newmmis pilot provider orientation august 21 & 22, 2008
DESCRIPTION
NewMMIS. NewMMIS Pilot Provider Orientation August 21 & 22, 2008. Agenda. WELCOME! Pilot Phase II. NewMMIS Overview/Update. NewMMIS Timeline/Activities: User Acceptance Testing (UAT) Pilot Trading Partner Testing (TPT) Implementation. Purpose of Pilot. - PowerPoint PPT PresentationTRANSCRIPT
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NewMMIS PilotNewMMIS Pilot
Provider Orientation Provider Orientation
August 21 & 22, 2008August 21 & 22, 2008
NewMMISNewMMIS
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AgendaAgenda9:00 – 9:05 AM Sign/Registration
9:05 – 9:55 AM Presentation Welcome NewMMIS Overview & Update Purpose of Pilot Pilot Timeline Pilot Activities Pilot Functionality Paper Claims Submission Pilot Data Parameters & Constraints Test Scenarios Pilot Participant Readiness Provider Communications Help Desk Support Pilot Coordinators Pilot Provider Access Contact/Available Resources E-Learning Debriefing Next Steps
9:55 - 10:00 AM Questions & Answers
WELCOME!WELCOME!Pilot Phase IIPilot Phase II
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NewMMIS NewMMIS Overview/UpdateOverview/Update NewMMIS Timeline/Activities:
User Acceptance Testing (UAT)
Pilot
Trading Partner Testing (TPT)
Implementation
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Purpose of PilotPurpose of Pilot Primary objective : TEST, TEST,
TEST
Pilot Responsibilities Test transactions Review responses Identify defects Based upon feedback CW may identify
additional training needs
What you can expect Claims may not pay accurately Claims may deny Responses may not be accurate Reporting may not be 100%
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Purpose of PilotPurpose of Pilot Validate Infrastructure
Environment is stable Interfaces are working Security is working Helpdesk ticketing system is functioning
appropriately
Prepare for Implementation Identify provider type specific defects Identify additional training needs Identify additional communication needs Identify additional helpdesk & infrastructure
needs
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EDS Readiness report – 8/8/08
Commonwealth (CW) Testing/Validation 8/11 – 8/22
Pilot Start Date: 8/25/08
Pilot End Date: 9/12/08
Debriefing Assess Provider experience Assess User experience Assess system performance
Pilot TimelinePilot Timeline
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Pilot ActivitiesPilot Activities Complete Trading Partner Testing
Complete test scenarios & provide feedback based on day-to-day business
Follow Pilot data parameters for transaction submission
Participate in debriefing
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Pilot FunctionalityPilot Functionality HIPAA Batch Transactions
270/271 276/277 837P 837I 997 835
Direct Data Entry (DDE)Eligibility Verification Professional Health Care Claim Institutional Health Care Claim Claim Status Inquiry
Paper Claims
Cross-Over Claims / COB
View Metrics / Reports Remittance Advice (RA) Claims Metrics
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Paper Claims Paper Claims SubmissionSubmission For Pilot Providers submitting paper and
TPL/COB claims, forward all paper claim forms to the following address:
MassHealth
Attn: Pilot
PO Box 9118
Hingham, MA 02043
Note "Pilot" on the claim form
Submit TPL paper claims
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Pilot Data Parameters Pilot Data Parameters Conversion claims data through 4/23/08
Member & Provider PA/PAS/Referrals Procedure/Revenue Codes TPL
Use claim and member data through 4/23/08 to submit pilot transactions
Timely filing edits will apply
Converted claims cannot be modified
NewMMIS initiated claims can be modified and resubmitted
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Pilot Data Pilot Data Parameters Parameters
Batch cycles that will be run during Pilot: Claims Financial—Thursday Eligibility Verification System (EVS) System Wide
HIPAA Batch Cycles Tracking number will display immediately 997 will display estimated 15 – 30 minutes HIPAA related response estimated 45 minutes to 1 hour
Batch Cycles are supported between 8:00AM – 5:00 PM
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Pilot Data ParametersPilot Data Parameters Use NewMMIS Provider ID/Service Location
(PID/SL) on all claims (obtain number after Pilot training)
Use NewMMIS Member ID on DDE to obtain member number through REVS or NewMMIS EVS functionality
HIPAA 837 batch claims will accept current MassHealth Member ID, however, NewMMIS ID is preferred
Input 2 leading Zeros when using existing referral numbers on claim submission
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ConstraintsConstraints Dupe “S” procedures – Some legacy service
codes are flagged/bypassed (small number of denials for services performed on the same day/same member)
Impact: Primarily DME Approach: Work around constraint
Professional claims with PA pricing – PA end dates may effect pricing
Impact: DME Approach: Do not submit claims with PA
Pricing procedure codes
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ConstraintsConstraints Max unit override – In some instances current
MMIS allows more units than on current procedure file. Some NewMMIS claims may be “cut back”
Impact: Physician, CHC, MH Centers, State agencies, OPD
Approach: Submit claims but be aware of constraint (less than 10 codes)
Home Health Claims – X-walk issue with Type of Bill
Impact: Home Health
Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports
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ConstraintsConstraints Holiday/weekend rates – Claims may not reflect
special rates Impact: Home Health
Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports
Restrictive Messages – Under CW review; less than 20 may result in incorrect messages being issued to providers
Impact: All
Approach: Work around constraint
Do not submit codes with modifiers
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ConstraintsConstraints Payment based on provider specialty - claims may not
pay accurately (25 estimated procedure codes impacted)
Impact: State Agencies
Approach: Work around constraints
Procedures codes paid on both a class rate and provider specific rates - Claims may pay incorrectly - (primarily when Community Health Centers (CHC) bill certain clinic visits codes e.g. codes 9993xx)
Impact: CHCs Approach: Do not submit certain procedure codes
Remittance Advice – currently prints portrait, which may be difficult to read
Impact: All
Approach: View remit on screen and use discretion when printing
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Test ScenariosTest Scenarios Review list of test scenarios and select those that
are pertinent to your day to day activities/ identified in your survey response
Perform up to 10 test case scenarios - examples: Check Member Eligibility Submit a Claim Download RA or 835
Complete the test scenario, including feedback section and email to your Pilot Coordinator
Follow-up outreach activities may occur
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List of Pilot Test List of Pilot Test Scenarios Scenarios POSC-LOG Provider logs in to Provider Online Service Center
EVS-DDE Provider submits DDE member eligibility
PHYS-DDE Provider submits Physician DDE claim
INST-DDE Provider submits Institutional DDE claim
STATUS-DDE Provider submits DDE claim status
CLAIM-837P Provider submits 837P
CLAIM-837I Provider submits 837I
EVS-270 Provider submits 270
STATUS-276 Provider submits 276
CLAIM-997 Provider views 997
EVS-271 Provider views 271
STATUS-277 Provider views 277
CLAIM-RA Provider views RAs
CLAIM-835 Provider views 835
CLAIM-REP Provider views metric reports
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Eligibility Test Eligibility Test ScenarioScenario
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Pilot Participants Pilot Participants ReadinessReadiness Continue preparing for the transition
Complete Trading Partner Testing (as applicable) Review EDI submission instructions Provide member numbers Use your NPI – it is required Obtain your User ID/Password (to access CST web page)
Complete System Readiness activities: Billing intermediary Practice management Software vendors
Review Pilot Materials: Companion guides Billing instructions Review E-Learning Participate in Pilot overview
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Pilot Participants Pilot Participants Readiness Readiness Identify for Pilot:
Provider numbers
Member identification numbers
Billing Intermediaries/Vendors
Identify claims you will use during testing
Identify PA/PAS & referral numbers you will use during testing using the data parameters date (4/23/08)
Coordinate resources within your organization
Determine daily testing timeframes
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Pilot Participant Pilot Participant ReadinessReadiness NewMMIS PID/SL will be provided to all
Pilot participants
Billing Intermediaries/Large Organizations: Identify the name and Legacy provider numbers of
the providers you will submit claims on behalf of during Pilot
CW will validate the existing relationship
Once the NewMMIS PID/SL is validated, it will be provided to you. This number is not to be shared with anyone and must only be used for testing purposes
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Provider Provider CommunicationsCommunications Help Desk
Pilot Coordinators
Pilot Provider Primary Contact
Weekly Status Meetings
Debriefing
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Help DeskHelp Desk
Trading Partner Testing (TPT)
Testing must be completed for HIPAA Transactions before providers can submit “production” transactions in the Pilot environment
Help Desk at @ 1-888-824-3484
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Help Desk SupportHelp Desk Support
Mirror implementation
Enhancements to existing customer service center environment
Monitoring tools in place to track caller, types of calls, response time results
Anticipated response time for critical impact is immediate < or = to 3 hours
Email option: [email protected]
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The help desk is the first line of support for providers with questions on their use of the NewMMIS
Support hours of operation: Phone: 1-888-824-3484 Monday - Friday 8AM - 5PM No after hours or weekend support will be available
A Three tier support system to address provider technical & non technical issues
Tier 1 = CST Tier 2 = NewMMIS Technical Team Tier 3 = NewMMIS SMEs and BAs
Help Desk Support Help Desk Support
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Help Desk Support - Help Desk Support - PriorityPriority
Priority/Severity
Impact Description Response Time
Resolution Time
Level 1 Critical
No work around
High: Large number of Providers
affected Affects online processing Major component not available
for use Loss of functionality Problem cannot be bypassed
3 hours
6 hours
Level 2 Serious
Work around available
Moderate: Large number of Providers affected Potentially affects online commitment Serious slow response times & functionality
6 hours
12 hours
Level 3 Moderate to Low
Non-critical problem
Low: No direct impact on Provider Few functions impaired Problem can be by passed & acceptable to the Provider
12 hours
5 days
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Pilot Coordinator Pilot Coordinator ActivitiesActivities Pilot Coordinators:
This team is comprised of NewMMIS Functional Coordinators
(FCs). They will function as liaison to Pilot Providers.
