Transcript TR569-First Steps Web interChange Presentation

October
2006
03-23-05
First Steps Presentation
Presentation by the EDS Provider Field Consultants
page 1
Agenda
Welcome and Announcements
• Overview
• Provider Enrollment
• Provider Profile
• Billing Guidelines
• Voids and Replacements
• Web interChange Screens
• Helpful Tools
• Questions
First Steps Presentation
October 2006
page 2
Overview
Terms
• EDS – The First Steps claims processor.
• IndianaAIM – Indiana Advanced Information
Management system. This is the name of the system
EDS uses to process claims.
• Web interChange – A secure Web site offered by EDS
that allows providers to inquire about claim information,
submit electronic claims, and maintain provider
information.
First Steps Presentation
October 2006
page 3
Overview
• EDS assumed the claims processing
responsibility for First Steps on
February 1, 2006. This change impacts
the following:
– Provider enrollment and updates
– Claim submission
– Claim payment
• A Provider Service Matrix is located on
the following Web site:
https://www.infirststeps.com
First Steps Presentation
October 2006
page 4
Provider Enrollment
Role of EDS Provider Enrollment Unit
• Enrolls new providers
• Services providers undergoing a change of
ownership
• Maintains and updates the provider file
• Performs credentialing and re-credentialing
Contact the EDS Provider Enrollment
Helpdesk at 1-877-707-5750.
First Steps Presentation
October 2006
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Provider Enrollment
New Enrollment and Update Forms and Procedures
• To participate in the First Steps program, providers
must enroll with the EDS Provider Enrollment Unit.
• First Steps provider enrollment information and the
required provider enrollment forms are available on
the First Steps Web site at
https://www.infirststeps.com.
– Providers must use these forms to submit a new
enrollment or update provider profile information.
– Providers must complete these forms on paper
and mail them to EDS for processing.
First Steps Presentation
October 2006
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Provider Enrollment
Enrollment and Update Processing
• Providers must mail all provider enrollment forms, update
forms, and supporting documentation by U.S. mail to:
– EDS Provider Enrollment
P.O. Box 7263
Indianapolis, IN 46207-7263
• Provider Enrollment completes new enrollments and
updates within 10 days of receipt.
• If documentation is incomplete, Provider Enrollment
returns the submitted form to the provider with a return
to provider (RTP) letter stating what information is
missing from the form.
First Steps Presentation
October 2006
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Provider Enrollment
Enrollment and Update Processing
• If a form is returned, the provider must resubmit the
form and the missing information to Provider Enrollment
to complete the original request.
• When Provider Enrollment receives the completed form, it
reviews the enrollment form to ensure proper enrollment
requirements are met. The enrollment requirements are
defined in the Early Intervention Personnel Guide and the
provider enrollment application instructions. These
documents are posted on the First Steps Web site at
http://www.infirststeps.com.
Note: The provider enrollment process also applies to
credentialing and re-credentialing.
First Steps Presentation
October 2006
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Provider Enrollment
Enrollment and Update Processing
• If the enrollment requirements are met,
the provider is enrolled and assigned a
provider identification number(s) based
upon how the provider has elected to
enroll.
– If a provider is enrolling as a individual
provider, one provider identification
number is issued for billing and rendering
services.
Note: Providers that were enrolled in the
First Steps Program prior to February 1,
2006, shall continue to have two numbers;
one number for billing services and one
number for rendering services.
First Steps Presentation
October 2006
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Provider Enrollment
Enrollment and Update Processing
– If a provider enrolls as a group
provider with rendering providers, one
provider identification number is issued
for the billing entity and one rendering
provider identification number is issued
for each servicing provider.
– Provider Enrollment mails a
confirmation letter to the provider with
the provider identifications number(s),
information about the First Steps
program and the provider profile
information for verification.
• The provider uses its provider
identification number to enroll in Web
interChange.
First Steps Presentation
October 2006
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Provider Enrollment
Enrollment and Update Processing - Credentialing
• Providers are also required to credential with the First
Steps program after enrollment.
