WV Bureau for Medical Services, WV Children s Health Insurance Program, & Molina Medicaid Solutions

Transcription

1 WV Bureau for Medical Services, WV Children s Health Insurance Program, & Molina Medicaid Solutions 1

2 Claims Processing 616,146 claims processed week ending 3/12/ ,927,263 State Fiscal Year to Date (July 1, 2016) Call Center 4,122 calls received in call center week ending 3/12/ % Call Quality week ending 3/12/2017 2

3 Molina Medicaid Solutions web site & EDI Web Portal provides significant functionality for the WV Medicaid provider community. Real Time Capabilities Fully automated Trading Partner registration and administration. Real-time claims Direct Data Entry (DDE) will include the following: Claims Submission Eligibility Verification Claim Status Referral Status Prior Authorization Status Payment Status Improved Patient/Member Roster Set-up and Editing Training Resources available for use by providers 3

4 In the Health PAS-Online banner click the Sign In hyperlink. Enter the trading partner: User Name Password Read the Attention HIPAA PHI statement and select the check box. Click Sign In If an incorrect password is entered five times, the account will be locked out and the EDI Helpdesk will need to be contacted to unlock the account. Health PAS Online

5 2 pieces of verifiable information Name (First, Last) DOB Medicaid ID Molina/Mountain Health Trust (PCP) 5

6 Addition/Removal: Service Locations Rendering Providers Ordering/Referring/Prescribing Providers MUST be Currently Enrolled/Active Original Documents still mailed All received within 60 days 6

7 Claim Status Terminology OPEN PEND Benefits Log Date processing Claim ID tracking WAIT PAY/DENY Maintains previously entered information PAID/DENIED 7

8 CHIP - 6 months (180 days) from DOS; 60 days from PAID/DENIED Ex. DOS 2/2/2017; claim file 2/3/2017; PAID 6/10/2017; Claim adjusted until 8/9/2018 Medicaid - Be on the lookout for policy clarification. 8

9 Molina Medicaid PO Box 2002 Charleston, WV CHIP Timely Filing PO Box 3732 Charleston, WV

10 Jennifer J. Myers Phone: Fax: Our physical/mailing address will be changing 5/1/17: WVCHIP 350 Capitol Street, Room 251 Charleston, WV *Please return your PERM documentation requests ASAP* 10

11 T1015 on first line with $0.00 Dental codes listed separately with charges on each line Be Sure To: Include tooth surface/number if needed for claim processing DO NOT include tooth surface and/or number on T1015 line Verify Age Restrictions with the Dental Provider Manual (Chapter 505) Provider Provider Billing Instructions 11

12 Effective 07/01/2017 CPT codes beginning with 0 : EDI - MUST be billed in minutes with MJ qualifiers; claims with UN qualifiers will be rejected. Paper claims - MUST be billed in minutes. Paper claims billed with Dates of Service prior to 07/01/2017 must be billed in units of 15 minute time increments. DDE claims - MUST be billed in minutes on the web portal. 12

13 Child-Up to age 19 If vaccine is state supplied by the Vaccines for Children program (VFC), you must use modifier SL with CPT code for children up to age 19. Administration (for each immunization) is billed on separate claim line. Adult-Age 19 and up Vaccine used from private supply. Reimbursed with no administration (cost and admin together for charge amount) 13

14 Licensed Professional Counselor (LPC) effective 3/1/2017 Current: Rendering CHIP/ORP Medicaid Update: Rendering CHIP/MEDICAID Day Report Centers-Policy 540 (policy effective 10/1/2016) Provider Types as Rendering: Psychologist Supervised Psychologist Licensed Independent Clinical Social Worker (LICSW) 14

15 Provides valuable contact information for Molina Medicaid Solutions as well as office hours and office closures. Phone Support Local and toll-free phone numbers Secure Messaging Send a secure Should NOT contain PHI Call Back Request a call back from a call rep that can review the issue ahead of time Web Chat Chat real time via the internet with a call rep during business hours Grievance & Appeal Submit online, mail or fax

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17 Fall 2017 Provider Workshops (tentative dates) September 18 - Flatwoods, WV September 19 - Charleston, WV September 20 - Huntington, WV September 21 - Beckley, WV September 25 - Martinsburg, WV September 26 - Morgantown, WV September 27 - Wheeling, WV September 28 - Parkersburg, WV 17