Maine MECMS Project

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Maine MECMS Project
Provider Forum MIHMS Phase 1 Status

• January 12, 2009

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Todays Agenda

• Recent Project Activities
• Provider Re-enrollment Schedule Training
• Trading Partner Agreements
• Billing Services and Clearinghouses
• Other Trading Partner Information
• National Provider Identification (NPI)
• Questions

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Provider Re-enrollment Project Status

• The target date for provider re-enrollment was
  scheduled to begin in late February
• Extensive analysis has been taking place via a
  Provider Type/ Specialty Workgroup
• Define provider types/specialties that meet CMS
  and industry standards
• Populate the Permission, Documentation, and
  Allowed Service Matrices
• Define business rules for the Provider Portal
  that will be used for provider re-enrollment

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Provider Re-enrollment Results of Analysis

• The workgroup has researched existing MaineCare
  policy, Federal Regulations, industry coding
  structures, and HealthPAS claims processing
  functionality, as well as interviews and
  documentation from other MaineCare staff
• Streamlined the matrices, example - the Allowed
  Service Matrix was reduced from over 9000 to
  under 150 lines
• This activity is critical for both the Provider
  Re-enrollment and MIHMS development as it will
  also be needed to process and adjudicate claims
• The result of this effort has impacted the
  re-enrollment and training schedule, but is on
  track to begin this Spring

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Provider Re-enrollment Schedule Training

• Provider Types and Re-Enrollment Schedule Handout
• Updated Provider Types and Re-enrollment Schedule
• Provider Agreement Renewals
• Provider Training Overview

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Trading Partner Agreements

• What is a Trading Partner Agreement?
• The Trading Partner Agreement (TPA) is a binding
  agreement between Unisys and organizations
  wishing to do electronic business with MIHMS
  (MaineCare will oversee this process)
• The TPA is a legal document which stipulates the
  terms and conditions that trading partners agree
  to before exchanging electronic documents
• Who must sign the TPA?
• Any Provider, Billing Service or Clearinghouse
  that exchanges electronic documents, including
  standard 837 claims transactions, standard 835
  electronic remittance advices, direct data entry
  (DDE) of claims and electronic eligibility
  validation (270/271) transactions, to name a few.

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Trading Partner Information - Providers

• Providers who submit data electronically must be
  approved for re-enrollment prior to registering
  as Trading Partner or submitting test file
  uploads
• Trading Partner Testing will be conducted later,
  as MIHMS prepares to receive 837 file uploads
• Trading Partners will be required to successfully
  submit three test files for each type of claim
  they will be submitting, that is, Dental,
  Institutional, or Professional claims

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Trading Partner Information - Others

• Billing Services and Clearinghouses -
• Will not enroll in MIHMS as they did in MeCMS
• Do not qualify for National Provider Identifiers
  (NPI)
• Will be required to register as Trading
  Partners and sign Trading Partner Agreements
  (TPA)
• Will be able to visit the portal, read the TPA
  and sign it electronically as soon as the
  re-enrollment portal is available
• Registration notices will be sent to billing
  services and clearinghouses
• Submitter identification numbers will be assigned
  to billing services and clearinghouses

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NPI Enumeration

• How have you enumerated your NPI with CMS?
• Individual
• Organization
• Both
• No NPI

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Questions

• Do you have any questions?
• Thanks for your participation