MDCH HIPAA Transactions Provider Outreach

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MDCH HIPAA Transactions Provider Outreach
David McLaury Director of Project Development and
Implementation mclauryd_at_michigan.gov
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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

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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

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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.

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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).

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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.

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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.

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HIPAA Outreach Program MDCH Web Site HIPAA
Page
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HIPAA Outreach Program 2003 Provider Brochure
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HIPAA Outreach Program 2003 Testing Brochure
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HIPAA Outreach Program HIPAA Tool Kit
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HIPAA Outreach Program Testing Instructions
Flyer
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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.
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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
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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
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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
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Slide Presentation Last Updated March 14, 2003