Provider Enrollment
Charity Bright, team lead with Provider Enrollment, provided current enrollment updates for Indiana.

• Pending inventory – 563
• Initial applications – 367
• 86.15% of inventory processed in 0-45 days
• 92.90% of inventory processed in less than 60 days
• 99.64% of inventory processed in less than 90 days
• 9 out of 9 CMS timeliness standards met in September

The revalidation process is in effect; 52 applications from Indiana and 14 from Kentucky have been received. Physicians have 60 days to respond with a completed CMS 855 application. This includes any requested data and the required electronic funds transfer (EFT) authorization agreement. 

Send revalidation letters to the contact person on file in the National Government Services (NGS) MCS system. Physicians who fail to respond will be contacted 10 days from the noted cut-off date for processing claims (a Centers for Medicare & Medicaid Services or CMS requirement).

Physicians who received letters dated Sept. 29, 2007, should have had applications returned no later than Nov. 29, 2007. Physicians who are unsure whether they received a letter can contact Customer Care at (866) 250-5665. 

Ask the Contractor (ACT) calls to discuss questions and concerns about the revalidation process will be held weekly on Tuesdays and Thursdays at 2 p.m. EST. The revalidation is effective for five years. Failure to comply can terminate your enrollment and Medicare billing privileges.
 
Comprehensive Error Rate Testing (CERT)
Sonja Racke, Provider Outreach, Clinical Education, advised of the current CERT error rates. Indiana is at 4.9 percent. NGS is under the national average error rate of 4.8 percent. 
Evaluation and Management (E/M) billing is a nationwide problem and not specific to one general area or region. Both Indiana and Kentucky share the same E/M errors. Common errors are:

• 99233 subsequent hospital visits
• 99214 office visits
• 99254 inpatient consults

Customer Care
Matt Meyers, Customer Care manager, advised that 20 new Customer Care representatives were hired and an additional eight are in training. The average answer time is 90 seconds versus the previous six minutes. 

Meyers discussed the Interactive Voice Response (IVR) process and said a new system should be in place by late        December 2007 or early January 2008. Some new features will include voice activation and touchtone options. Attendees were advised that the best call times are between 8 and 10 a.m.

An open discussion occurred regarding lengthy wait times of up to 45 minutes, callers’ inability to reach a tier II representative when needed, failure to receive call-backs in a timely manner and inconsistent information. Attendees also expressed their concerns with the Customer Care representatives’ professionalism and general knowledge of the Medicare program. 

Attendees suggested listservs be sent when a widespread problem arises that could potentially affect many physicians. Send concerns and issues to Jeri Biedenkopf at the ISMA or to Mike Davis who will forward them to Matt Myers.

Electronic Data Interchange (EDI)
Julie McBee, team leader for the EDI Help Desk, updated physicians on help desk procedures for the EDC contract and said EDI anticipates a high call volume regarding password resets. 

Physicians with questions regarding National Provider Identifier (NPI) can call the help desk at (877) 273-4334. Use option 7 for NPI and option 2 for Medicare specific issues. Callers with questions about password resets should use option 4 and then the Indiana option. For non-password related issues use option 2; then option 2 again. 

The EDI Web site is also available. However, e-mail may be the best option for general questions since the mailbox is monitored and offers 24-hour turnaround time.

Appeals
Carolyn Henson, Provider Outreach, discussed and provided a handout regarding telephone reopenings for the Appeals Unit. She noted that Customer Care representatives also have this information and can assist if physicians are unsure what calls are acceptable for the reopening line.

Here are a few acceptable/unacceptable situations for reopenings:

Acceptable

• Adding/changing a diagnosis code
• Changing the place of service
• Procedure code changes
• Claims with processing errors
• Incorrect fee schedule allowance

Unacceptable

• Re-determination of overpayment
• Affirmation
• Ambulance inquiries regarding GY modifier
• Year of service changes
• Medicare secondary payer
  

Customer Care representatives can determine additional acceptable or unacceptable situations if you are unsure of what constitutes a telephone reopening. 

EDS
Bill Woodruff, provider representative, reviewed the new provider enrollment form intended to simplify required information.

For a new physician enrolling in the program, EDS needs complete information, including board members’ signatures. Since the requirement was announced, concern about obtaining those signatures and Social Security numbers has caused EDS to consider implementing a signature-on-file system.

When physicians update information, board members’ signatures are not necessary. 

Woodruff discussed the Healthy Indiana Plan (HIP), administered by Indiana Family Social Services Association (IFSSA). HIP is a private health plan and will provide medical benefits for up to 135,000 Hoosiers.

Because HIP does not provide maternity benefits, a woman who becomes pregnant will transfer to Medicaid Package B for the duration of her pregnancy. When no longer eligible for Package B, she can enroll again in HIP, as long as an open slot is available.

Anthem and MDwise/AmeriHealth Mercy are the two vendors selected to provide services under HIP. Woodruff encouraged attendees to watch for updates on this plan.

The HIP prior authorization (PA) function is now provided by Advantage. Health Care Excel has not done prior authorizations since Nov. 1.

Anthem
Renee Hudson-Johnson, Provider Relations representative, advised that Anthem has a Pre-birth Selection Form intended to expedite the assignment process for newborns. Physicians can contact Anthem to receive a copy of this form.

Anthem has a form for physicians to complete if information about the practice changes. This form can be found on Anthem’s Web site under the State Sponsored Business area or by contacting your provider relations representative.

Urgent prior authorization requests can be processed within 24 hours if the physician makes the appropriate contact.

Anthem recently contracted with Clarian Health system and LaPorte Hospital.

Bring eligibility discrepancies to Hudson-Johnson for research on claim payment.
 
Managed Health Services (MHS)
Michelle Spurlock, network manager for MHS, announced new prior authorization requirements for high-impact radiology services beginning Jan. 1, 2008. MHS will send letters to contracted physicians about this change; however, any physician can obtain more specific information on the MHS Web site.

MHS has developed an online claims submission process that is currently in a testing stage. MHS expected to go live with this capability Dec 1. Also, MHS will eventually have online claim re-submission capability in early 2008.

MDwise/Hoosier Healthwise Program
Sherri Miles, Provider Relations manager, encouraged physicians to utilize the specific delivery system prior authorization process online. Access www.mdwise.org to view updates to the pharmacy formulary listing.

If you have additional questions regarding HIP, administered by MDwise, access the Web site. You will also find updates there.

MDwise/Care Select Program
Chris Kern, Provider Relations, offered information about the Care Select link on the MDwise Web site. An overview presentation of the program, FAQs and various forms also are available in this section of the Web site.

Find details regarding BT20073 on the Medicaid Web site.

Contact MDwise for prior authorization for MDwise patients within the Care Select program. Care Select claims should not go to MDwise; those claims should be sent to EDS.

Providers who are not primary care can continue to participate in the Care Select program without signing any additional contracts or addendums as long as they are currently participating in the Indiana Health Care Program (IHCP).

Advantage
Kelvin Orr, Provider Relations, clarified details about the Care Coordination conferences and how they should be billed. Physicians should use 99211 with an SC modifier for every hour spent discussing all panel members. Find additional guidelines on the Medicaid Web site in Bulletin 200723.

Please see Advantage’s Web site for specific Care Select program, prior authorization and restricted card information.