Pilot Coordinators Role: Serve as a liaison to Pilot Providers Conduct welcome call – initial contact Check in with providers Collect test scenarios feedback from Providers Review monitoring reports & confer with Providers
regarding status of activities & support needs Research issues, identify defects and solutions Conduct debriefing with Providers Report debriefing results to Project Leadership
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Pilot ProviderPilot Provider Role of Pilot Provider Primary contact:
Coordinate activities within your organization
Work directly with the NewMMIS Pilot Coordinator to communicate issues and resolve Pilot process concerns from your organization
Validate the number of pilot participants/users from your organization
Confirm your organization is prepared for Pilot by validating that participants/users have conducted the following activities:
Completed TPT Reviewed the E-learning Identified the member and claims data that will be used for Pilot Participants/users have helpdesk number and email Etc.
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AccessAccess Provide Access To Pilot Environment
The Commonwealth will issue User ID & Passwords to all participants
Provide security data collection information required to initiate a request for a User ID & password
Contact Pilot Support to provide security data
Environment available on 8/25/08
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AccessAccess User ID & Passwords:
User ID and password to access the Pilot environment will be sent to you via email shortly after you attend the Pilot training
The email will be auto-generated to the email address you supplied to us (security data collection information)
The password is temporary and will be revoked once Pilot is completed
Once you receive the User ID and Password, you must log-in to Virtual Gateway, change your password, and set up a series of security questions.
This User ID and password can then be used to access the NewMMIS Pilot Environment on 8/25/08.
URL: www.mass.gov/masshealth/newmmispilot
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Contact Contact InformationInformation
CST Phone Number: 1-888-824-3484
Email for MassHealth Customer Service:
Email Address @ [email protected]
Paper Claims Mailing Address:MassHealth
Attn: Pilot
PO Box 9118
Hingham, MA 02043
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Available ResourcesAvailable Resources Check our web site often for the most up-to-
date information: www.mass.gov/masshealth/newmmis
Masshealth provider bulletins & transmittal letters
MassHealth trainings
E-Learning: http://masshealthnewmmisprovidertraining.ehs.state.ma.us/
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Available Available ResourcesResources Accessing E-learning Tips
If you have not yet registered, go to Don’t have a user name click here
Allow pop ups…. Go to tools on your menu bar, Select Pop Up Blocker, then select Turn off Pop up blocker
Complete all fields, regardless of * (don’t forget county) User name must be different from password Password must be a minimum of 6 characters Select one provider type if you have many. If you have multiple
provider types, have different staff select different provider numbers and types.
Select Register Select Continue Select Course Catalog Select appropriate courses, beginning with A Provider Information
and Navigation course Select course from center of screen Select Enroll Select Launch Select Launch again
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E-Learning/Help E-Learning/Help OverviewOverview E-Learning overview
Navigation
Panel help & field level help
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DebriefingDebriefing At the end of Pilot, a debriefing
session will be held to obtain feedback on the NewMMIS and the overall Pilot experience:
Assess Provider experience
Assess User experience
Assess System performance
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Next StepsNext Steps Issue User IDs & Passwords
Identify provider numbers to test
Review E-learning
Define testing data & testing timeframes
Submit HIPAA Batch Tests (TPT)
Open Pilot Environment
Test, Test, Test!!!
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Q & AQ & A
Questions & Answers