• The enrollment confirmation letter supplies the required
date to obtain the credential.
– Additional letters are sent to notify the provider of the
upcoming credentialing date.
– If the provider has not responded, a final notice is sent to
the provider terminating participation in the First Steps
program.
• When the provider meets the credentialing requirements,
an approval letter is sent to the provider along with a
certificate.
• Credentialing requirements are included in the Early
Intervention Personnel Guide which is posted on the First
Steps Web site at http://www.infirststeps.com.
First Steps Presentation
October 2006
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Provider Profile
Using Web interChange
• Provider Profile allows providers to view the following
information on file with EDS:
― Provider name
― Current addresses
― Phone numbers
― Type and specialties
• Groups can view all of the rendering providers
associated with their practice.
Note: A group is defined as a payee and rendering is
defined as the person who provides the service.
First Steps Presentation
October 2006
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Provider Profile
Using Web interChange
• To view Provider Profile information
online, providers must enroll in Web
interChange.
• To enroll in Web interChange, providers
must complete and submit the application
located at
https://interchange.indianamedicaid.com.
• Providers can view their provider profile
information (read-only) through Web
interChange.
• Providers may print copies of the Provider
Profile information from Web interChange.
First Steps Presentation
October 2006
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Provider Profile
First Steps Presentation
October 2006
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Provider Profile
First Steps Presentation
October 2006
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Provider Profile
First Steps Presentation
October 2006
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Billing Guidelines
Enrollment And Update Processing - Electronic Funds Transfer
• All First Steps providers must sign up for electronic
funds transfer (EFT) upon enrollment.
• The EFT form is part of the Provider Enrollment
Application.
• EFT begins 18 days following completion of the
enrollment process.
• EFT payments occur each Wednesday.
• The time of day when payment appears in an
account depends on the financial institution.
• Providers should direct questions about the posting
of an EFT to their financial institution.
First Steps Presentation
October 2006
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Billing Guidelines
Prior Authorization
• All services provided to First Steps members
require a prior authorization (PA) from the
system point of entry (SPOE).
• To obtain PAs, the provider completes an
evaluation form during an initial assessment
with the member.
– The provider faxes the completed evaluation
form to the intake coordinator within two
business days of completing the assessment.
– If the child qualifies for First Steps services, an
initial Individualized Family Service Plan (IFSP)
is developed with the family and the
appropriate provider(s).
First Steps Presentation
October 2006
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Billing Guidelines
Prior Authorization
– The intake coordinator enters the PA at the
SPOE based on the information on the
Evaluation Report within two business days
of receiving the report.
– Providers should allow five to seven days
from the time the authorizations are
entered to view PAs on the EDS Web
interChange system. If a PA is not on Web
interChange, the provider must fax all
pertinent information to the SPOE office
and request that the SPOE ensure that the
PA is entered.
– Changes to PAs must be coordinated
through the service coordinator and
approved by the parent, primary care
physician before changes can be entered
into the SPOE computer system.
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission
• Providers must bill for services using
the Current Procedural Terminology
(CPT®) and Healthcare Common
Procedure Coding System (HCPCS)
codes for First Steps services. A list of
the proper codes is posted on the First
Steps Web site at
https://www.infirststeps.com
• All providers must be enrolled in the
First Steps program as valid providers.
• Providers must always bill the First
Steps program for services rendered
before billing any other entity.
Current Procedural Terminology © 2004 American Medical Association. All Rights Reserved.
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission
• First Step claims cannot be submitted
for payment with a claim for Medicaid or
services for any other Indiana Health
Coverage Programs (IHCP).
• Claims for First Steps should never
indicate a third party liability (TPL) paid
amount.
• First Steps claims must be submitted
with the unique First Steps member
identification number (child ID number)
that begins with 950.
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission
• All First Steps claims must be submitted
electronically, using Web interChange or the 837P
transaction.
• Providers may submit claims 24 hours a day, seven
days a week.
