How will the new Remittance Advice be more user-friendly to providers?

Transcription

1 Count down to Go-Live, Dec. 7, 2010! Coming in December 2010! A new, reformatted and user-friendly PDF version of the Provider Remittance Advice (RA) will be available in the new Medicaid Information Technology System (MITS) Web Portal. How will the new Remittance Advice be more user-friendly to providers? The new Remittance Advice will be easier to read and will contain more information. It will be a much more valuable financial claims management tool. New Fields Providers will see several new fields on the MITS RA. Depending on the provider type, the provider may see the following: Recipient ID Changed from the Medicaid ID in MMIS. Recipient Name Changed from the Bene Name in MMIS. Recipient County In MITS it will be a two-digit code. For example: 01-Franklin County. Medical Record Number This will be the provider s internal tracking number. Patient Number This will be the account number assigned to the recipient and will be seen if provided on the claim. Dates of Service Billed Amount Allowed Amount TPL Amount Spenddown Amount Co-Pay Amount Paid Amount CCR_07_10_New_Remittance_Advices.doc Page 1 of 5

2 Separate Pages Pages on the RAs will be separated and titled by type of claim and the claim outcome. Depending on the provider type, a provider may see any of the following: Paid claims section with a total for all paid claims Denied claims section with a total for all denied claims Adjusted claims section with a total for all adjusted claims Medicare crossover section (for A, B and C, if applicable) with a total for those sections Note: Suspended claims will not appear on the RA. Providers will be able to view those claims on the MITS Web Portal by doing a claim search for suspended claims. Claims will be separated into a Header Section and a Detail Section. Both sections will have Ohiospecific Explanation of Benefits (EOB) codes that will identify how the claim was processed. In other words, both the Header Section EOB codes and the Detail Section EOB codes will appear on the RAs. For adjusted claims, the original claim and its Internal Control Number (ICN) will appear with the adjusted claim and its associated ICN below it. As applicable, Header and Detail EOB codes relating to the adjustment will appear at the Detail line. New Financial Transaction Page A new feature for providers on the reformatted MITS Remittance Advice is the Financial Transaction page. This will prove to be an extremely useful tool, especially for accounts receivable tracking. The purpose of the Financial Transaction page is to give providers a full accounting of their financial activity for the payment cycle. It also informs providers on a weekly basis of all their outstanding accounts receivable. The Financial Transaction page may include: Non-claim-specific payout information This is a lump sum not related to a single claim. Claim and non-claim refund information If a provider submits a refund check to Ohio Medicaid, the information will be shown here. Accounts receivable information and tracking. Examples include: ο A/R number This is the adjustment ICN if the accounts receivable is claim-related. ο Recouped this cycle This is the amount subtracted from the current warrant amount and decreases the amount of the AR. ο Original amount This is the dollar amount owed at the time the accounts receivable was set up. ο Total recouped This is the amount that has been satisfied to date. CCR_07_10_New_Remittance_Advices.doc Page 2 of 5

3 ο If a balance remains, the accounts receivable will carry over to the next week's financial cycle. New MITS Web Portal Summary Page Providers will also see a new Summary Page that lists claims data for paid claims, adjustments and denials. The information on this page will include: Current claims information Current month claims information Year-to-date claims information The Summary Page also includes earnings data for the current claims financial cycle and year-to-date claims data, including: Payment information Refund information Other financial information Net earnings Please note that the year-to-date information on the Summary Page should mirror the providers 1099 information. The 1099 information also will be available to view on the new MITS Web Portal. Newly Formatted MITS Web Portal Informational Pages The newly formatted MITS Remittance Advice will have informational pages for providers that will vary depending on the providers claim submissions for the week. These pages may include: RA Banner Messages RAs will continue to have timely messages posted on a weekly basis or as needed EOB Code Descriptions This section will provide a more detailed description and comparison of the EOB codes that appear on the claims in the Paid, Denied and Adjusted pages of the RA. TPL Information If a claim on the RA was denied because the recipient had other insurance (third-party liability), this section will provide you with the other insurance information. Will I still have access to the current MMIS Remittance Advices? Yes. After December 7, 2010, providers will be able to access Remittance Advices processed prior to the implementation of MITS. Information regarding how to access historical RAs in MMIS will be posted in future communication materials, as soon as information is available. CCR_07_10_New_Remittance_Advices.doc Page 3 of 5

