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MDCH HIPAA Transactions Provider Outreach

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835 Claims Remittance advice currently in internal testing. April 16, 2003: Begin testing 835 claim remittance advice & all other HIPAA transactions. ... – PowerPoint PPT presentation

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Title: MDCH HIPAA Transactions Provider Outreach


1
MDCH HIPAA Transactions Provider Outreach
David McLaury Director of Project Development and
Implementation mclauryd_at_michigan.gov
2
MDCH Medicaid Overview
  • 1.2 Million Beneficiaries
  • 800,000 Beneficiaries in Managed Care Plans
  • 20 Managed Care Plans
  • Capitated Dental Program for Children
  • 18 Prepaid Health Plans for Mental Health
    Services
  • 16 Prepaid Plans for Substance Abuse
  • 30,000 Medicaid Providers
  • 33,000,000 Claims Annually

3
Michigan MedicaidInformation System (MMIS)
  • The Michigan Department of Community Health
    (MDCH) is the single state agency for Medicaid
  • MDCH operates its own management information
    system and makes continual updates to its MMIS
  • Converting the MMIS to HIPAA compliance.has been
    a large multi-year project
  • MDCH works with outside consultants to ensure
    MMIS is HIPAA compliant
  • MDCH works with outside consultants to educate
    providers through outreach efforts

4
Collaborative Activities with BCBSM and Other
Large Payers
  • Established a strong collaborative effort with
    Blue Cross Blue Shield of Michigan (BCBSM) and
    Medicare Part A B to strongly encourage
    electronic claims and remittance.
  • Stayed in sync with the implementation plans of
    BCBSM and Medicare Part A B.
  • HIPAA Validator (Integrity Testing) made
    available to all Medicaid providers free of
    charge.

5
Collaborative Activities with BCBSM and Other
Large Payers (cont.)
  • Regularly scheduled meetings to coordinate
    provider outreach activities (e.g., brochures and
    other outreach materials).
  • Joint provider seminars and training sessions.
    Ten sessions were held June 2002. 5000 providers,
    billers and software vendors attended.
  • Joint HIPAA technical seminars exclusively for
    software vendors (February, 2003).
  • More sessions scheduled for providers and
    e-Billers (June, 2003).

6
MDCH Assistance for Health Plansand other
Capitated Plans
  • Several informative sessions for health plans.
  • Monthly meetings to discuss encounter data
    clarifications and QI reporting.
  • HIPAA brochure for Mental Health and Substance
    Abuse capitated plans.
  • Training and educational seminars for all
    capitated health plans. Additional training
    sessions in the near future.

7
Assistance for Medicaid Providers
  • Several informative sessions for provider
    associations and members.
  • Outreach team has presented at several provider
    association meetings.
  • Collateral materials (provider brochures,
    e-newsletters, flyers, postcards).
  • Informative materials for inclusion in provider
    association monthly mailings, bulletins and
    newsletters.
  • Provider training for Medicaid billing.
  • Online interactive learning sessions at Michigan
    Virtual University (MiVU) for Medicaid HCFA 1500
    and UB-92 (Uniform Billing Project).
  • HIPAA Primer course featuring transactions and
    code sets hosted at MiVU.

8
HIPAA Outreach Program MDCH Web Site HIPAA
Page
9
HIPAA Outreach Program 2003 Provider Brochure
10
HIPAA Outreach Program 2003 Testing Brochure
11
HIPAA Outreach Program HIPAA Tool Kit
12
HIPAA Outreach Program Testing Instructions
Flyer
13
MDCH HIPAA Transaction Compliance Plan Schedule
October 1, 2002 Began accepting 837 v. 4010
Dental, Professional and Institutional
claims. January 1, 2003 Began accepting 837 v.
4010 encounters from Medicaid Health
Plans. Began accepting 837 v. 4010 Nursing
Facility claims. 835 Claims Remittance advice
currently in internal testing. April 16,
2003 Begin testing 835 claim remittance advice
all other HIPAA transactions. October 16,
2003 Only HIPAA compliant transactions accepted.
14
Transactions Currently Operational
HIPAA Transaction No. and Description MDCH Transaction Type
837 X096 Claim (Institutional) Inbound
837 X097 Claim (Dental) Inbound
837 X098 Claim (Professional) Inbound
837 Encounter (096, 097, 098) Inbound
15
Transactions Scheduled for B2B Testing in April
HIPAA Transaction No. and Description MDCH Transaction Type
835 Payment Advice Outbound
277 Unsolicited Response Outbound
820 Capitated Payment Outbound
276 Claim Status Request Inbound
277 Claim Status Response Outbound
270 Eligibility Inquiry Inbound
271 Eligibility Response Outbound
Transactions are scheduled for production by
October 2003
16
Transactions Scheduled for B2B Testing in May
HIPAA Transaction No. and Description MDCH Transaction Type
834 Plan Enrollment Outbound
278 Prior Authorization Request Inbound
278 Prior Authorization Response Outbound
Transactions are scheduled for production by
October 2003
17
Slide Presentation Last Updated March 14, 2003
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