• Clean claims submitted by 4:30 p.m. on Friday will
be adjudicated and appear on the following week’s
remittance advice (RA).
• All First Steps claims submitted on paper are
returned to the provider.
• Each claim submitted electronically is assigned a
unique Internal Control Number (ICN).
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission - Internal Control Number
A 13-digit ICN is assigned to each claim after it is processed in
IndianaAIM.
Region
Year
Julian Date
Batch Range
Sequence
20
06
010
150
000
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission - First Steps Modifiers
• All First Step procedure codes must be
billed with the modifier TL (early
intervention/individualized family service
plan).
• When billing for services that are
measured in minutes, the 52 (reduced
services) modifier must also be included.
• When billing for services measured in
minutes, one unit equals 15 minutes.
• When billing for services that are
provided in a group setting the modifier
HQ must also be included on the claim.
First Steps Presentation
October 2006
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Billing Guidelines
First Steps Modifiers Example
A provider renders 45 minutes of treatment for speech
language, voice communication.
The provider bills First Steps as follows:
CPT Procedure Code
92507 TL 52
First Steps Presentation
Units billed
3
October 2006
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Billing Guidelines
Claim Submission - Taxonomy
• Taxonomy is required on all claim submissions
(using Web interChange or the 837P 4010 version)
except for assistive technology services.
• Taxonomy is a unique 10-digit alphanumeric code.
• The code is structured into the following three
distinct levels:
– Provider type
– Classification
– Area of specialization
• Example
– Provider type – Physical therapist
– Area of specialization – pediatrics
– Taxonomy – 2251P0200X
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission - Taxonomy
• Providers may have one or more than
one taxonomy.
• First Steps providers may access the
First Steps code crosswalk to
determine taxonomy and procedure
code combinations.
• A list of the proper current taxonomy
and procedure code combinations is
posted on the First Steps Web site at
https://www.infirststeps.com.
First Steps Presentation
October 2006
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Billing Guidelines
Claim submission - OEIS
• Procedure code 99199 TL (other EI services or OEIS)
is manually priced.
• Claims submitted with procedure code 99199 TL will
suspend for explanation of benefits (EOB) 6000,
manual pricing.
• All claims will suspend to an analyst for the claim to
be priced from the authorization on file.
• All claims will be finalized within 21 days from the
date of receipt of the claim.
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission - Place of Service
• All First Steps claims must include the proper
place of service (POS).
• POS is used to determine pricing for the
claim.
• If the POS is missing, the claim will deny.
• POS codes are listed in Chapter 8, Section 3,
of the IHCP Provider Manual, which is
available at http://www.indianamedicaid.com
First Steps Presentation
October 2006
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Billing Guidelines
Claim Submission - Filing Limitations
• Providers must submit claims for First Steps within 60 days of
the date of service.
• Claims submitted on the 61st day following the date of service
will deny with the following EOB:
― 512 – Your claim was filed past the filing limit without acceptable
documentation
• The filing limit is strictly enforced.
• Claims past the 60-day filing limit must be approved by the
First Steps Program to be processed.
• First Steps contact for past filing limit approval:
– Julie Escue
Assistant to Jerry Allen
First Steps CRO Financial Manager
(317) 232-4372
[email protected]
First Steps Presentation
October 2006
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Voids and Replacements
Types
• Non-check related
• Mass
First Steps Presentation
October 2006
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Voids and Replacements
Region Codes
• Void and replacement region codes:
– 50 – Non-check-related adjustment
– 56 – Mass adjustment initiated by EDS
– 62 – Provider-initiated replacement with no
attachments and/or claim notes
– 63 – Provider-initiated void
– 80 – Claim reprocessed by EDS
First Steps Presentation
October 2006
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Void or Replacement
Guidelines
• Providers have 180 days from the date the initial
claim was processed to replace claims.
• Voids can be performed on PAID claims only.
• Voids and replacements can be performed to correct
an incorrect or partial payment, including zero dollar
amount.
• Denied line items may be billed as a new claim, but
may also be submitted as a replacement claim.