4 How can providers receive training on the new MITS Remittance Advices? The Ohio Department of Job and Family Services (ODJFS) and Hewlett-Packard are conducting MITS training sessions for providers through the end of November The main focus of the trainings is (1) how to use the MITS Web Portal, and (2) describing and demonstrating the new Remittance Advices. Sample RAs are provided at the trainings and can be found on the MITS Web site at The MITS provider training is free and is being offered to fee-for-service providers and their billing agents. Classroom training is being conducted in the following cities: Ashland, Cambridge, Canton, Chillicothe, Cincinnati, Cleveland, Columbus, Dayton, Garfield Heights, Maumee, New Philadelphia, Portsmouth, St. Clairsville, Toledo, Youngstown and also Hebron, Ky. Web-based trainings (webinars) also are being offered. Webinars are particularly beneficial to providers who have a large number of staff who need to be trained. Webinars can be conducted in a provider's facility with multiple staff gathered in one classroom, in front of one screen. The only requirements are access to the Internet and sound capability from a PC or laptop. Registering for either classroom or webinar training is quick and easy. All providers who register will need an address. Confirmation letters will be sent once the registration is completed. To register for either classroom or webinar training, go to the Welcome Providers page on the ODJFS Web site at Then click on the link titled "MITS Provider Training Registration Now Open!" Note: Please make sure to sign up for the correct training. We have noticed that some individual dentists, physicians and other practitioners are signing up for Independent Provider training. Please note that the Independent Provider training is intended for independent waiver providers. If you are a dentist, physician or other practitioner and you are a sole proprietor (not affiliated with a group), please sign up for the appropriate training that fits your provider type and specialty. For example: Dental training, Physician/Practitioner training, DME training, etc. Training will continue to be available after implementation. Additionally, self-paced, Web-based elearning courses are being developed. These will provide a walkthrough of key functions of the MITS Web Portal. Dates for these elearning courses will be announced as soon as they are available. Please refer to the MITS Web site for updates at Updates and Corrections Current Ohio Medicaid providers will not receive a letter with new log-on IDs. If you are a current Medicaid provider, you will use your current billing provider number to set up your new administrator account in the secure MITS Web Portal. The initial password will be the provider s Social Security Number (SSN) or Employee Identification Number (EIN). We know that many people working for providers know the provider EIN so it is important that the appropriate person in your office or practice sets up the administrator account. The account administrators are considered to be the gatekeepers to provider accounts. They have responsibility for maintaining all account information. Here are some tips for choosing your account administrator and account agent(s): CCR_07_10_New_Remittance_Advices.doc Page 4 of 5

5 Account Administrator We recommend that you choose someone who is in an administrative, leadership or management position. The administrator will be responsible for setting up the account agent roles and determining what access each agent will have to your billing account. They also will be responsible for maintaining and updating your provider demographic information. Account Agent(s) You may set up as many account agents as you need. We recommend that you choose employees who are already well-versed in the day-to-day administrative functions of your office. For example, you might consider choosing a registration clerk who checks eligibility, a billing clerk who bills or views claims, the person responsible for submitting prior authorization requests, or a representative from your billing agency. Keep in mind that when staff members leave your practice or office, for security reasons you must deactivate their account agent access to your secure provider information. We encourage you to take advantage of the provider training sessions. For all training-related information, please visit the MITS Web site at Remember to keep informed and keep in touch ODJFS and Hewlett-Packard are committed to working closely with you during the MITS training and transition. Other states have found that the more providers attend training and share information with all affected staff, the smoother the transition is for everyone. Please share information (including this Provider Information Release!) with your leaders and staff members and plan to attend one of the many training sessions being conducted. Doing so will put you one step ahead of the game. For the most up-to-date information about the MITS Web Portal, as well as information on MITS functionality, tools, training and how the replacement system will impact you as a provider, go to CCR_07_10_New_Remittance_Advices.doc Page 5 of 5