
Click EDIT to make claim corrections.
Click VOID to have the claim recouped.
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Search Payment History
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Search Payment History
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Search Payment History
Auto populates last 12 weeks; or search by 12-week span.
You can search ALL payments,
or search for paper checks or
electronic funds transfer (EFT)
only.
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Search Payment History
To view the remittance advice for claims
associated with the EFT or check, click the
icon for the PDF file.
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Reminders
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Reminders
• Delegated administrator
must maintain managed
individuals
• Review and deactivate
staff no longer employed
• Functionality can be
changed based on staff
role
• Do not share Portal log in
• Delegate number is for
life
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Helpful Tools
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Provider Relations Consultants
Helpful Tools
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Helpful Tools
IHCP website at in.gov/medicaid/:
• IHCP Provider Reference Modules
• Medical Policy Manual
• Contact Us – Provider Relations Field Consultants
Customer Assistance available:
• Monday – Friday, 8 a.m. – 6 p.m. Eastern Time
• 1-800-457-4584
Secure Correspondence:
• Via the Provider Healthcare Portal
(After logging in to the Portal, click the Secure Correspondence link to submit a request)
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Questions?Following this session, please review your schedule for the next session
you are registered to attend
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Session Survey - Tuesday
https://tinyurl.com/fssa1047
Please use the QR code or the weblink below to complete a survey about the sessionyou just attended. Each session has a unique survey so be sure to complete theappropriate one for each session you attend. We will be taking your feedback fromthis survey to improve future IHCP events.
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Session Survey - Wednesday
https://tinyurl.com/fssa1056
Please use the QR code or the weblink below to complete a survey about the sessionyou just attended. Each session has a unique survey so be sure to complete theappropriate one for each session you attend. We will be taking your feedback fromthis survey to improve future IHCP events.
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Session Survey - Thursday
https://tinyurl.com/fssa1064
Please use the QR code or the weblink below to complete a survey about the sessionyou just attended. Each session has a unique survey so be sure to complete theappropriate one for each session you attend. We will be taking your feedback fromthis survey to improve future IHCP events.