• A void and replacement can be completed on the
same day, or in the same week as a claim
submission or after the claim has been finalized.
• New region codes are assigned to post financial
claims for electronic voids or replacements.
• A void or replacement must be submitted through
Web interChange.
First Steps Presentation
October 2006
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Voids and Replacements
Definition of a Void
• A void is a cancellation of an entire claim.
• A denied claim cannot be voided.
• If the original claim being voided is in a paid or
suspended status and it is the same day or same week:
― A new claim is not created.
― The same ICN is used.
― The original claim denies with EOB 0120 – Claim denied
due to an electronic void request.
• If the original claim being voided is a historical claim:
― A new claim is created.
― The new ICN starts with 63.
First Steps Presentation
October 2006
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Voids and Replacements
Void Examples
Pre-Financial
Post-Financial
2006010000002 – Paid
2006002001001 – Paid
Provider voids the claim.
Today’s date: 10/02/06
Denied with EOB 0120
6306010001000 – Denied with
EOB 0120
RA/835 shows:
RA/835 shows:
Claim shows on the denied
page only – same ICN.
2006002001001 and
6306010001000 on the
adjustment page.
First Steps Presentation
October 2006
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Voids and Replacements
Definition of a Replacement
• Replacement is a change to an original
claim, whether same day, same week,
or post financial.
• Original claim indicates the most
recent ICN assigned to that claim.
• An electronically-submitted
replacement claim can be for a
previously-submitted electronic claim.
• First Steps replacements are only
accepted electronically.
First Steps Presentation
October 2006
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Voids and Replacements
Replacements
• If EDS receives a replacement claim for
an original claim that has been through a
financial process (has appeared on an
RA), the replacement claim ICN starts
with the following:
― 62 – Provider initiated replacement with no
attachments and/or claim notes
First Steps Presentation
October 2006
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Voids and Replacements
Replacement Examples
Pre-Financial
2006010222111 – Paid
Post-Financial
RA/835 shows:
2006010222111 – Replacement Original claim ICN
request submitted and claim is 2006010333555 – On denied page
denied with EOB 0121
with EOB 0121
Claim resubmitted – New ICN
Replacement claim ICN
2006010333444
6206050108765 – On paid or
denied page
2006010333555 – Mother claim
6206050108765 – Daughter claim
Both ICNs appear on the
adjustments page of the RA
First Steps Presentation
October 2006
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Voids and Replacements
EOBs
• 0120 – Claim denied due to an
electronically submitted void.
• 0121 – Claim denied due to an
electronically submitted replacement.
First Steps Presentation
October 2006
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Voids and Replacements
Filing Limits
• There is no filing limit for void requests.
• There is a 180 days filing limit for
replacement requests.
The system compares the last date of
claim activity and the date of the
current activity to make sure that a
180 days has not passed. If the
replacement is greater than 180 days,
Web interChange will not display a
replacement button on claims. These
replacements must be submitted to
the First Steps Program for approval.
First Steps Presentation
October 2006
page 40
Web interChange
Overview
• Web interChange features:
– Is HIPAA compliant
– Allows providers to submit professional First Steps claims
– Allows providers to inquire on claims status
– Allows providers to inquire on the status of authorizations
Note: Authorizations must be submitted through the System
Point Of Entry (SPOE) applications.
• To use Web interChange, providers must:
– Be enrolled as a First Steps provider and have a provider ID
– Complete a new application to obtain a logon ID and
password (if not already enrolled to use Web interChange)
First Steps Presentation
October 2006
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Web interChange
• Providers may download the Web interChange
enrollment form at
https://interchange.indianamedicaid.com
• This form is only available from the Web interChange
Web site.
• Each provider must assign an Administrator.
• In addition to the enrollment form, providers must send
a note of acknowledgement on company letterhead
indicating the owner approves the person completing
the request form as an Administrator for the
organization.
• By signing, the owner acknowledges reading and
understanding the document and agrees to the terms
and conditions as they describe the role that the owner
performs for the organization.
First Steps Presentation
October 2006
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Web interChange
Administrator Functions
• Creates new users
• Creates, maintains, and deletes user
groups
• Resets passwords
• Modifies user information
First Steps Presentation
October 2006
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Web interChange
Screen Overview
First Steps Presentation
October 2006
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Web interChange
Web interChange Logon Screen
First Steps Presentation
October 2006
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Web interChange
Administrator Main Menu
First Steps Presentation
October 2006
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Web interChange
Create a User
First Steps Presentation
October 2006
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Web interChange
Maintain User Information
First Steps Presentation
October 2006
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Web interChange
Create User Groups
First Steps Presentation
October 2006
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Web interChange
Create, Maintain, and Delete Users From A User Group
First Steps Presentation
October 2006
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Web interChange
Reports
First Steps Presentation
October 2006
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Web interChange
Password Reset (By Administrator)
First Steps Presentation
October 2006
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Web interChange
Password Reset (By User)
First Steps Presentation
October 2006
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Web interChange
Password Reset (By User)
First Steps Presentation
October 2006
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Web interChange
Home Page
First Steps Presentation
October 2006
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Web interChange
Check Inquiry Window
First Steps Presentation
October 2006
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Web interChange
Claim Inquiry Window
First Steps Presentation
October 2006
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Web interChange
Claim Inquiry Window Copy Function
First Steps Presentation
October 2006
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Web interChange
Claim Inquiry Window Copy Function – Show Me More Button
First Steps Presentation
October 2006
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Web interChange
Claim Inquiry Window Copy Function – Old Claim ICN Information
First Steps Presentation
October 2006
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Web interChange
Claim Inquiry Window Copy Function – New Claim ICN Information
First Steps Presentation
October 2006
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Web interChange
Claim Submission – Professional Billing
First Steps Presentation
October 2006
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Web interChange
Professional Billing – Header Information
First Steps Presentation
October 2006
page 63
Web interChange
Professional Billing – Detail Information-Taxonomy
First Steps Presentation
October 2006
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Web interChange
Voids and Replacements
First Steps Presentation
October 2006
page 65
Web interChange
List Function
First Steps Presentation
October 2006
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Web interChange
List Function-Procedure/HCPCS Information
First Steps Presentation
October 2006
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Web interChange
List Function
First Steps Presentation
October 2006
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Web interChange
278 Prior Authorization Inquiry
First Steps Presentation
October 2006
page 69
Web interChange
278 Prior Authorization Search
First Steps Presentation
October 2006
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Web interChange
278 Prior Authorization
First Steps Presentation
October 2006
page 71
Claim Submissions
Batch Claims
• Providers that wish to submit batch
claims for services provided to First
Steps members should communicate
directly with their vendor to ensure
First Steps claims are submitted
appropriately to EDS for processing.
First Steps Presentation
October 2006
page 72
Helpful Tools
Technical Assistance
• Select Help from Web interChange
• Contact the EDI Solutions Help Desk
– Indianapolis area – (317) 488-5160
– Toll Free – 1-877-877-5182
• Select Option 2 for First Steps
technical calls
First Steps Presentation
October 2006
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Helpful Tools
Avenues of Resolution
• First Steps Web site: https://www.infirststeps.com.
• First Steps Provider Billing Manual
• IHCP Web site: http://www.indianamedicaid.com.
• Customer Assistance
– Indianapolis area – (317) 655-3240
– Toll Free – 1-800-457-4584
• Option 1, Member calls (family)
• Option 2, Provider calls
• Written Correspondence
P.O. Box 7263
Indianapolis, IN 46207-7263
• Provider Field Consultant
First Steps Presentation
October 2006
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Questions
First Steps Presentation
October 2006
page 75
October
2006
03-23-05
Presentation by the EDS Provider Field Consultants
EDS
950 N. Meridian St., Suite 1150
Indianapolis, IN 46204
EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation. EDS is an equal opportunity employer
and values the diversity of its people. © 2005 Electronic Data Systems Corporation. All rights reserved.
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